Analysis of Delays in Breast Cancer Treatment and Late-Stage Diagnosis in Kazakhstan

Document Type: Research Articles

Authors

1 Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, VCU Massey Cancer Center, USA.

2 Kazakh National Research Institute of Oncology and Radiology, Kazakhstan.

3 Department of Medicine in the Geffen, School of Medicine, University of California Los Angeles, USA.

4 Office of Biostatistics, Center for Drug Evaluation and Research, FDA, USA.

5 Department of Medicine in the Geffen School of Medicine, Department of Health Policy and Management in the Fielding School of Public Health, University of California Los Angeles, USA.

Abstract

Objective: Although Kazakhstan has made significant investments to improve health and life expectancy of its
population, high cancer rates persist, with breast cancer being the most prevalent type. Factors contributing to delays
in treatment and late staging for breast cancer patients were assessed. Methods: A retrospective follow-up study
with registry data identified 4,248 breast cancer patients in sixteen regions of Kazakhstan in 2014. We used logistic
regressions to estimate (i) associations of treatment delays with patient demographics and cancer center regions; and
(ii) associations of late-stage (III and IV) cancer diagnosis with patient demographics and cancer center regions, with
and without controlling for treatment delays. Results: Breast cancer patients treated in regions located further away
from Almaty City had higher risks of treatment delays. However, the risks of late-stage cancer diagnosis were greater
for patients treated in Almaty City and those with treatment delays. Conclusion: The main driver of delayed treatment
is cancer center region. Residents of Almaty City, a major urban area of Kazakhstan, may have a better access to a
tertiary cancer center, resulting in less treatment delays. Referrals of sicker patients from neighboring regions to Almaty
City for cancer treatment is likely to increase risks of late-stage diagnosis. New or upgraded cancer centers may reduce
treatment delays, but their case-mix is likely to increase.

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