System-related delays in diagnosis and treatment of breast cancer in Poland

Abstract

Introduction. Breast cancer (BC) treatment results depend greatly on prompt and efficient diagnostic and therapeutic decisions. This means that the final treatment outcome is determined by the amount of time elapsed from disease onset to treatment implementation. Delays in implementation may be due to patients, physicians or the healthcare system. The aim of this research project was to identify healthcare system-related causes of delayed diagnosis and treatment of BC in Polish women. In our previous study, we presented causes related to patient attitudes. In this paper causes related to the healthcare system are discussed.

Materials and methods. Data were collected using a questionnaire, completed by 1000 BC patients treated in 10 randomly selected Polish cancer centers and hospitals with oncological wards. The time and structure of BC diagnostic processes were evaluated based on an electronic and interactive questionnaire, where patients selected from the six proposed events that applied to them, and defined the time between specific stages.

Results. The mean delay time due to healthcare system-related causes was 9.0 weeks. If no member of the patient’s immediate family had been previously diagnosed with cancer, the delay was prolonged by 2.1 weeks. When the first physician consulted was an oncologist, the delay time was shorter on average by 1.8 weeks, as compared to the patients whose first consulted physician held a different specialization. Patients aged over 59 waited about 1.5 weeks less for treatment than younger women. Treatment duration was 1.3 weeks shorter for patients living in a city of over 300,000 inhabitants, than for those from smaller cities. An increase in mistrust towards the healthcare system and treatment results further extended the delay by 0.8 weeks for each degree of mistrust. Family support shortened the time to treatment implementation by 0.6 week per level of support.

Conclusions. Actions that should be undertaken to reduce delays in BC diagnosis and treatment in Poland include an increase in efficiency, better standardization of diagnostic pathways, better availability of testing procedures in smaller cities, overcoming the mistrust towards the healthcare system, and increasing the role and competencies of general practitioners in the prophylaxis of neoplastic diseases. Priority should be given to actions which aim to create specialized diagnostic and therapeutic centers, providing comprehensive oncological care, standardized diagnostic procedures and high therapeutic standards.