Delays and factors influencing delays in breast cancer care pathway and its impact on survival in Nepal and Low- and Middle-Income Countries

Abstract

The thesis aims to explore the waiting time intervals and the factors influencing the time in breast cancer (bc) care pathways in LMICs including Nepal. It also assessed the impact of longer time intervals on patients’ survival in Kathmandu Valley, Nepal. The thesis consists of 4 chapters. The introductory chapter is the broader overview of burden of bc and waiting time intervals to diagnosis and treatment, factors influencing the longer time intervals in bc care pathways. Chapter 2 is a systematic review of the articles published between 2010-2023 on facilitators and barriers for shorter diagnosis and treatment in LMICs. In most of the LMICs, the median waiting time for diagnosis and treatment was longer than the recommended waiting time for optimal survival. Low socioeconomic status, place of residence, and use of traditional medicine were found to be the common barriers for timely diagnosis and treatment while the initial presentation with a specialist was the common facilitator. Chapter 3 is a local study conducted in Kathmandu Valley, Nepal among 385 bc cases diagnosed between 2018 and 2019 to assess the waiting time from diagnosis to treatment. Lower education was an independent factor for longer time to treatment. Three-year survival for bc in the Kathmandu Valley was 88.6%. Advanced-stage at diagnosis was associated with poor survival, and there was a potential association between longer time to treatment and poorer survival among advanced-stage cases. However, the data quality and sample size limited the analysis. Results of the thesis address the current gap in evidence on bc in LMICs and in Nepal and may help inform policies and programmes aiming to strengthen the bc care pathway in LMICs. This could be relevant to similar settings.The thesis highlights the importance of early detection and timely treatment of bc in LMICs. The thesis recommends the need for more complete and quality data on cancer stage recorded in the cancer registry in Nepal.