Factors involved in the delay of treatment initiation for cervical cancer patients
Open Access
- 1 August 2016
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Medicine
- Vol. 95 (33), e4568
- https://doi.org/10.1097/md.0000000000004568
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.Keywords
This publication has 20 references indexed in Scilit:
- Characteristics of the Delayed or Refusal Therapy in Breast Cancer Patients: A Longitudinal Population-Based Study in TaiwanPLOS ONE, 2015
- Factors Associated with Lung Cancer Patients Refusing Treatment and Their Survival: A National Cohort Study under a Universal Health Insurance in TaiwanPLOS ONE, 2014
- Health examination utilization in the visually disabled population in Taiwan: a nationwide population-based studyBMC Health Services Research, 2013
- Who Does Not Receive Treatment for Cancer?Journal of Oncology Practice, 2013
- Beliefs and Perceptions of Women with Newly Diagnosed Breast Cancer Who Refused Conventional Treatment in Favor of Alternative TherapiesThe Oncologist, 2012
- Refuseniks. Why some cancer patients reject their doctor's advice.2011
- Cervical neoplasia in pregnancy. Part 2: current treatment of invasive diseaseAmerican Journal of Obstetrics and Gynecology, 2008
- Management and clinical outcomes of pregnant patients with invasive cervical cancerAnnals of Oncology, 2003
- Cancer patients who refuse treatmentCancer Causes & Control, 1993
- Adapting a clinical comorbidity index for use with ICD-9-CM administrative databasesJournal of Clinical Epidemiology, 1992