title: Barriers to treatment in patients with locally advanced breast cancer.
abstract: Delays between presentation and treatment could have a significant effect on breast cancer mortality. The authors hypothesized that patient, physician, and system barriers are all responsible for treatment delays. Therefore, a study was conducted to define prevalent barriers to treatment from the patient's perspective. A modified 43-item Likert-scale questionnaire was administered to patients with clinical stage III locally advanced breast cancer (LABC) who had experienced a delay in treatment of 3 months or more. Between October 2008 and January 2010, 153 patients presented with LABC; 43 patients (28.1%) met eligibility, and 40 completed the questionnaire. Among the patient barriers reported, 38% of patients delayed care for fear of losing their breast and 47% awaited previously scheduled routine appointments instead of seeking care. Among the physician barriers reported, 20% of physicians of initial contact did not believe the breast lump/symptom was related to cancer and 15% did not believe it needed a biopsy. Among the system barriers reported, the most prevalent were delays in performing diagnostic tests and obtaining insurance authorization for tests, treatment, or physician visits. Substantial delays were seen in 28.1% of patients from presentation to when they sought therapy at City of Hope Comprehensive Cancer Center. The high prevalence of patient barriers versus physician/system barriers suggests that increased educational efforts for patients and health care professionals are needed.
authors.affiliation: From the aDepartment of Nursing, Sage College, Troy, New York; bDepartment of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California; cDivision of Medical Oncology, Cedars Sinai-Samuel Oschin Cancer Center, Los Angeles, California; dDivision of Biostatistics, Department of Information Sciences, City of Hope Comprehensive Cancer Center, Duarte, California; and eDivision of Nursing Research and Education, Department of Population Science, City of Hope Comprehensive Cancer Center, Duarte, California.
authors.forename: Laura
authors.initials: L
authors.lastname: Bourdeanu
authors.forename: Thehang
authors.initials: T
authors.lastname: Luu
authors.forename: Norma
authors.initials: N
authors.lastname: Baker
authors.forename: Suzanne
authors.initials: S
authors.lastname: Swain-Cabriales
authors.forename: Cathie T
authors.initials: CT
authors.lastname: Chung
authors.forename: Joanne
authors.initials: J
authors.lastname: Mortimer
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
authors.forename: Sandra
authors.initials: S
authors.lastname: Helton
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.forename: Betty
authors.initials: B
authors.lastname: Ferrell
authors.forename: Gloria
authors.initials: G
authors.lastname: Juarez
authors.forename: George
authors.initials: G
authors.lastname: Somlo
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010865:Pilot Projects; D012307:Risk Factors