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Provider delay in the diagnosis and initiation of definitive treatment for breast cancer patients.

OBJECTIVE
To determine the extent and nature of provider delay in breast cancer management at Kenyatta National Hospital (KNH).


DESIGN
Retrospective descriptive study.


SETTING
Kenyatta National Hospital breast clinic.


SUBJECTS
Records of 500 patients were reviewed over a four year period.


RESULT
Out of the 500 patient files reviewed a total of 111 (22.2%) were excluded because either whole or part of their diagnostic work-up was done outside KNH (n=66) or they had recurrent disease (n=45), thus leaving 389 eligible for analysis. Mean overall provider delay (time lapse between the patients' first hospital visit date to time definitive anti-cancer treatment was started) was 87.9 days, (n=160, range 1 to 1683 days) and a median of 21.5 days. Nine (5.6%) patients were started on treatment three or more years after they initially presented to the hospital. Mean delay with regard to confirmatory laboratory diagnostic test was 56.2 days (n=83, range 1 to 985 days, standard deviation 146.7) with a median of 17.0 days. Eighty seven (22.4%) patients had complete data set to assess for the lapse in time from definitive diagnosis to the time definitive anti-cancer treatment was initiated. This mean delay was 93.5 days with a median of 28.0 days.


CONCLUSION
The median overall provider delay for patients diagnosed with breast cancer at KNH is reasonable and compares well with that of other institutions. It remains to be determined why a small number of patients take unusually long to be put on definitive anti-cancer treatment.