Treatment delay of cancer patients in Indonesia: a reflection from a national referral hospital
Abstract
BACKGROUND Cancer is a complex disease requiring a multidisciplinary approach in establishing prompt diagnosis and treatment. Treatment in a timely manner is crucial for the outcomes. Hence, this study aimed to provide information on treatment delay including patient and provider delays and its associated factors.
METHODS Cancer patients were recruited conveniently in the outpatient clinic of Department of Radiation Oncology, Cipto Mangunkusumo Hospital, Indonesia between May and August 2015. All patients were asked to fill a questionnaire and interviewed in this cross-sectional study. Treatment delay was explored and categorized into patient delay and provider delay. Patient delay could be happened before (patient-delay-1) or after (patient-delay-2) the patient was diagnosed with cancer. Provider delay could be due to physician, system-diagnosis, and system-treatment delays.
RESULTS Among 294 patients, 86% patient had treatment delay. Patient delay was observed in 153 patients, and 43% of them had a history of alternative treatment. An older age (p = 0.047), lower educational level (p = 0.047), and history of alternative treatment (p<0.001) were associated with patient delay. Meanwhile, 214 patients had provider delay, and 9%, 36%, and 80% of them experienced physician, system-diagnosis, and system-treatment delays, respectively. All types of provider delay were associated with patient delay (p<0.001).
CONCLUSIONS Most of the patient had treatment delay caused by either patient or provider.
References
National Cancer Institute. Cancer statistics [Internet]. 2018. Available from: https://www.cancer.gov/about-cancer/understanding/statistics.
Rafiemanesh H, Mehtarpour M, Khani F, Hesami SM, Shamlou R, Towhidi F, et al. Epidemiology, incidence and mortality of lung cancer and their relationship with the development index in the world. J Thorac Dis. 2016;8(6):1094-102. https://doi.org/10.21037/jtd.2016.03.91
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7-30. https://doi.org/10.3322/caac.21590
Nayak MG, George A, Vidyasagar MS, Mathew S, Nayak S, Nayak BS, et al. Quality of life among cancer patients. Indian J Palliat Care. 2017;23(4):445-50. https://doi.org/10.4103/IJPC.IJPC_82_17
Indonesian National Health Insurance System. Oppose cervical cancer with early detection iva / pap smear [Internet]. 2017. Available from: http://bpjs-kesehatan.go.id/bpjs/index.php/post/read/2017/555/Oppose-Cervical-Cancer-with-Early-Detection-IVA-Pap-Smear.
Li Y, Zhou Y, Mao F, Guan J, Lin Y, Wang X, et al. The influence on survival of delay in the treatment initiation of screening detected non-symptomatic breast cancer. Sci Rep. 2019;9(1):10158. https://doi.org/10.1038/s41598-019-46736-1
Huo Q, Cai C, Zhang Y, Kong X, Jiang L, Ma T, et al. Delay in diagnosis and treatment of symptomatic breast cancer in China. Ann Surg Oncol. 2015;22(3):883-8. https://doi.org/10.1245/s10434-014-4076-9
National Cancer Management Committee (KPKN) Ministry of Health of the Republic of Indonesia. Guidelines for the implementation of cancer services in health facilities. Jakarta: Ministry of Health of the Republic of Indonesia. Indonesian.
Yau TK, Choi CW, Ng E, Yeung R, Soong IS, Lee AW. Delayed presentation of symptomatic breast cancers in Hong Kong: experience in a public cancer centre. Hong Kong Med J. 2010;16(5):373-7.
Fadelu T, Damuse R, Lormil J, Pecan E, Dubuisson C, Pierre V, et al. Patients characteristics and outcomes of nonmetastatic breast cancer in Haiti: results from a retrospective cohort. Oncologist. 2020;25(9):e1372-81. https://doi.org/10.1634/theoncologist.2019-0951
Huo Q, Cai C, Zhang Y, Kong X, Jiang L, Ma T, et al. Delay in diagnosis and treatment of symptomatic breast cancer in China. Ann Surg Oncol. 2015;22(3):883-8. https://doi.org/10.1245/s10434-014-4076-9
Caplan L. Delay in breast cancer: implications for stage at diagnosis and survival. Front Public Health. 2014;2:87. https://doi.org/10.3389/fpubh.2014.00087
Stefanuto P, Doucet JC, Robertson C. Delays in treatment of oral cancer: a review of the current literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;117(4):424-9. https://doi.org/10.1016/j.oooo.2013.12.407
Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999;353(9159):1119-26. https://doi.org/10.1016/S0140-6736(99)02143-1
Asakura K, Yoshida Y, Sakurai H, Nakagawa K, Motoi N, Watanabe SI. Prognostic impact of tumor doubling time in patients with metachronous lung cancer. World J Surg. 2019;43(12):3259-66. https://doi.org/10.1007/s00268-019-05162-0
Stapleton JM, Mullan PB, Dey S, Hablas A, Gaafar R, Seifeldin IA, et al. Patient-mediated factors predicting early- and late-stage presentation of breast cancer in Egypt. Psychooncology. 2011;20(5):532-7. https://doi.org/10.1002/pon.1767
Peacock ZS, Pogrel MA, Schmidt BL. Exploring the reasons for delay in treatment of oral cancer. J Am Dent Assoc. 2008;139(10):1346-52. https://doi.org/10.14219/jada.archive.2008.0046
Popescu MJ, Ciobanu A. Factors influencing delayed diagnosis in oncology. Maedica (Bucur). 2020;15(2):191-5. https://doi.org/10.26574/maedica.2020.15.2.191
Ellis PM, Vandermeer R. Delays in the diagnosis of lung cancer. J Thorac Dis. 2011;3(3):183-8. https://doi.org/10.3978/j.issn.2072-1439.2011.01.01
Perri T, Issakov G, Ben-Baruch G, Felder S, Beiner ME, Helpman L, et al. Effect of treatment delay on survival in patients with cervical cancer: a historical cohort study. Int J Gynecol Cancer. 2014;24(7):1326-32. https://doi.org/10.1097/IGC.0000000000000211
Smith EC, Ziogas A, Anton-Culver H. Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surg. 2013;148(6):516-23. https://doi.org/10.1001/jamasurg.2013.1680
Forbes LJ, Warburton F, Richards MA, Ramirez AJ. Risk factors for delay in symptomatic presentation: a survey of cancer patients. Br J Cancer. 2014;111(3):581-8. https://doi.org/10.1038/bjc.2014.304
Vejlgaard AS, Rasmussen S, Jarbøl DE, Balasubramaniam K. Is healthcare-seeking with gynaecological alarm symptoms influenced by personal and professional relations? A Danish population-based, cross-sectional study. BMJ Open. 2020;10(5):e033471. https://doi.org/10.1136/bmjopen-2019-033471
Noonan B. Understanding the reasons why patients delay seeking treatment for oral cancer symptoms from a primary health care professional: an integrative literature review. Eur J Oncol Nurs. 2014;18(1):118-24. https://doi.org/10.1016/j.ejon.2013.07.005
Pita-Fernández S, Pértega-Díaz S, López-Calviño B, Seoane-Pillado T, Gago-García E, Seijo-Bestilleiro R, et al. Diagnostic and treatment delay, quality of life and satisfaction with care in colorectal cancer patients: a study protocol. Health Qual Life Outcomes. 2013;11:117. https://doi.org/10.1186/1477-7525-11-117
Djatmiko A, Octovianus J, Fortunata N. Profile of cancer delay in breast cancer cases at Surabaya Oncology Hospital. Indonesian J Cancer. 2013;7(2):47-52. Indonesian.
Yurdakul AS, Kocatürk C, Bayiz H, Gürsoy S, Bircan A, Özcan A, et al. Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey. Cancer Epidemiol. 2015;39(2):216-21. https://doi.org/10.1016/j.canep.2014.12.015
Majeed I, Rana A, Rafique M, Waheed AA, Mahmood F. Time delay barriers in diagnosis and treatment of cancer. WCRJ. 2018;5(3):e1118. https://doi.org/10.32113/wcrj_20189_1118
National Institute of Health Research and Development, Indonesian Ministry of Health. Main results RISKESDAS 2018. Jakarta: Indonesian Ministry of Health; 2018. Indonesian.
Mohd Mujar NM, Dahlui M, Emran NA, Abdul Hadi I, Wai YY, Arulanantham S, et al. Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia. PLoS One. 2017;12(4):e0176394. https://doi.org/10.1371/journal.pone.0176394
Akhtar K, Akhtar K, Rahman MM. Use of alternative medicine is delaying health-seeking behavior by Bangladeshi breast cancer patients. Eur J Breast Health. 2018;14(3):166-72. https://doi.org/10.5152/ejbh.2018.3929
Elshami M, Kmeil HA, Abu-Jazar M, Mahfouz I, Ashour D, Aljamal A, et al. Breast cancer awareness and barriers to early presentation in the Gaza-strip: a cross-sectional study. J Glob Oncol. 2018;4:1-13. https://doi.org/10.1200/JGO.18.00095
Mansell G, Shapley M, Jordan JL, Jordan K. Interventions to reduce primary care delay in cancer referral: a systematic review. Br J Gen Pract. 2011;61(593):e821-35. https://doi.org/10.3399/bjgp11X613160
Toftegaard BS, Bro F, Falbord AZ, Vedsted P. Impact of a continuing medical education meeting on the use and timing of urgent cancer referrals among general practitioners- a before-after study. BMC Fam Pract. 2017;18(1):44. https://doi.org/10.1186/s12875-017-0607-3
Fønhus MS, Dalsbø TK, Johansen M, Fretheim A, Skirbekk H, Flottorp SA. Patient-mediated interventions to improve professional practice. Cochrane Database Syst Rev. 2018;9(9):CD012472. https://doi.org/10.1002/14651858.CD012472.pub2
Copyright (c) 2021 Soehartati Gondhowiardjo, Sugandi Hartanto, Sigit Wirawan, Vito Filbert Jayalie, Ida Ayu Putri Astiti, Sonar Soni Panigoro, Sri Mutya Sekarutami, Andhika Rachman, Adang Bachtiar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with Medical Journal of Indonesia agree to the following terms:
- Authors retain copyright and grant Medical Journal of Indonesia right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial License that allows others to remix, adapt, build upon the work non-commercially with an acknowledgment of the work’s authorship and initial publication in Medical Journal of Indonesia.
- Authors are permitted to copy and redistribute the journal's published version of the work non-commercially (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Medical Journal of Indonesia.
