Women with suspicious breast symptoms often delay seeking critical treatment because of difficulties obtaining insurance authorizations and scheduling tests, fears they might lose their breast and other factors, according to City of Hope researchers.
Laura Bourdeanu, R.N., M.S.N., nurse practitioner in the Department of Medical Oncology & Therapeutics Research and the study’s lead author, presented the findings in December 2009, at the 32nd annual San Antonio Breast Cancer Symposium.
|George Somlo and Laura Bourdeanu explored why women experienced delays in treatment for breast concerns. (Photo by p.cunningham)|
Bourdeanu and City of Hope colleagues noted that their patients often present for treatment after waiting more than three months from the time they first detect symptoms. That could make a significant difference in their health.
“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?” asked Somlo. “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 III breast cancer responded to questionnaires that explored why their care was postponed. Some patients cited health-system barriers: About 38 percent reported delays in scheduling tests, and nearly 27 percent cited delays due to obtaining insurance authorization for tests, treatments and doctor visits.
Patients also identified physician barriers: Nearly 24 percent said their primary care physician did not believe that the breast lumps or symptoms were related to cancer, and almost 18 percent said their physicians thought biopsies were unnecessary.
Patients sometimes delayed treatment themselves. About 47 percent 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 proportion of patients thought the symptoms were due to an infection, muscle strain or menstruation-related breast changes. Nearly 28 percent believed the symptoms would just go away.
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.
“The system and physician barriers contributing to the delays we identified could serve as the basis for future intervention studies to decrease the time lapsed between the presentation of signs and symptoms of breast disease, and diagnosis and treatment of breast cancer,” said Bourdeanu.
“Further studies are needed to better identify factors that may help us predict women at risk for encountering barriers to health care so that interventions can be implemented to reduce breast cancer morbidity and mortality,” she added.
Other City of Hope researchers contributing to the study included Thehang Luu, M.D., Cathie Chung, M.D., Ph.D., Joanne Mortimer, M.D., Arti Hurria, M.D., Norma Baker, R.N., Suzanne Swain-Cabriales, R.N., Sandra Helton, R.N., and David Smith, Ph.D.