title: Closing the global cancer divide--performance of breast cancer care services in a middle income developing country.
abstract: BACKGROUND
  Cancer is the leading cause of deaths in the world. A widening disparity in cancer burden has emerged between high income and low-middle income countries. Closing this cancer divide is an ethical imperative but there is a dearth of data on cancer services from developing countries.
  
  
  METHODS
  This was a multi-center, retrospective observational cohort study which enrolled women with breast cancer (BC) attending 8 participating cancer centers in Malaysia in 2011. All patients were followed up for 12 months from diagnosis to determine their access to therapies. We assess care performance using measures developed by Quality Oncology Practice Initiative, American Society of Clinical Oncology/National Comprehensive Cancer Network, American College of Surgeons' National Accreditation Program for Breast Centers as well as our local guideline.
  
  
  RESULTS
  Seven hundred and fifty seven patients were included in the study; they represent about 20% of incident BC in Malaysia. Performance results were mixed. Late presentation was 40%. Access to diagnostic and breast surgery services were timely; the interval from presentation to tissue diagnosis was short (median = 9 days), and all who needed surgery could receive it with only a short wait (median = 11 days). Performance of radiation, chemo and hormonal therapy services showed that about 75 to 80% of patients could access these treatments timely, and those who could not were because they sought alternative treatment or they refused treatment. Access to Trastuzumab was limited to only 19% of eligible patients.
  
  
  CONCLUSIONS
  These performance results are probably acceptable for a middle income country though far below the 95% or higher adherence rates routinely reported by centres in developed countries. High cost trastuzumab was inaccessible to this population without public funding support.
authors.forename: Gerard C C
authors.initials: GC
authors.lastname: Lim
authors.forename: Emran N
authors.initials: EN
authors.lastname: Aina
authors.forename: Soon K
authors.initials: SK
authors.lastname: Cheah
authors.forename: Fuad
authors.initials: F
authors.lastname: Ismail
authors.forename: Gwo F
authors.initials: GF
authors.lastname: Ho
authors.forename: Lye M
authors.initials: LM
authors.lastname: Tho
authors.forename: Cheng H
authors.initials: CH
authors.lastname: Yip
authors.forename: Nur A
authors.initials: NA
authors.lastname: Taib
authors.forename: Kwang J
authors.initials: KJ
authors.lastname: Chong
authors.forename: Jayendran
authors.initials: J
authors.lastname: Dharmaratnam
authors.forename: Matin M
authors.initials: MM
authors.lastname: Abdullah
authors.forename: Ahmad K
authors.initials: AK
authors.lastname: Mohamed
authors.forename: Kean F
authors.initials: KF
authors.lastname: Ho
authors.forename: Kananathan
authors.initials: K
authors.lastname: Ratnavelu
authors.forename: Chiao M
authors.initials: CM
authors.lastname: Lim
authors.forename: Kin W
authors.initials: KW
authors.lastname: Leong
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Wahid
authors.affiliation: ClinResearch SB, Kuala Lumpur, Malaysia. limteckonn@gmail.com.
authors.forename: Teck O
authors.initials: TO
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D015331:Cohort Studies; D003906:Developing Countries / Q000191:economics*; D005260:Female; D014943:Global Health / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult