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Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia

机译：马来西亚公立医院补充和替代药物（CAM）的使用以及乳腺癌患者出诊和诊断的延迟

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Complementary and alternative medicine (CAM) is widely used among the breast cancer patients in Malaysia. Delays in presentation, diagnosis and treatment have been shown to impact the disease prognosis. There is considerable use of CAM amongst breast cancer patients. CAM use has been cited as a cause of delay in diagnosis and treatments in qualitative studies, however there had not been any confirmatory study that confirms its impact on delays. The purpose of this study was to evaluate whether the use of CAM among newly diagnosed breast cancer patients was associated with delays in presentation, diagnosis or treatment of breast cancer. This multi-centre cross-sectional study evaluating the time points of the individual breast cancer patients’ journey from first visit, resolution of diagnosis and treatments was conducted in six public hospitals in Malaysia. All newly diagnosed breast cancer patients from 1st January to 31st December 2012 were recruited. Data were collected through medical records review and patient interview by using a structured questionnaire. Complementary and alternative medicine (CAM) was defined as the use of any methods and products not included in conventional allopathic medicine before commencement of treatments. Presentation delay was defined as time taken from symptom discovery to first presentation of more than 3 months. The time points were categorised to diagnosis delay was defined as time taken from first presentation to diagnosis of more than 1 month and treatment delay was defined as time taken from diagnosis to initial treatment of more than 1 month. Multiple logistic regression was used for analysis. A total number of 340 patients participated in this study. The prevalence of CAM use was 46.5% (n = 158). Malay ethnicity (OR 3.32; 95% CI: 1.85, 5.97) and not interpreting symptom as cancerous (OR 1.79; 95% CI: 1.10, 2.92) were significantly associated with CAM use. The use of CAM was associated with delays in presentation (OR 1.65; 95% CI: 1.05, 2.59), diagnosis (OR 2.42; 95% CI: 1.56, 3.77) and treatment of breast cancer (OR 1.74; 95% CI: 1.11, 2.72) on univariate analyses. However, after adjusting with other covariates, CAM use was associated with delays in presentation (OR 1.71; 95% CI: 1.05, 2.78) and diagnosis (OR 2.58; 95% CI: 1.59, 4.17) but not for treatment of breast cancer (OR 1.58; 95% CI: 0.98, 2.55). The prevalence of CAM use among the breast cancer patients was high. Women of Malay ethnicity and not interpreting symptom as cancerous were significantly associated with CAM use. The use of CAM is significantly associated with delay in presentation and resolution of diagnosis. This study suggests further evaluation of access to breast cancer care is needed as poor access may cause the use of CAM. However, since public hospitals in Malaysia are heavily subsidized and readily available to the population, CAM use may impact delays in presentation and diagnosis.
机译：补充和替代医学（CAM）在马来西亚的乳腺癌患者中广泛使用。表现，诊断和治疗的延迟已经显示出会影响疾病的预后。 CAM在乳腺癌患者中有大量使用。在定性研究中，CAM的使用被认为是诊断和治疗延迟的原因，然而，尚无任何证实性研究证实其对延迟的影响。这项研究的目的是评估在新诊断的乳腺癌患者中使用CAM是否与乳腺癌的表现，诊断或治疗延迟有关。在马来西亚的六家公立医院中进行了这项多中心的横断面研究，评估了乳腺癌患者个体初次就诊，诊断和治疗解决方案的时间点。招募了2012年1月1日至12月31日期间所有新诊断的乳腺癌患者。通过使用结构化调查表的病历审查和患者访谈收集数据。补充和替代药物（CAM）的定义是在治疗开始之前使用常规同种疗法药物中未包括的任何方法和产品。出现延迟定义为从症状发现到首次出现超过3个月的时间。将时间点分类为诊断延迟，将其定义为从首次出现到诊断超过1个月的时间，将治疗延迟定义为从诊断到开始治疗超过1个月的时间。使用多元逻辑回归进行分析。共有340名患者参加了这项研究。 CAM使用率为46.5％（n = 158）。马来族裔（OR 3.32; 95％CI：1.85，5.97）且未将症状解释为癌性（OR 1.79; 95％CI：1.10，2.92）与CAM使用显着相关。 CAM的使用与出现延迟（OR 1.65; 95％CI：1.05，2.59），诊断（OR 2.42; 95％CI：1.56，3.77）和乳腺癌的治疗（OR 1.74; 95％CI：1.11）有关。 ，2.72）进行单变量分析。但是，在用其他协变量进行调整后，CAM的使用与表现延迟（OR 1.71； 95％CI：1.05，2.78）和诊断（OR 2.58； 95％CI：1.59，4.17）相关，但与乳腺癌的治疗无关（或1.58； 95％CI：0.98，2.55）。在乳腺癌患者中使用CAM的患病率很高。马来族裔妇女且未将症状解释为癌性与使用CAM显着相关。 CAM的使用与表现和诊断的延迟显着相关。这项研究表明，需要进一步评估获得乳腺癌治疗的机会，因为缺乏机会可能导致使用CAM。但是，由于马来西亚的公立医院得到大量补贴，并且随时可供民众使用，因此使用CAM可能会影响就诊和诊断的延迟。

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