Factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, from 2010 to 2019: a cohort study

Silva, Fernanda de Paula Ciribelli da; Souza, Mirian Carvalho; Bertoni, Neilane

doi:10.1590/S2237-96222024v33e20231177.en

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 33 • 2024 • https://doi.org/10.1590/S2237-96222024v33e20231177.en copy

Factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, from 2010 to 2019: a cohort study

Factores asociados al retraso en el inicio del tratamiento del cáncer de mama en un centro oncológico de referencia en Juiz de Fora, de 2010 a 2019: estudio de cohorte

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives

To analyze factors associated with delayed initiation of breast cancer treatment at an oncology referral center in Juiz de Fora, Minas Gerais state, between 2010 and 2019.

Methods

This was a cohort study using data from the Hospital-based Cancer Registry. The probability of not starting treatment within 60 days, in accordance with Brazilian law, was estimated using Kaplan-Meier, method and its association with the factors studied was assessed using the Cox model, presenting hazard ratios (HR) and respective 95% confidence intervals (95%CI).

Results

Among the 911 participants, the probability of delayed treatment initiation was 18.8% (95%CI 16.4;21.5). Those who underwent treatment at a health service other than the one where the cancer was diagnosed had a significantly higher risk (HR: 3.49; 95%CI 3.00;4.07).

Conclusion

Receiving a diagnosis and treatment at the same institution may help reduce waiting time to initiate cancer treatment.

Keywords
Breast Cancer; Time to Treatment Initiation; Public Health; Observational Study; Cohort Studies

Study contributions

Main results

The probability of study participants not initiating treatment within 60 days was 18.8%. Undergoing treatment at a healthcare service other than the one where the diagnosis was made was the main factor associated with delay.

Implications for services

Organizing healthcare services based on strategies that optimize referral flows and avoid transitions of care, can be crucial in reducing the time to initiation of breast cancer treatment.

Perspectives

It is essential to improve the workflows at the different stages of health care to ensure timely initiation of oncological treatment.

Variables	Total		Time between diagnosis and start of treatment				p-value^a
	Total		No delay (≤ 60 days)		With delay (> 60 days)		p-value^a
	N	%	N	%	N	%
Total	911	100	740	81.2	171	18.8	-
Race/skin color ^b
White	572	63.6	466	63.7	106	62.7	0.872
Mixed-race/Black/Indigenous	328	36.4	265	36.3	63	37.3	0.872
Age at diagnosis (years)
18-49	298	32.7	255	34.5	43	25.1	0.063
50-69	427	46.9	339	45.8	88	51.5
70 and older	186	20.4	146	19.7	40	23.4
Education level ^b
Up to incomplete elementary education	466	53.2	386	54.1	80	49.1	0.521
Complete elementary education	100	11.4	78	10.9	22	13.5
Complete high school	232	26.5	184	25.8	48	29.4
Complete or incomplete higher education	78	8.9	65	9.1	13	8.0
Referral origin
Brazilian National Health System (SUS)	856	94.0	691	93.4	165	96.5	0.173
Not from SUS	55	6.0	49	6.6	6	3.5	0.173
Medical specialty of first treatment
Surgical oncology	593	65.1	531	71.8	62	36.3	< 0.001
Clinical oncology	287	31.5	188	25.4	99	57.9
Radiotherapy	31	3.4	21	2.8	10	5.8
Transition of care
No	587	64.4	550	74.3	37	21.6	< 0.001
Yes	324	35.6	190	25.7	134	78.4	< 0.001
Staging ^b
0-IIA	405	47.6	340	49.3	65	40.4	0.114
IIB-IIIC	326	38.4	257	37.3	69	42.9
IV	119	14.0	92	13.4	27	16.8
Time of diagnosis ^c
Before the law came into force	332	36.4	291	39.3	41	24.0	< 0.001
After the law came into force	579	63.6	449	60.7	130	76.0	< 0.001

Variables	Probability		p-value^a
Variables	%	95%CI	p-value^a
Total	18.8	16.4;21.5
Race/skin color ^b
White	18.5	15.6;22.0	0.500
Mixed-race/Black/Indigenous	19.2	15.4;24.0
Age at diagnosis (years)
18-49	14.4	10.9;19.0
50-69	20.6	17.1;24.8	0.300
70 and older	21.5	16.3;28.3
Education level ^b
Up to incomplete elementary education	17.2	14.1;21.0
Complete elementary education	22.0	15.2;31.8	0.500
Complete high school	20.7	16.1;26.6
Complete or incomplete higher education	16.7	10.1;27.4
Referral origin
Brazilian National Health System (SUS)	19.3	16.8;22.1	0.040
Not from SUS	10.9	5.1;23.2
Medical specialty of first treatment
Surgical oncology	10.5	8.3;13.2
Clinical oncology	34.5	29.4;40.5	< 0.001
Radiotherapy	32.3	19.4;53.7
Transition of care
No	6.3	4.6;8.6	< 0.001
Yes	41.4	36.3;47.1
Staging ^b
0-IIA	16.0	12.8;20.1
IIB-IIIC	21.2	17.2;26.1	< 0.001
IV	22.7	16.3;31.6
Time of diagnosisc
Before the law came into force	11.1	8.2;15.2	< 0.001
After the law came into force	23.0	19.8;26.6

Variables	Total			Diagnosis period
	Total			Before the law			After the law
	HR	(95%CI)	p-value ^a	HR	(95%CI)	p-value ^a	HR	(95%CI)	p-value^a
Age at diagnosis (years)
18-49	1.00	-	0.114	1.00	-	0.220	1.00	-	0.230
50-69	1.04	(0.89;1.21)		1.06	(0.17;6.72)		1.00	(0.14;7.09)
70 and older	0.90	(0.74;1.10)		1.03	(0.15;6.90)		0.86	(0.09;8.43)
Referral origin
Brazilian National Health System (SUS)	1.00	-	0.068	1.00	-	0.010	1.00	-	0.640
Not from SUS	0.81	(0.59;1.13)	0.068	0.82	(0.08;8.94)	0.010	0.79	(0.06;9.51)	0.640
Medical specialty of the first treatment
Surgical oncology	1.00	-	<0.001	1.00	-	<0.001	1.00	-	<0.001
Clinical oncology	2.48	(2.10;2.92)		3.02	(1.58;5.78)		2.29	(0.97;5.39)
Radiotherapy	2.15	(1.46;3.17)		0.99	(0.14;7.19)		2.32	(1.00;5.40)
Transition of care
No	1.00	-	<0.001	1.00	-	<0.001	1.00	-	<0.001
Yes	3.49	(3.00;4.07)	<0.001	4.94	(3.32;7.35)	<0.001	3.03	(1.59;5.78)	<0.001
Staging ^b
0-IIA	1.00	-	<0.001	1.00	-	0.050	1.00	-	<0.001
IIB-IIIC	1.13	(0.96;1.32)		1.18	(0.22;6.22)		1.08	(0.18;6.61)
IV	1.00	(0.80;1.24)		1.06	(0.17;6.73)		0.98	(0.13;7.27)
Time of diagnosis ^c
Before the law came into force	1.00	-	0.129	-			-
After the law came into force	1.31	(1.13;1.51)	0.129	-			-

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 (61) 3315-3464 - Brasília - DF - Brazil
E-mail: revista.saude@saude.gov.br

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[1] Correspondence: Fernanda de Paula Ciribelli da Silva | f.ciribelli@hotmail.com