Patient delay among cervical cancer cases in Eastern Kazakhstan in 2003-2012: an registry-based study

Tuesday, 19 August 2014
Exhibit hall (Dena'ina Center)
Gulnar Shalgumbayeva, MD , Semey State Medical University, Semey, Kazakhstan
Tolebay Rakhypbekov, PhD , Semey State Medical University, Semey, Kazakhstan
Zayituna Khismetova, MD , Semey State Medical University, Semey, Kazakhstan
Farida Rakhimzhanova, MD , Semey State Medical University, Semey, Kazakhstan
Yerkin Kuluspayev, MD , Semey State Medical University, Semey, Kazakhstan
Gulzira Shalgimbayeva, MD , Semey State Medical University, Semey, Kazakhstan
Gulmira Sagidullina, MD , Semey State Medical University, Semey, Kazakhstan
Yulia Semenova , Semey State Medical University, Semey, Kazakhstan
Andrej M Grjibovski, PhD , Northern State Medical University, Arkhangelsk, Russia
INTRODUCTION:  The mortality from cervical cancer (CC) in Kazakhstan is among the highest in the European WHO region. Late initiation of treatment is associated with poor survival. However, in spite of high proportion of cases diagnosed in advanced stage the evidence on patient delays in Kazakhstan is non-existent. The objective of this study was to assess patient delays across social- and ethnic groups in East Kazakhstan.

METHODS:  Patient delay was defined as time between the first symptoms and the first visit to a doctor. Data on first symptoms and date of first visit were abstracted for all 1,107 cases of CC registered in East Kazakhstan in 2003-2012. Data on education, nationality, stage and urban/rural residence were obtained from medical records. Data are presented as medians (Md) and quartiles (Q1, Q3). Differences in delays across studied strata were assessed using Mann-Whitney tests (2 groups) and Kruskal-Wallis tests (3 groups) in bivariate analysis and using quantile regression multivariable models.

RESULTS:  Of the 1107 cases, 236 (21.3%) were asymptomatic and diagnosed at screening. Median patient delay for the remaining 871 cases was 3 months (Q1=1.0, Q3=6.0). Of them, 45.2% were diagnosed at late stage (III and IV). Altogether, 95.8% of percent of cases had delays of >1 month. Kazakhs (Md=3.0, Q1=1.0, Q3=6.0), Russians (Md=3.0, Q1=1.5, Q3=6.0) and others (Md=2.0, Q1=1.0, Q3=5.0) had similar delays (p=0.131). Cases with higher (Md=3.0, Q1=1.0, Q3=5.7), secondary or less (Md=3.0, Q1=3.0, Q3=6.0) and unknown (Md=3.0, Q1=1.5, Q3=6.0) education had similar delays (p=0.835). No difference between urban and rural residents was observed (Md=3.0, Q1=1.0, Q3=6.0 for both, p=0.738). Similar conclusion was drawn using quintile regression.

CONCLUSIONS:  We observed high proportion of cases detected in advanced stage and long patient delays without inequalities suggesting that population-based interventions may reduce patient delays for the most Kazakhstani women. Further studies are needed to assess healthcare delays and their correlated.

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