Factors involved in the delay of treatment initiation for cervical cancer patients A nationwide population-based study

doi:10.1097/MD.0000000000004568

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Title:	Factors involved in the delay of treatment initiation for cervical cancer patients A nationwide population-based study
Authors:	Shen, Szu-Ching Hung, Yao-Ching Kung, Pei-Tseng Yang, Wen-Hui Wang, Yueh-Hsin Tsai, Wen-Chen
Contributors:	China Med Univ, Dept Publ Hlth China Med Univ, Dept Hlth Serv Adm Buddhist Dalin Tzu Chi Hosp, Dept Med Affairs Chia Nan Univ Pharm & Sci, Dept Hlth Serv Adm China Med Univ Hosp, Dept Obstet & Gynecol China Med Univ, Sch Med, Grad Inst Clin Med Sci Asia Univ, Dept Healthcare Adm
Keywords:	cancer treatment cervical cancer delayed treatment survival universal health insurance
Date:	2016-08
Issue Date:	2018-01-18 11:38:12 (UTC+8)
Publisher:	Lippincott Williams & Wilkins
Abstract:	Cervical cancer ranks as the fourth leading cause of cancer death in women worldwide. In Taiwan, although the universal health insurance system has achieved 99.9% coverage and ensured easy access to medical care, some cervical cancer patients continue to delay initiation of definitive treatment after diagnosis. This study focused on cervical cancer patients who delayed treatment for at least 4 months, and examined the characteristics, related factors, and survival in these patients. Data on patients with a new confirmed diagnosis of cervical cancer by the International Federation of Gynecology and Obstetrics (FIGO) staging system between 2005 and 2010 were obtained from the National Health Insurance Research Database and the Taiwan Cancer Registry. Logistic regression analysis was performed to analyze the association of various factors with treatment delay. The Cox proportional hazards model was used to analyze the effects of various factors on mortality risk. The rate of treatment delay for cervical cancer decreased steadily from 6.46% in 2005 to 2.48% in 2010. Higher rates of treatment delay were observed among patients who were aged >= 75 years (9.91%), had severe comorbidity, had stage IV (9.50%), diagnosing hospital level at nonmedical center, or at public hospital ownership. Factors that correlated with treatment delay were age >= 75 years (odds ratio [ OR] = 2.42), higher comorbidity Charlson comorbidity index (CCI) 4-6, or >= 7 (OR= 1.60, 2.00), cancer stage IV (OR= 2.60), the diagnosing hospital being a regional, district hospital, or other (OR= 3.00, 4.01, 4.60), and at public hospital ownership. Those who delayed treatment had 2.31 times the mortality risk of those who underwent timely treatment (P<0.05). Delayed cervical cancer treatment in Taiwan was associated with age, comorbidity, cancer stage, diagnosing hospital level, and hospital ownership. Delaying treatment for >= 4 months substantially raised mortality risk in cervical cancer patients.
Relation:	Medicine, v.95 n.33, e4568
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles

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