Patient Delay and Contributing Factors Among Breast Cancer Patients at Two Cancer Referral Centres in Ethiopia: A Cross-Sectional Study

Figures & data

Table 1 Socio-Demographic Characteristics of Breast Cancer Patients at Two Cancer Referral Centers in Northwest Ethiopia, 2020

Characteristics	Frequency (n=371)	Percentage
Age group
<40	83	22.4
≥40	288	77.6
Mean	48.1
Home residence
Rural	249	67.1
Urban	122	32.9
Marital status
Married	298	80.3
Single	73	19.7
Religion
Orthodox	172	46.4
Muslim	96	25.9
Protestant	97	26.1
Catholic	6	1.6
Educational status
Illiterate	136	36.7
Primary education	153	41.2
Secondary education and above	82	22.1
Occupational status
Housewife	215	58.0
Farmer	94	25.3
Government employee	52	14.0
Other	10	2.7
Distance to the health facility
<5 km	163	43.9
≥5 km	208	56.1

Table 2 Clinical Characteristics of Breast Cancer Patients at Two Cancer Referral Centers in Northwest Ethiopia, 2020

Characteristics	Frequency (n=371)	Percentage
Menopausal status
Pre-Menopausal	209	56.3
Menopausal	69	18.6
Post-Menopausal	93	25.1
HIV status
Negative	360	97.0
Positive	11	3.0
Family history of breast cancer
Yes	74	19.9
No	297	80.1
History of any breast problem before
Yes	138	37.2
No	233	62.8
Practicing breast self-examination
Yes	45	12.1
No	326	87.9
History of any comorbidities
Yes	142	38.3
No	229	61.7
Use of traditional treatment
Yes	256	69.0
No	115	31.0
Presenting chief compliant
Breast lump or mass	328	88.4
Swelling or lump in armpit	38	10.2
Painful wound	161	43.4
Other*	12	3.2
Method of detection of symptoms
Accidentally	248	66.8
During breast feeding	57	15.4
During breast self-examination	43	11.6
Other**	23	6.2
Patient reason for late presentation
Lack of awareness about early symptoms	345	92.9
Relating symptoms with other medical problems	132	35.6
Belief that breast cancer has not any medical treatment	88	23.7
Use of traditional and spiritual treatment options	286	77.1
Financial problems	217	58.5
Others***	35	9.4

Notes: * nipple retraction, nipple discharge, skin color change;** when produce discharge, and pain; *** fear of surgery (loss of breast), lack of trust of HCP.

Table 3 Tumor Characteristics of Breast Cancer Patients at Two Cancer Referral Centers in Northwest Ethiopia, 2020

Characteristics	Frequency	Percentage
Axillary lymph node status
Positive	320	86.3
Negative	51	13.7
Tumor metastases to other body parts
Yes	53	14.3
No	318	85.7
Type of tumor
Ductal	347	93.5
Lobular	18	4.9
Other*	6	1.6
Tumor size in cm
≤5 cm	162	43.7
>5 cm	209	56.3
Median±IQR	6.3±3.1 cm
Tumor grade (n=307)
Grade I	39	12.7
Grade II	128	41.7
Grade III	140	45.6
Patient had taken any treatment
Yes	364	98.1
No	7	1.9
Type of treatment the patient had taken
Surgery	357	96.2
Chemotherapy	163	43.9
Hormonal therapy	50	13.5
Other**	4	1.1

Notes: * mixed tumors and inflammatory carcinoma’s. ** radiotherapy and other systemic treatments for underlying disease.

Abbreviation: IQR, interquartile range.

Table 4 Association Between Socio-Demographic and Clinical Characteristics with Patient Delay at Two Cancer Referral Centers in Northwest Ethiopia, 2020

Characteristics	Frequency (n, %)	Patient Delay		χ^2	P-value
		≥3 Months	<3 Months
Age group
<40	83	40 (48.2%)	43 (51.8%)	9.0	0.015*
≥40	288	191 (66.3%)	97 (33.7%)
Home residence
Rural	249	217 (87.2%)	32 (12.8%)	53	<0.001*
Urban	122	64 (52.5%)	58 (47.5%)
Marital status
Married	298	234 (75.5%)	64 (21.5%)	6.3	0.007*
Single	73	47 (64.4%)	26 (35.6%)
Educational status
Illiterate	136	113 (83.1%)	23 (196.9%)	23.6	<0.001*
Primary education	153	107 (69.9%)	46 (30.1%)
Secondary education and above	82	61 (74.4%)	21 (25.6%)
Travel distance
<5 km	163	96 (58.9%)	67 (41.1%)	44.9	<0.001*
≥5 km	208	185 (88.9%)	23 (11.1%)
Family history of breast cancer
Yes	74	51 (68.9%)	23 (31.1%)	2.3	0.126
No	297	230 (77.4%)	67 (22.6%)
Painful breast ulcer or wound
Yes	161	104 (64.6%)	57 (35.4%)	19.2	<0.001*
No	210	177 (84.3%)	33 (15.7%)
History of any comorbidities
Yes	142	76 (53.5%)	66 (46.5%)	61.8	<0.001*
No	229	205 (89.5%)	24 (10.5%)
History of any breast problem before
Yes	138	91 (65.9%)	47 (34.1%)	11.5	0.0004*
No	233	190 (81.5%)	43 (18.5%)
Swelling/lump in armpit
Yes	38	17 (44.7%)	21 (55.3%)	22	<0.001*
No	333	264 (79.3%)	69 (20.7%)
Stage at diagnosis
Early stage (I&II)	107	70 (65.4%)	37 (34.6%)	8.7	0.0003*
Late stage (II&IV)	264	211 (79.9%)	53 (20.1%)

Notes: * statistical significant association, χ² =chi-square test.

Table 5 Multivariable Logistic Regression Analysis of Factors Associated with Patient Delay of Breast Cancer at Two Cancer Referral Centers in Northwest Ethiopia, 2020

Characteristics	Patient delay		Crude OR with 95% CI	Adjusted OR with 95% CI	P-value
	≥3 Months	<3 Months
Age group
<40	40 (48.2%)	43 (51.8%)	1	1	0.634
≥40	191 (66.3%)	97 (33.7%)	2.12 (1.29–3.47)	1.16 (0.638–2.09)
Home residence
Rural	217 (87.2%)	32 (12.8%)	6.1(3.67–10.27)	3.72 (1.82–7.61)	<0.001*
Urban	64 (52.5%)	58 (47.5%)	1	1
Marital status
Married	234 (75.5%)	64 (21.5%)	2.02 (1.16–3.52)	1.38 (0.66–2.91)	0.395
Single	47 (64.4%)	26 (35.6%)	1	1
Comorbidities
Yes	76 (53.5%)	66 (46.5%)	1	1	0.734
No	205 (89.5%)	24 (10.5%)	7.4 (4.33–12.68)	1.11 (0.59–2.07)
Educational status
Illiterate	113 (83.1%)	23 (196.9%)	1.69 (1.06–3.30)*	3.8 (1.71–8.64)	0.001*
Primary education	107 (69.9%)	46 (30.1%)	0.80 (0.44–1.47)	0.96 (0.93–4.14)	0.079
Secondary education and above	61 (74.4%)	21 (25.6%)	1	1
Painful breast ulcer or wound
Yes	104 (64.6%)	57 (35.4%)			<0.001*
No	177 (84.3%)	33 (15.7%)	2.94 (1.79–4.81)	3.32 (1.93–5.72)
Distance to the nearby health facility
<5 km	96 (58.9%)	67 (41.1%)	1		0.0093*
≥5 km	185 (88.9%)	23 (11.1%)	5.61 (3.29–9.58)	1.66 (1.09–3.00)
Swelling or lump in armpit
Yes	17 (44.7%)	21 (55.3%)	1		<0.001*
No	264 (79.3%)	69 (20.7%)	4.73 (2.37–9.44)	6.16 (2.80–13.54)
History of any breast problem before
Yes	91 (65.9%)	47 (34.1%)	1		0.001*
No	190 (81.5%)	43 (18.5%)	2.28 (1.41–3.70)	2.46 (1.43–.22)

Notes: *Istatistically significant association.

Abbreviation: OR, odds ratio.