Patient-level factors associated with delays to adjuvant chemotherapy in female patients with breast cancer
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Authors
Stevens, Taylor
Date
2024-09-30
Type
thesis
Language
eng
Keyword
breast cancer , time to treatment , adjuvant chemotherapy , epidemiology
Alternative Title
Abstract
Background: Longer time to initiation of adjuvant chemotherapy following surgery (TTC) is associated with worse patient outcomes in breast cancer treatment. This thesis examined patient sociodemographic and clinical factors for their relationships with TTC through a scoping review and analysis of data from patients who received treatment at the National Cancer Institute Sri Lanka (NCISL).
Methods: A scoping review was conducted by searching MEDLINE, EMBASE, CINHAL, Web of Science, and grey literature repository databases for papers that evaluated patient sociodemographic and clinical factors for association with TTC in breast cancer treatment. A single-institution retrospective cohort study was performed with data from female patients with stage II-III breast cancer treated at the NCISL. Delay in TTC was defined as initiation >12 weeks following surgery. A Poisson regression with robust variance estimation was used to estimate the independent relationships of patient sociodemographic and clinical factors with delayed TTC.
Results: In the scoping review, 49 papers met the inclusion criteria and 41 patient sociodemographic and clinical factors were identified. The most commonly evaluated factors were age, stage, and surgical complications. Retrospective cohort designs and administrative or clinical data were most often used. A paucity of studies from lower middle income (LMIC) and low-income country (LIC) contexts was identified.
The cohort study included 2,907 female patients who had undergone surgery for stage II-III breast cancer and received adjuvant chemotherapy within 6 months of surgery. The median TTC was 6.1 weeks and 11.9% of participants experienced delay. An age ≥70 years compared to <40 years, having less than three children compared to three or more, having no education compared to secondary level or higher, having a primary hospital outside the Western Province of Sri Lanka, and wide local excision compared to mastectomy with or without reconstruction were found to be associated with delayed TTC.
Conclusion: More research in the area of TTC is necessary in the context of LMIC and LICs. The findings of this study contribute to by identifying factors in the context of a LMIC that can be used to identify patients at risk for delayed TTC and inform targeted intervention.
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Attribution-NonCommercial-NoDerivatives 4.0 International
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivatives 4.0 International