Closing the global cancer divide- performance of breast cancer care services in a middle income developing country

BMC Cancer

Gerard CC Lim²  Emran N Aina²  Soon K Cheah²  Fuad Ismail²  Gwo F Ho⁸  Lye M Tho⁸  Cheng H Yip⁸  Nur A Taib⁸  Kwang J Chong⁴  Jayendran Dharmaratnam⁴  Matin M Abdullah¹  Ahmad K Mohamed¹  Kean F Ho⁷  Kananathan Ratnavelu⁹  Chiao M Lim⁹  Kin W Leong⁵  Ibrahim A Wahid⁶  Teck O Lim³ 

[1] Sime Darby Medical Centre, Petaling Jaya, Malaysia

[2] Kuala Lumpur Hospital, Kuala Lumpur, Malaysia

[3] ClinResearch SB, Kuala Lumpur, Malaysia

[4] Mahkota Cancer Centre, Melaka, Malaysia

[5] Gleneagles Medical Centre Pinang, Pinang, Malaysia

[6] Beacon International Specialist Centre, Petaling Jaya, Malaysia

[7] Mount Miriam Cancer Hospital, Pulau Pinang, Malaysia

[8] Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia

[9] Nilai Medical Centre, Nilai, Malaysia

关键词: Health system research;    Health services research;    Health policy;    Healthcare quality;    Performance measurement;    Developing country;    Cancer burden;    Breast cancer;   

Others  :  858944
DOI  :  10.1186/1471-2407-14-212

 received in 2013-07-10, accepted in 2014-03-06,  发布年份 2014

【 摘 要 】

Background

Cancer is the leading cause of deaths in the world. A widening disparity in cancer burden has emerged between high income and low-middle income countries. Closing this cancer divide is an ethical imperative but there is a dearth of data on cancer services from developing countries.

Methods

This was a multi-center, retrospective observational cohort study which enrolled women with breast cancer (BC) attending 8 participating cancer centers in Malaysia in 2011. All patients were followed up for 12 months from diagnosis to determine their access to therapies. We assess care performance using measures developed by Quality Oncology Practice Initiative, American Society of Clinical Oncology/National Comprehensive Cancer Network, American College of Surgeons’ National Accreditation Program for Breast Centers as well as our local guideline.

Results

Seven hundred and fifty seven patients were included in the study; they represent about 20% of incident BC in Malaysia. Performance results were mixed. Late presentation was 40%. Access to diagnostic and breast surgery services were timely; the interval from presentation to tissue diagnosis was short (median = 9 days), and all who needed surgery could receive it with only a short wait (median = 11 days). Performance of radiation, chemo and hormonal therapy services showed that about 75 to 80% of patients could access these treatments timely, and those who could not were because they sought alternative treatment or they refused treatment. Access to Trastuzumab was limited to only 19% of eligible patients.

Conclusions

These performance results are probably acceptable for a middle income country though far below the 95% or higher adherence rates routinely reported by centres in developed countries. High cost trastuzumab was inaccessible to this population without public funding support.

【 授权许可】

   
2014 Lim et al.; licensee BioMed Central Ltd.

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