Patient-attributable delay and its impact on two-year survival in breast cancer: A multicenter prospective cohort study

Abstract

Background: Delays in the diagnosis and treatment of breast cancer can be attributed to sociodemographic characteristics, clinical-pathological factors, and the functioning of the health system. This study aims to examine the impact of patient-attributable delay (PPAD) on timely medical care and its effect on patient survival.

Methods: This multicenter, prospective, observational study included 543 patients diagnosed with breast cancer between 2013 and 2015. A PPAD was defined as a delay of more than 90 days between symptom onset and consultation with a primary care physician or emergency department. The rate of PPAD in this population was 14.18 %.

Results: Segmented analysis revealed significant associations with age and living alone, with living alone emerging as the only independent predictor of PPAD (Odds Ratio OR: 1.882; 95 % Confidence Interval CI: 1.033-3.42). Significant associations were identified between clinical stage (p < 0.001), immunophenotype (p < 0.001), PPAD (p < 0.05), age (p < 0.001), household situation (p < 0.001) and body mass index (p < 0.05) with breast cancer prognosis. In the multivariate analysis, PPAD was an independent risk factor for two-year mortality (OR 3.08; 95 % CI 1.05-9.07), second only to clinical stage (OR 6.78; 95 % CI 2.51-18.3). Age also remained as a significant predictor (OR 1.04; 95 % CI 1.01-1.07).

Conclusion: Our findings highlight the need for targeted interventions to raise cancer symptom awareness and address barriers faced by vulnerable groups, such as the elderly and individuals living alone, to reduce delays, improve clinical outcomes, increase survival rates, and ultimately the quality of life for patients.

Keywords: Breast cancer; Cancer awareness; Diagnosis delay; Patient-attributable delay (PPAD); Prognosis; Survival.