Bio statistical analysis of time delay impact on breast and cervical cancers survival in Khartoum State, Sudan (2011-2016)
Adel Ali Ahmed, Ahmed Mohamed Hamad Alnory, Amanda Gamal Ahmed Elgoraish
كلية الاقتصاد والتنمية الريفية-جامعة الجزيرة · السودان
Sudan breast and cervical cancers hit women during their reproductive age causing enormous suffering and premature death that exceeding burden of their maternal health care diseases. Both cancers can be described as invasive, advanced in stage leading to poor survival. Delays in women seeking medical care exasperated the more complicated situation caused by the advanced stage at presentation and impact on prognosis and survival outcome. The aim of the study was to examine clinical and socio-demographic factors associated with stage at diagnosis and delays and their impact on patient prognosis and survival outcome. This retrospective cross-sectional hospital-based study subjects were 1736, patients diagnosed and treated with the disease. Clinical and socio-demographic data of these patients were extracted from their medical files and followed up during the study period. These patients’ data were also collected by telephone questionnaire survey interview to measure delays and collect other important vital status statistics. Chix2, Kaplan-Meier, log-rank, Cox proportional hazards and logistic regression models were used in the analysis to draw important indicators and conclusion. The mean age of breast cancer patients was 49.51 years and 56.91 years for the cervical cancer patients. In four phases multivariate backward elimination process of controlling confounding and interaction terms models confirmed strongly breast cancer patients’ worse prognosis and survival outcome were influenced by advanced stage at diagnosis, age and most likely treated with surgery and radiotherapy. For cervical cancer, survival analysis confirmed advanced stage at diagnosis and chemotherapy and radiotherapy were strongest effectors of prognosis and survival outcome. Breast and cervical cancers patients experienced long delays at 198 days and 190 days, respectively. These long delays were most likely related to patient delay and were closely associated with advanced stage at diagnosis leading to worse outcome. Stage at diagnosis and delay are important factors affecting cancer patient prognosis and survival. Both cancers current bleak situation can be reversed by early detection and prompt treatment. Patients diagnosed at an early stage would have the best chances of getting better curative treatment and improved quality of life.