Access to care issues adversely affect breast cancer patients in Mexico: oncologists’ perspective

BMC Cancer

Paul E Goss¹  Dianne M Finkelstein²  Alejandro Mohar³  Cynthia Villarreal-Garza⁶  Heather Symecko²  Pedro ER Liedke⁴  Jessica St Louis⁴  Yanin Chavarri-Guerra⁵ 

[1]Massachusetts General Hospital Cancer Center, 55 Fruit Street, Lawrence House, LRH-302, Boston, Massachusetts 02114, USA

[2]Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA

[3]National Cancer Institute, Mexico City, Mexico

[4]MGH-Avon International Breast Cancer Program, Massachusetts General Hospital, Boston, MA, USA

[5]Hemato-Oncology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico

[6]Medical Oncology and Breast Cancer Departments, National Cancer Institute, Mexico City, Mexico

关键词: Survey;    Patterns of care;    Access to care;    Mexico;    Socioeconomic disparities;    Breast cancer;   

Others  :  1121096
DOI  :  10.1186/1471-2407-14-658

 received in 2013-09-11, accepted in 2014-08-22,  发布年份 2014

【 摘 要 】

Background

Despite recently implemented access to care programs, Mexican breast cancer (BC) mortality rates remain substantially above those in the US. We conducted a survey among Mexican Oncologists to determine whether practice patterns may be responsible for these differences.

Methods

A web-based survey was sent to 851 oncologists across Mexico using the Vanderbilt University REDCap database. Analyses of outcomes are reported using exact and binomial confidence bounds and tests.

Results

138 participants (18.6% of those surveyed) from the National capital and 26 Mexican states, responded. Respondents reported that 58% of newly diagnosed BC patients present with stage III-IV disease; 63% undergo mastectomy, 52% axillary lymph node dissection (ALND) and 48% sentinel lymph node biopsy (SLNB). Chemotherapy is recommended for tumors > 1 cm (89%), positive nodes (86.5%), triple-negative (TN) (80%) and HER2 positive tumors (58%). Trastuzumab is prescribed in 54.3% and 77.5% for HER2 < 1 cm and > 1 cm tumors, respectively. Tamoxifen is indicated for premenopausal hormone receptor (HR) positive tumors in 86.5% of cases and aromatase inhibitors (AI’s) for postmenopausal in 86%. 24% of physicians reported treatment limitations, due to delayed or incomplete pathology reports and delayed or limited access to medications.

Conclusions

Even though access to care programs have been recently applied nationwide, women commonly present with advanced BC, leading to increased rates of mastectomy and ALND. Mexican physicians are dissatisfied with access to appropriate medical care. Our survey detects specific barriers that may impact BC outcomes in Mexico and warrant further investigation.

【 授权许可】

   
2014 Chavarri-Guerra et al.; licensee BioMed Central Ltd.

【 图 表 】

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