Norsa'adah, Bachok
(2012)
Delay in seeking diagnosis and treatment among women with breast cancer.
Other.
Pusat Pengajian Sains Perubatan.
(Submitted)
Abstract
Breast cancer is the leading cancer that causes mortality among women in Malaysia.
Delay in its diagnosis and treatment has major implications on the patients' prognosis
and survival. The objectives of this study were to identify the magnitude of delay in
consultation, diagnosis and initiation of treatment; and its associated factors among
women with breast cancer. This study was a combination of quantitative and
qualitative methods. The quantitative study was a retrospective cohort. Respondents
were histo-pathologically diagnosed breast cancer patients who were registered at
various medical centres in the year 2005-2007. Validated questionnaires were used to
interview respondents. The qualitative study was using an in-depth interview. It was
carried out in the East Coast and 12 volunteers were selected. A total of 328
respondents were included in the quantitative study. The mean (SD) age was 47.9
(9.4) years. The majority of respondents were Malays who had low a socio-economic
status. The median time for first doctor consultation was 2 months, diagnosis 5.5
months and initiation of treatment 2.4 weeks. The rate of consultation delay more
than a month was 66.8%, diagnosis delay more than three months was 73.2% and
treatment delay more than a month was 27.4%. The significant factors associated with
diagnosis delay were the number of children, grossly swollen breast, self-detected
symptom, first doctor's inappropriate action, non-cancer interpretation, low level of
fear and negative attitude to treatment. While factors associated with treatment delay
were pregnancy, taking complementary alternative medicine, initially refusing
mastectomy and having lumpectomy prior the definitive treatment. The reasons for
delay were strengthened by the qualitative study. The identified themes were lack of
knowledge, fear, beliefs in complementary alternative medicine, sanction by others,
barriers, denial, attitude of wait and see and weakness of health care services system.
This study found that delays in diagnosis and consultation were serious problems.
Decision on health seeking behaviour was influenced by a complex interaction of
socio-demographic, clinical, cognitive, practices, environmental, beliefs, cultural and
psycho-social factors. A comprehensive intervention is suggested in order to detect,
diagnose and treat breast cancer early before the tumour enlarges and spreads to
lymph nodes and metastasis.
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