System delays in breast cancer

Abstract

Background. Centralised multidisciplinary management of breast cancer occurs in KwaZulu-Natal, South Africa, and requires a diagnostic and staging pathway at the referring hospital. Delays in this pathway are unknown. This study, conducted at a referring hospital, R K Khan (RKK), quantifies and analyses these delays.

Methods. A retrospective folder review included all patients with breast cancer diagnosed at RKK from January 2008 to January 2009. Data extraction included demographic data, time to diagnosis and initial staging using a standardised data sheet. Specific care steps were identified, namely delays to initial imaging with mammography, pathology confirmation, staging work-up and eventual referral to a centralised breast clinic. 

Results. A total of 45 patients were included (43 females and 2 males). The average age was 56 years. The mean individual care step delays were 18.3 days to initial imaging, 21.2 days to pathological confirmation, 9.2 days to initial staging and 22.7 days to review at the centralised breast clinic. The delays were sequential, with a mean total delay of 70.1 days or 10 weeks with an interquartile range of 48 - 82 days. 

Conclusion. This study confirmed significant delays in the care pathway, which are almost double the international recommendations of 6 weeks. Steps to reduce delays at all phases have been instituted with specific care step targets leading to the establishment of a breast cancer registry with an audit capability. We suggest targeting an 8-week period for the work-up and staging of every patient with breast cancer. The establishment of a breast cancer registry and regular audits thereof are essential in maintaining care standards and achieving best practice.