An audit of provider delay in newly diagreferral hospital in Johannesburg,South Africa

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2019

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Ross, Douglas Graham

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Introduction Breast cancer is one of the most common cancers in women worldwide and accounts for an increasing burden of disease. One of the factors identified in improving outcome newly diagnosed breast cancer is decreased time from recognition of a symptom to initiation of primary therapy. This study aims to quantify provider delay and identify potential reasons for the delay. Methods: 251 patients diagnosed with breast cancer from 1 January 2014 to 31 December 2014 were included. Patient records were examined and date intervals for each patient was recorded, from presentation to primary therapy. The results were compared to a standard of 90% of patients reaching primary therapy within 60 days. Results: Median delay (interquartile range) to primary therapy was 49 days (d) (33-80d). The primary chemotherapy group had a median delay of 48d (30-71d), the primary endocrine therapy group had a 28d (22-41d) delay, and the primary surgery group had a delay of 75d (39.8-113.5d). The addition of sentinel lymph node biopsy to the treatment plan added 37d to the chemotherapy group and 38d to the surgery group. 99 patients (39.4%) had a delay greater than 60 days. Conclusions: The centre did not achieve the standard of 90% of patients reaching primary therapy within 60 days. Sentinel lymph node biopsy added a significant delay to patients reaching primary therapy, and the recommendation is that that these procedures be done at the time of primary surgery. Factors affecting delay to primary surgery include logistical issues within the unit as well as the health system.

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A research report submitted to the Faculty of Health Sciences. University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine (Surgery) Johannesburg, May 2019

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