Delay in Diagnosis and Treatment of Breast Cancer Among Omani Women

Background: Cancer is the leading cause of death in developed and developing countries. Early detection of cancer is associated with decreased mortality, improved prognosis and reduces the need for extensive and aggressive treatments. However, evidence shows that there is a delay in cancer diagnosis in both developed and developing countries. The national cancer statistics in Oman show that breast cancer is the most common types of cancer diagnosed in the country. Significant number of breast cancer women in Oman tends to present at an advanced stage, at younger age with low survival rates. There has been no previous research conducted in Oman to investigate the causes of delay in the diagnosis and treatment of breast cancer. Aim of the Research: To identify causes of delay in the diagnosis and treatment of breast cancer in the Omani women. The objectives of the research are to: 1.Quantify the time interval from the onset of the first possible breast cancer symptoms to the first consultation with a medical doctor at government or private hospital/clinic in Oman or abroad. 2.Identify causes of patient delay from symptom recognition of possible cancer symptoms to the first consultation with a medical doctor in Oman or abroad. 3.Investigate ?help-seeking decisions? from detecting a bodily change of first cancer symptoms and deciding the first consultation with a medical doctor in Oman or abroad. 4.Quantify the time interval from the first consultation with a medical doctor at a government or private hospital/clinic in Oman or abroad to a confirmation of a histopathological diagnosis of breast cancer and the commencement of cancer treatment (surgery, chemotherapy and radiotherapy). 5.Identify causes of doctor and system delay from the first consultation with a medical doctor in Oman to the initiation of investigations, confirming of histopathological diagnosis and the commencement of cancer treatment (surgical, chemotherapy, radiotherapy). Methods: The International Cancer Benchmarking Partnership (ICBP) has developed modules that measure the total time intervals from the first possible symptoms of cancer up to the start of cancer treatment. The modules were modified to be relevant to the healthcare system in Oman. Two different studies will be conducted. The first will address objectives one, two and three and the second will address objectives four and five. There are two phases in the first study. The first phase is a prospective cross-sectional study involving all new Omani women diagnosed with breast cancer during one year time period at the time of data collection. Patients will be identified and recruited from the Oncology Unite of the Sultan Qaboos University Hospital (SQUH)and the National Oncology Centre (NOC) of the Royal Hospital. Data will be collected through face-to-face interview with patients at their home or in the hospitals using special forms developed by the ICBP. The data should quantify the time taken from the onset of the first possible symptoms of breast cancer to the first consultation with a medical doctor, including assessing the factors associated with this delay. In the second phase of the first study, a group of patients (approximately 25 women with breast cancer) will be selected and recruited for semi-structured individual interviews. The interviews will explore the beliefs, psychosocial and cultural factors which could influence the patient?s ?medical help-seeking decisions? in relation to early cancer signs and symptoms. The second study is a retrospective review of medical records (written or electronic) and other relevant documents for all patients who have been identified in the first study. Another form has been developed by ICBP which will be used to measure the time interval from the first consultation with a medical doctor in Oman to the start of breast cancer treatment. The measured time will be compared with the standard international time. In addition, doctors and healthcare system factors which delay investigations and referral to oncologists, including during the start of oncology treatment, will also be investigated. Importance of the study: It is strongly anticipated that the findings from this research will identify reasons for the delay of breast cancer diagnosis at the different stages mentioned above. This will provide information which can be used for strategic planning at a national level to improve practice and policy. It is hoped that this will lead to recommendations being made which will enhance the early diagnosis of breast cancer, in turn improving patients? prognosis, survival rates and lead to a decrease in the overall cost of cancer care and treatment. The findings from this research could also indicate the direction in which more focused and relevant research is needed in the future.