Provider delay in the diagnosis and initiation of definitive treatment for breast cancer patients

Abstract

Objective: To determine the extent and nature of provider delay in breast cancer management at Kenyatta National Hospital (KNH). Design: Retrospective descriptive study. Setting: Kenyatta National Hospital breast clinic. Subjects: Records of 500 patients were reviewed over a four year period. Result: Out of the 500 patient files reviewed a total of 111 (22.2%) were excluded because either whole or part of their diagnostic work-up was done outside KNH (n=66) or they had recurrent disease (n=45), thus leaving 389 eligible for analysis. Mean overall provider delay (time lapse between the patients’ first hospital visit date to time definitive anti-cancer treatment was started) was 87.9 days, (n=160, range 1 to 1683 days) and a median of 21.5 days. Nine (5.6%) patients were started on treatment three or more years after they initially presented to the hospital. Mean delay with regard to confirmatory laboratory diagnostic test was 56.2 days (n=83, range 1 to 985 days, standard deviation 146.7) with a median of 17.0 days. Eighty seven (22.4%) patients had complete data set to assess for the lapse in time from definitive diagnosis to the time definitive anti-cancer treatment was initiated. This mean delay was 93.5 days with a median of 28.0 days. Conclusion: The median overall provider delay for patients diagnosed with breast cancer at KNH is reasonable and compares well with that of other institutions. It remains to be determined why a small number of patients take unusually long to be put on definitive anti-cancer treatment.