Barriers to Treatment in Patients with Locally Advanced and Inflammatory Breast Cancer.

Background: Breast cancer in the United States will affect approximately one in eight women. Despite a decrease in breast cancer mortality due to increased awareness and more effective screening, many patients still present for treatment after extended delays in diagnosis, resulting in large tumor size, locally advanced disease, inflammatory features, and greater likelihood of regional and distant metastasis. The purpose of this study was to identify reasons why patients may encounter delays in obtaining a diagnosis, seeking medical care, and initiating treatment once symptoms appear. Methods: From 12/2006 through 5/2009, a questionnaire was administered to thirty-four consecutive patients who presented to our institution with histologically-verified stage III breast cancer who had experienced a 3-month or greater delay in diagnosis and initiation of treatment from time of onset of symptoms. The 39-item Likert-scale questionnaire was developed to explore perceived barriers. Responses were rated on a scale of "Strongly Agree" through "Strongly Disagree," relative to the barriers presented. Results: The median age of patients who completed the questionnaire was 52 years (range, 30 to 78 years). Of these, there were 29.4% White/Non-Hispanic, 52.9% White/Hispanic, 11.8% Black and 5.9% Asians. For 73.5% of patients, the diagnosis of breast cancer was made at an outside institution. Most of the participants were diagnosed with locally advanced infiltrating ductal carcinoma (82.4%) and 8.8% were diagnosed with inflammatory breast cancer. Barriers to treatment were divided into the following categories: Patient barriers: The most commonly reported barrier among respondants was "waiting for the scheduled visit to get results." (47.1% with a response of Agree or Strongly Agree) However, 35.2% of patients did not seek treatment because they were concerned about losing their breast. More than a third of patients delayed care because of perception that their breast symptoms were due to infection, muscle strain, or related to their menstrual cycle (35.3%). For 27.6% of respondants, no care was sought because of perception that their breast symptoms would resolve with time. Other barriers, such as access to transportation,, inconvenient physician office hours, child care problems and inability to take time off from work, continued to be present but were not as frequently reported (less than 20%). Physician barriers: Approximately one fourth of women reported that their physician of initial contact, did not believe that their breast lump/symptom was related to cancer (23.5%). System barriers: Among systems barriers, "delay in scheduling diagnostic tests" remained the most prevalent barrier to breast cancer treatment (38.2%). Conclusion: We observed substantial delays between symptom presentation and diagnosis in patients who came to seek therapy at a tertiary comprehensive cancer center (City Of Hope National Medical Center) in Southern California. Patients and physicians need to be educated on the importance of timely diagnostic tests and follow-up visits. In addition, studies are needed to better identify predictive factors for women at risk for encountering barriers to healthcare so that for these subpopulations, interventions can be implemented to reduce breast cancer morbidity and mortality. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3084.