One of the foremost rules of successful cancer treatment is “get it early.” That’s why City of Hope clinicians want to better understand a disturbing trend they saw among breast cancer patients — many were waiting more than three months after their first symptoms appeared to seek care.

Laura Bourdeanu, Ph.D., R.N., M.S.N., nurse practitioner in the Department of Medical Oncology & Therapeutics Research, and her colleagues wanted to know what held the women back, especially since the delays could affect the women’s health.

George Somlo, left, and Laura Bourdeanu (Photo by p.cunningham)

“Any type of delay in seeking treatment may lead to a possible larger tumor, a higher risk of metastasis and a higher-stage breast cancer with inherently worse prognosis,” she said.

George Somlo, M.D., co-director of the Breast Cancer Program and the study’s senior author, said the team wanted to understand the exact reasons why patients arrived in the clinic with such advanced stages of breast cancer.

“Was it a lack of insurance or financial issues, lack of awareness on the patients’ part that something is wrong, fear of surgery or system delays?” Somlo asked. “What can we do in the health-care system to avoid this situation in the future?”

From 2005 to 2009, 34 City of Hope patients diagnosed with stage 3 breast cancer responded to questionnaires asking why their care was postponed.

Some patients cited health-system barriers: About 38 percent reported delays in scheduling tests; more than a quarter cited delays due to obtaining insurance authorization for tests, treatments and doctor visits.

Patients also noted physician barriers. Nearly 24 percent said their primary care physician did not believe that the breast lumps or symptoms were related to cancer. Almost 18 percent said their physicians thought biopsies were unnecessary.

Patients sometimes delayed treatment themselves. Close to half said they waited for their regularly scheduled doctor visit instead of requesting an earlier appointment when they noticed a lump or other irregularities. Some 35 percent delayed treatment because of fear of losing a breast. The same number thought the symptoms were due to an infection, muscle strain or breast changes related to their periods.

Nearly 28 percent believed the symptoms would just go away.

In contrast, fewer than 20 percent of patients said they were unable to take time off from work or had transportation or child-care issues that impeded their treatment.

Bourdeanu noted that their findings regarding health-care and physician barriers could lead to future studies that aim “to decrease the time lapsed between the presentation of signs and symptoms of breast disease, and diagnosis and treatment of breast cancer,” Bourdeanu said.

She added that more studies are needed to better name the factors that put women at risk for running into health-care barriers. Those findings then could lead to improved measures that reduce poor outcomes for breast cancer patients.