Breast cancer treatment waiting time, patient and provider contributions: An Egyptian breast cancer centre experience

Abstract

Background: Breast cancer is the most common type of female cancer in Egypt and world wide. Most of the cases present as locally advanced or metastatic rather than early stages in Egypt. There is no data to assess waiting times in the Egyptian breast cancer patient journey from developing first symptom until initiating treatment. Methods: This is a descriptive study in which the electronic records and paper notes of 200 patients presenting from April until September 2016 to a public non governmental breast cancer centre in Cairo were reviewed for different waiting times. The wait time from developing the first symptom until commencing treatment was divided into stages; Symptom to call (booking an appointment), call to review , review to diagnosis, diagnosis to multidisciplinary team meeting (MDT) and MDT to first therapy. Results: The average time from developing symptom to booking an appointment (patient factor) was 131 days /4.4 months. The time lag from booking until medical review was 47 days /1.5 months. This is because of the booking systemwaiting list. The mean time taken from review until getting a final diagnosis was 11 days. All cases were discussed in the MDT and therapy ensued the MDT by 17 days in average. The mean in hospital waiting time (time from review until commencing treatment whether surgery, systemic therapy or radiotherapy) was 37 days while the mean time for the whole journey (symptom to treatment) was 214 days /7.1 months. Patients contributed to 61% of the wait time (131 days / 4.4 months) whereas the provider contributed by 39%with average of less than 3 months. Conclusions: Patients contributed to the biggest part of the delay. The second factor was the booking systemwaiting list. Once reviewed by the medical team the process was accelerated. This indicates a need to improve public awareness of breast cancer symptoms and facilitate patient access to services.