Abstract：
OBJECTIVE: Breast cancer (BC) is the most common type of cancer among women in Brazil. Evidence shows that delayed treatment onset is associated with increased mortality. This study aimed to evaluate median days between diagnosis and treatment and factors associated with delayed start of treatment (> 60 days after diagnosis): stage, treatment received, subtype, epidemiological characteristics, and type of healthcare coverage.
METHODS: This analysis included 1709 stage I-III BC patients from AMAZONA III, a prospective, observational study, diagnosed from January 2016 to March 2018 in 22 centers in Brazil.
RESULTS: The median number of days from diagnosis to beginning of first oncologic treatment was 46 days (IQR 28-75) overall, 43 days (IQR 25-75) for stage I disease, 49 days (IQR 28-81) for stage II, and 44 days (IQR 30-68) for stage III, (p = 0.1180). According to first treatment received, diagnosis-to-treatment interval was 43 days (IQR 29-65) for neoadjuvant chemotherapy and 48 days (IQR 26-81) for surgery. Diagnosis-to-treatment interval was higher in women treated in the public system versus the private system (56 vs. 34 days, p < 0.0001). Patients in the public system had an increased odds of delayed treatment initiation (OR 4.74 95% CI 3.09-7.26, p < .0001). The longer interval from diagnosis to treatment in the public system was independent of clinical stage, type of treatment (systemic vs surgery first), subtype and region of the country.
CONCLUSIONS: By characterizing the delays in care delivery, our study will aid stakeholders to better design interventions and allocate resource to improve timely treatment for breast cancer in Brazil.
RESULTS: gov Identifier: NCT02663973, registered on January, 26th, 2016.
METHODS: This analysis included 1709 stage I-III BC patients from AMAZONA III, a prospective, observational study, diagnosed from January 2016 to March 2018 in 22 centers in Brazil.
RESULTS: The median number of days from diagnosis to beginning of first oncologic treatment was 46 days (IQR 28-75) overall, 43 days (IQR 25-75) for stage I disease, 49 days (IQR 28-81) for stage II, and 44 days (IQR 30-68) for stage III, (p = 0.1180). According to first treatment received, diagnosis-to-treatment interval was 43 days (IQR 29-65) for neoadjuvant chemotherapy and 48 days (IQR 26-81) for surgery. Diagnosis-to-treatment interval was higher in women treated in the public system versus the private system (56 vs. 34 days, p < 0.0001). Patients in the public system had an increased odds of delayed treatment initiation (OR 4.74 95% CI 3.09-7.26, p < .0001). The longer interval from diagnosis to treatment in the public system was independent of clinical stage, type of treatment (systemic vs surgery first), subtype and region of the country.
CONCLUSIONS: By characterizing the delays in care delivery, our study will aid stakeholders to better design interventions and allocate resource to improve timely treatment for breast cancer in Brazil.
RESULTS: gov Identifier: NCT02663973, registered on January, 26th, 2016.
摘要：
目的：乳腺癌（BC）是巴西女性中最常见的癌症类型。证据表明，延迟治疗发作与死亡率增加有关。这项研究旨在评估诊断和治疗之间的中位天数以及与延迟开始治疗（诊断后>60天）相关的因素：阶段，接受治疗,子类型,流行病学特征，以及医疗保险的类型。
方法：该分析包括1709例来自AMAZONAIII的I-III期BC患者，一个潜在的，观察性研究，从2016年1月至2018年3月在巴西的22个中心诊断。
结果：从诊断到开始首次肿瘤治疗的中位天数为46天（IQR28-75），I期疾病43天（IQR25-75），第二阶段为49天(IQR28-81)，第三阶段为44天(IQR30-68)，（p=0.1180）。根据接受的第一次治疗，新辅助化疗的诊断-治疗间期为43天(IQR29-65),手术的诊断-治疗间期为48天(IQR26-81).在公共系统中接受治疗的女性与在私人系统中接受治疗的女性的诊断至治疗间隔更高（56vs.34天,p<0.0001)。公共系统中的患者延迟开始治疗的可能性增加（OR4.7495％CI3.09-7.26，p<0.0001）。公共系统从诊断到治疗的时间间隔较长，与临床分期无关，治疗类型（首先是全身和手术），国家的亚型和地区。
结论：通过表征护理交付的延迟，我们的研究将帮助利益相关者更好地设计干预措施和分配资源,以改善巴西乳腺癌的及时治疗.
结果：政府标识符：NCT02663973，1月注册，26日,2016年。
方法：该分析包括1709例来自AMAZONAIII的I-III期BC患者，一个潜在的，观察性研究，从2016年1月至2018年3月在巴西的22个中心诊断。
结果：从诊断到开始首次肿瘤治疗的中位天数为46天（IQR28-75），I期疾病43天（IQR25-75），第二阶段为49天(IQR28-81)，第三阶段为44天(IQR30-68)，（p=0.1180）。根据接受的第一次治疗，新辅助化疗的诊断-治疗间期为43天(IQR29-65),手术的诊断-治疗间期为48天(IQR26-81).在公共系统中接受治疗的女性与在私人系统中接受治疗的女性的诊断至治疗间隔更高（56vs.34天,p<0.0001)。公共系统中的患者延迟开始治疗的可能性增加（OR4.7495％CI3.09-7.26，p<0.0001）。公共系统从诊断到治疗的时间间隔较长，与临床分期无关，治疗类型（首先是全身和手术），国家的亚型和地区。
结论：通过表征护理交付的延迟，我们的研究将帮助利益相关者更好地设计干预措施和分配资源,以改善巴西乳腺癌的及时治疗.
结果：政府标识符：NCT02663973，1月注册，26日,2016年。
