title: Effect of socio-economic factors on delayed access to health care among Chinese cervical cancer patients with late rectal complications after radiotherapy.
abstract: OBJECTIVE
  To determine the effect of socio-economic status (SES) on delayed access to medical treatment by Chinese cervical cancer patients who suffered from late rectal sequelae (LRS) after external beam radiation therapy (EBRT) and intracavitary brachytherapy.
  
  
  METHODS
  Patients diagnosed with LRS were interviewed for their SES, factors including age, residing district, religion, marital status, income, education, insurance and patient delay (the time interval from the onset of symptoms to the first medical consultation) and other factors such as weight, symptom duration and disease stage at diagnosis.
  
  
  RESULTS
  One hundred and twenty nine patients were interviewed. Seventy-one patients (55%) sought medical treatment within three months after the first symptom being recognized and fifty-eight patients (45%) delayed their medical treatment over 3 months. The study shows that age ≥ 55 (OR=12.1; 95% CI: 3.3-43.9), lower education (OR=4.6; 95% CI: 2.0-10.4 for women with primary school education or illiterate), low annual household income (OR=2.3; 95% CI: 1.2-5.1) and widow/divorce (OR=0.1; 95% CI: 0.01-0.07) were the high risk factors for delayed reporting. Patients with bleeding or bleeding plus other symptoms (61.2%) were more likely to seek treatment within three months, compared to patients with other symptoms only (38.8%) (p=0.002). Additionally, delayed reporting was found to be significantly associated with the late stage of late rectal sequelae (LRS) (p=0.000) and the patients with 55 years or older (p=0.000).
  
  
  CONCLUSIONS
  Delayed reporting and late-stage presentation of late rectal sequelae are more prevalent among Chinese cervical cancer patients with 55 years or older, low education, poor marital status, or poor financial status. Effective social support and educational programs should be implemented to encourage these patients to seek medical treatment as soon as possible.
authors.affiliation: Department of Radiation Oncology, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China.
authors.forename: Jinlu
authors.initials: J
authors.lastname: Ma
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhu
authors.forename: Suxia
authors.initials: S
authors.lastname: Han
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Ou
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Zhao
authors.forename: Zi
authors.initials: Z
authors.lastname: Liu
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D002681:China; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D011832:Radiation Injuries / Q000191:economics / Q000209:etiology*; D011878:Radiotherapy / Q000009:adverse effects / Q000379:methods; D012002:Rectal Diseases / Q000191:economics / Q000209:etiology*; D012007:Rectum / Q000528:radiation effects*; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000191:economics / Q000532:radiotherapy*