Consultation, Diagnosis and Treatment Delays for Breast Cancer among Patients Followed up at the YaoundéGeneral Hospital, Cameroon

Introduction: Breast cancer is often diagnosed at an advanced stage in Cameroon. The objective was to analyse consultation, diagnosis and treatment delays for breast cancer among patients followed up at the Yaoundé General Hospital (YGH) in Cameroon. Materials and Methods: This was a cross-sectional study carried out from the files of patients followed up for breast cancer at the YGH from January 1, 2014 to April 30, 2018. A total of 183 patients were included. We measured time elapsed between the awareness of first signs of disease and the initial consultation (consultation delays), time lapse between the initial consultation and pathological diagnosis of breast cancer (diagnosis delays), interval between pathological diagnosis and treatment onset (treatment delays), time elapsed between the initial consultation and management (health system delays) and time elapsed from awareness of first signs of disease to treatment onset (overall delays). Results: The delays (median, IIQ) were: (5.1 months;IIQ: 1.7 - 12.4), (25 days;IIQ: 10 - 67), (27 days;IIQ: 13 - 63), (2.2 months;IIQ: 1.2 - 5.8) and (9.9 months;IIQ: 4.4 - 17.6) respectively for consultation, diagnosis, treatment, health system and overall delays. The risks associated with a delay in initial consultation of greater than 3 months were (OR;95% CI): unschooled patients (2.01;1.66 - 2.40);monthly income below the minimum wage (2.70;1.81 - 5.96);unemployment (2.14;1.02 - 3.24) and absence of a family history of cancer (2.44;1.66 - 6.10). The main reasons for a late first consultation were: ignorance (60.2%), financial challenges (17.6%) and a preference for alternative treatment (11.1%). Conclusion: The consultation, diagnosis and treatment delays for breast cancer are very often long in our setting than those reported in developed countries. Both patients’ and institutional factors are demonstrated. There is a need to increase public awareness on the value of early diagnosis of breast cancer. Also, health system should be improved to enable early diagnosis and treatment of this affection.

Postoperative adverse cardiac events in acute myocardial infarction with high thrombus load and best time for stent implantation

BACKGROUND Myocardial infarction is one of the most common types of coronary heart disease.It is mainly caused by the rupture of coronary atherosclerotic plaque,which leads to platelet agglutination and thrombosis.The occlusion of coronary arteries and vessels leads to insufficient myocardial blood supply,subsequently causing cardiac interstitial fibrosis,gradual enlargement of ventricles,and heart failure,which affects the quality of life and safety of patients.AIM To investigate the effects of emergency percutaneous interventional therapy(PCI)and delayed stenting in acute myocardial infarction with high thrombotic load and identify factors related to major adverse cardiovascular events(MACE).METHODS A total of 164 patients with acute myocardial infarction and high thrombotic load who received PCI were included.Of them,92 patients were treated with delayed stent implantation(delayed group)and 72 patients received emergency PCI(immediate group).Myocardial perfusion after stent implantation was compared between the two groups.Patients were followed up for 12 mo,and the occurrence of MACE was used as the endpoint.Univariate and multivariate models were used to analyze the factors affecting MACE occurrence.RESULTS After stent implantation,66(71.74%)patients in the delayed group and 40(55.56%)patients in the immediate group had thrombolysis in myocardial infarction(TIMI)flow grade 3(P<0.05),while 61(66.30%)patients in the delayed group and 39(54.17%)patients in the immediate group reached TIMI myocardial perfusion grade 3(P>0.05).MACE occurred in 29 patients.There were statistically significant differences between the MACE and non-MACE groups in diabetes rate,TIMI grading,stent implantation timing,intraoperative use of tirofiban,and the levels of white blood cells(WBC),neutrophils,red blood cell distribution width(RDW),and uric acid,and high-sensitivity C-reactive protein(hs-CRP)at admission(P<0.05).Logistic regression analysis showed that TIMI grade 3 and intraoperative use of tirofiban effectively reduced the risk of MACE(P<0.05),while immediate stent implantation,increased WBC,hs-CRP and RDW on admission increased the risk of MACE(P<0.05).CONCLUSION Delayed stent implantation outweighs emergency PCI in improving postoperative myocardial perfusion in acute myocardial infarction with high thrombotic load,and effectively reduces MACE in these patients.

Impact of delay from transperineal biopsy to radical prostatectomy upon objective measures of cancer control

Objective:Treatment delays in prostate cancer have been characterised,although not explicitly in men undergoing transperineal prostate biopsies.We aimed to determine if delays to radical prostatectomy correlate with adverse outcomes using a contemporary population-based cohort of men diagnosed by transperineal biopsies.Methods:This study analysed men with prostate cancer of the International Society for Urological Pathology grade group≥2,diagnosed by transperineal prostate biopsies who underwent prostatectomy,using the prospectively data from 1 January 2014 to 30 June 2018 Prostate Cancer Outcomes Registry-Victoria.Data were analysed according to stratified demographic and disease characteristics.Time intervals from biopsy(28,60,90,120,and 270 days)were compared using odds ratios and regression analyses for proportion of upgrading,early biochemical recurrence,pT3 disease at prostatectomy,and positive surgical margins.Results:In total,2008 men were analysed.There were 306(16.7%)men with upgrading,151(8.4%)with biochemical recurrence,1068(54.1%)with pT3 disease,and 464(23.1%)with positive surgical margins(percentages excluded patients with missing data).All adverse outcomes studied were significantly associated with higher prostate-specific antigen and grade at diagnosis.Delays of 120-270 days did not adversely alter the incidence of Gleason upgrading,pT3,or recurrence.Delays(most frequent 60-89 days,28%)were associated with positive surgical margins but not monotonically.Regression modelling demonstrated no increased likelihood of most adverse outcomes for up to 270 days.Conclusion:Men with prostate cancer of grade group≥2 diagnosed through transperineal biopsy may wait up to 270 days for a prostatectomy without a greater likelihood of upgrading,pT3 disease,positive surgical margins,or biochemical recurrence.

An Assessment, with NICE Guidelines as a Benchmark, of Delay to Care in a Cohort of Colorectal Cancer Patients Seen in the Witwatersrand University Academic Complex

Background: Colorectal cancer (CRC) in South Africa (S.A) is the second most common in women and the third in men. Worldwide it is the second most deadly cancer. As a subset, colon cancer is the fifth most deadly with an estimated 551,000 deaths in 2018. CRC makes up 5.8% of all cancer-related deaths globally. Despite this, there are no screening programmes in S.A, with a diagnosis being largely dependent on symptomatology. Additionally, there is no clear understanding of the significance of the outcome imposed by delay in referral and treatment. Unlike countries in Europe, South Africa has no guidelines defining cut-offs for acceptable delays in this context. Methods: A retrospective study was done on the delay in referral, diagnosis, and treatment of CRC patients. A cohort of patients in which surgery was the primary treatment that was presented to Witwatersrand Academic Hospitals was studied. Delays were benchmarked against fourteen days from primary contact to consultation with a specialist and consultation to treatment delay of more than 31 days. Definitive treatment delay was defined as the time from referral to the treatment centre and tumour resection of more than 62 days. Outcomes were evaluated by defining the 90-day mortality. Results: The median referral delay was 78 days, for treatment delay was 54 days and for definitive treatment delay was 175 days. Of the 587 patients analysed, 341 had therapeutic surgery, 17 demised within 90 days post-surgery. Longer delays and higher mortality rates were seen in the public sector and a lower socio-economic group of patients. Conclusion: The time parameters set out by the NHS and Europe were not met. There were greater delays seen in patients with lower socio-economic backgrounds and in those attending the public sector. The effect of delays on 90-day mortality is doubtful. Delays to care both outside of hospitals and in hospitals may be a point of investigation in future studies.

An appropriate treatment interval does not afect the prognosis of patients with breast Cancer

Purpose:Major public health emergencies may lead to delays or alterations in the treatment of patients with breast cancer at each stage of diagnosis and treatment.How much do these delays and treatment changes afect treatment outcomes in patients with breast cancer?Methods:This review summarized relevant research in the past three decades and identifed the efect of delayed treatment on the prognosis of patients with breast cancer in terms of seeking medical treatment,neoadjuvant treatment,surgery,postoperative chemotherapy,radiotherapy,and targeted therapies.Results:Delay in seeking medical help for≥12weeks afected the prognosis.Surgical treatment within 4 weeks of diagnosis did not afect patient prognosis.Starting neoadjuvant chemotherapy within 8 weeks after diagnosis,receiving surgical treatment at 8 weeks or less after the completion of neoadjuvant chemotherapy,and receiving radiotherapy 8 weeks after surgery did not afect patient prognosis.Delayed chemotherapy did not increase the risk of relapse in patients with luminal A breast cancer.Every 4 weeks of delay in the start of postoperative chemotherapy in patients with luminal B,triple-negative,or HER2-positive breast cancer treated with trastuzumab will adversely afect the prognosis.Targeted treatment delays in patients with HER2-positive breast cancer should not exceed 60days after surgery or 4months after diagnosis.Radiotherapy within 8 weeks after surgery did not increase the risk of recurrence in patients with early breast cancer who were not undergoing adjuvant chemotherapy.Conclusion:Diferent treatments have diferent time sensitivities,and the careful evaluation and management of these delays will be helpful in minimizing the negative efects on patients.

In-hospital delay to primary angioplasty for patients with ST-elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention （PPCI） for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 （interquartile range 105 to 180） minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals （147 minutes vs. 120 minutes, P〈0.001; 55 minutes vs. 45 minutes, P=0.035）. After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

An assessment of racial differences in epidemiological, clinical and psychosocial factors among head and neck cancer patients at the time of surgery

Objective:Racial disparities have been well characterized and African American(AA)patients have 30%lower 5-year survival rates than European Americans(EAs)for head and neck squamous carcinoma(HNSCC).This poorer survival can be attributed to a myriad of different factors.The purpose of this study was to characterize AA-EA similarities and differences in sociodemographic,lifestyle,clinical,and psychosocial characteristics in HNSCC patients near the time of surgery.Methods:Setting:Single tertiary care center.Participants:Thirty-nine newly diagnosed,untreated HNSCC patients(n=24 EAs,n=15 AAs)who were to undergo surgery were recruited.Study Design:Cross-sectional study Sociodemographic,lifestyle factors,and disease factors(cancer site,AJCC clinical and pathologic stage,and HPV status)were assessed.Risk factors,leisure time,quality of life and social support were also assessed using validated questionnaires.Exposures:EA and AA patients were similar in the majority of sociodemographic factors assessed.AAs had a higher trend toward pathologically later stage disease compared to EAs and significantly increased time to treatment.Results:EA and AA patients were similar in the majority of sociodemographic factors assessed.AAs had a higher trend toward pathologically later stage disease compared to EAs.AAs also had significantly increased time to treatment(P=0.05).The majority of AA patients(62%)had later stage pathologic disease.AA were less likely to complete high school or college(P=0.01)than their EA counterparts.Additionally,AAs were more likely to report having a gap in health insurance during the past decade(37%vs.15%).Conclusions:This preliminary study demonstrates a similar profile of demographics,clinical and psychosocial characteristics preoperatively for AAs and EAs.Key differences were AAs tending to have later pathologic stage disease,educational status,delays in treatment initiation,and gaps in health insurance.

Study of pedestrian hybrid beacon's effectiveness for motorists at midblock pedestrian crossings

Pedestrian signals, particularly at signalized, midblock crossings, delay drivers, which is termed ＂unnecessary delay＂ in this study. A pedestrian hybrid beacon was proven to be effective in decreasing this unnecessary delay to the drivers at midblock pedestrian crossings when compared to standard signalized midblock crossings. Two pedestrian hybrid beacons were installed at midblock pedestrian crossings in Lawrence, Kansas. A study was conducted at these two locations to determine the effectiveness of the pedestrian hybrid beacon in decreasing the unnecessary delay to drivers by comparing them with a signalized midblock on Massachusetts Street, Lawrence, Kansas. In addition to the delay measurements for drivers at pedestrian hybrid beacon and signalized treatment at midblock pedestrian crossings, other parameters such as driver compliance rate, pedestrian compliance rate, and other driver and pedestrian characteristics were also studied. Video cameras were used at these test locations and the effectiveness of the pedestrian hybrid beacon was analyzed from the video. A more than 90% reduction in delays was observed for the drivers at the pedestrian hybrid beacon at midblock crossings compared to the signalized crossing. Further, a better driver compliance rate was also recorded at the pedestrian hybrid beacon. Information about reductions in unnecessary delay to drivers and improvements to driver and pedestrian compliance rates from the use of pedestrian hybrid beacons would be useful to engineers, decision makers, and researchers to determine an optimum treatment at desired pedestrian crossings.