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Background: Breast cancer (BC) poses a significant public health concern as it is the most common cancer detected among women worldwide. Early detection and intervention are associated with better prognosis and survival. A primary reason for the rising mortality and morbidity in developing countries is the lack of patient education and practice early detection programs and presentation. Aims and Objectives: The main objective of this study is to evaluate the prevalence of delayed presentation and the factors lead to delay among BC patients in Sri Lanka. Materials and Methods: A descriptive cross-sectional study was conducted from January 01, 2023, to June 30, 2023 among women diagnosed with BC attending two selected state hospitals in Sri Lanka. All women with histological diagnosis of early, locally advanced, or metastatic BC attending for treatment were included and women with recurrent BC and concomitant other cancers were excluded. Presentation delay was defined as ≥3 months. The calculated sample size was 396. Results: About 47.5% of our study population (n=188) had a presentation delay of more than 3 months. The main reasons for the delay in presentation were, being unaware that BC is a major problem in Sri Lanka, difficulty in accessing healthcare, and not being able to find time due to family and social commitments. Women who had not been practicing self-breast examination had a significant association with presentation delay (OR=3.26, 95% CI - 0.090–0.362, P=0.001). The participants who were having a presentation delay were also more likely to be diagnosed with an advanced stage of cancer (OR=2.86, 95% CI - 2.573–3.153, P=0.000). Conclusion: Our study population depicts a good knowledge related to BC symptoms, risk factors, and early detection methods. However, very few are practicing them. There is also a significant delay of presentation due to various factors. Awareness and good practices would lead to early detection and diagnosis and improve overall survival.

Background: Breast cancer (BC) poses a significant public health concern as it is the most common cancer detected among women worldwide. Early detection and intervention are associated with better prognosis and survival. A primary reason for the rising mortality and morbidity in developing countries is the lack of patient education and practice early detection programs and presentation. Aims and Objectives: The main objective of this study is to evaluate the prevalence of delayed presentation and the factors lead to delay among BC patients in Sri Lanka. Materials and Methods: A descriptive cross-sectional study was conducted from January 01, 2023, to June 30, 2023 among women diagnosed with BC attending two selected state hospitals in Sri Lanka. All women with histological diagnosis of early, locally advanced, or metastatic BC attending for treatment were included and women with recurrent BC and concomitant other cancers were excluded. Presentation delay was defined as ≥3 months. The calculated sample size was 396. Results: About 47.5% of our study population (n=188) had a presentation delay of more than 3 months. The main reasons for the delay in presentation were, being unaware that BC is a major problem in Sri Lanka, difficulty in accessing healthcare, and not being able to find time due to family and social commitments. Women who had not been practicing self-breast examination had a significant association with presentation delay (OR=3.26, 95% CI - 0.090-0.362, P=0.001). The participants who were having a presentation delay were also more likely to be diagnosed with an advanced stage of cancer (OR=2.86, 95% CI - 2.573-3.153, P=0.000). Conclusion: Our study population depicts a good knowledge related to BC symptoms, risk factors, and early detection methods. However, very few are practicing them. There is also a significant delay of presentation due to various factors. Awareness and good practices would lead to early detection and diagnosis and improve overall survival. [ABSTRACT FROM AUTHOR]

ObjectivePresentation delay of cancer patients prevents the patient from timely diagnosis and treatment leading to poor prognosis. Predicting the risk of presentation delay is crucial to improve the treatment outcomes. This study aimed to develop and validate prediction models of presentation delay risk in gastric cancer patients by using various machine learning models.Methods875 cases of gastric cancer patients admitted to a tertiary oncology hospital from July 2023 to June 2024 were used as derivation cohort, 200 cases of gastric cancer patients admitted to other 4 tertiary hospital were used as external validation cohort. After collecting the data, statistical analysis was performed to identify discriminative variables for the prediction of presentation delay and 13 statistically significant variables are selected to develop machine learning models. The derivation cohort was randomly assigned to the training and internal validation set by the ratio of 7:3. Prediction models were developed based on six machine learning algorithms, which are logistic regression (LR), support vector machine (SVM), random forest (RF), gradient boosted trees (GBDT), extremely gradient boosting (XGBoost) and muti-layer perceptron (MLP). The discrimination and calibration of each model were assessed based on various metrics including accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), F1-Score and area under curve (AUC), calibration curves and Brier scores. The best model was selected based on comparing of various metrics. Based on the selected best model, the impact of features to the prediction result was analyzed with the permutation feature importance method.ResultsThe incidence of presentation delay for gastric cancer patients was 39.3%. The developed models achieved performance metrics as AUC (0.893-0.925), accuracy (0.817-0.847), sensitivity (0.857-0.905), specificity (0.783-0.854), PPV (0.728-0.798), NPV (0.897-0.927), F1 score (0.791-0.826) and Brier score (0.107-0.138) in internal validation set, which indicated good discrimination and calibration for the prediction of presentation delay in gastric cancer patients. Among all models, RF based model was selected as the best one as it achieved good discrimination and calibration performance on both of internal and external validation set. Feature ranking results indicated that both of subjective and objective factors have significant impact on the occurrence of presentation delay in gastric cancer patients.ConclusionThis study demonstrated that the RF based model has favorable performance for the prediction of presentation delay in gastric cancer patients. It can help medical staffs to screen out high-risk gastric cancer patients for presentation delay, and to take appropriate and specific interventions to reduce the risk of presentation delay.

Abstract Background Cancer represents a significant global public health challenge, with escalating incidence rates straining healthcare systems. Malaysia, like many nations, has witnessed a rise in cancer cases, particularly among the younger population. This study aligns with Malaysia’s National Strategic Plan for Cancer Control Programme 2021–2025, emphasizing primary prevention and early detection to address cancer’s impact. Therefore, we aim to describe the timeliness of cancer care for symptom presentation, socio-demographic, patient, as well as organizational-related factors among patients in Malaysia diagnosed with breast, colorectal, nasopharyngeal, and cervical cancer. Methods This cross-sectional study enrolled adult cancer patients diagnosed with breast, cervical, colorectal, or nasopharyngeal cancer from 2015 to 2020 in seven public hospitals/oncology centres across Malaysia. Data were collected through patient-administered surveys and medical records. Presentation delay, defined as the duration between symptom onset and the patient's first visit to a healthcare professional exceeding 30 days, was the primary outcome. Statistical analysis included descriptive statistics and chi-square tests. Results The study included 476 cancer patients, with breast cancer (41.6%), colorectal cancer (26.9%), nasopharyngeal cancer (22.1%), and cervical cancer (9.5%). Over half (54.2%) experienced presentation delays with a median interval of 60 days. Higher proportions of presentation delay were observed among nasopharyngeal cancer patients, employed patients with lower socioeconomic statuses, and those without family history of cancer. Most patients self-discovered their first cancer symptoms (80%), while only one-third took immediate action for medical check-ups. Emotional and organizational factors, such as long waiting times during doctor's visits (47%), were potential barriers to seeking cancer care. Conclusion This study highlights the significant problem of presentation delay among cancer patients in Malaysia. The delay is influenced by various factors encompassing sociodemographic characteristics, health-seeking behaviours, and healthcare system-related issues. A comprehensive approach addressing both individual barriers and institutional obstacles is imperative to mitigate this presentation delay and improve cancer outcomes.

Background: Cancer represents a significant global public health challenge, with escalating incidence rates straining healthcare systems. Malaysia, like many nations, has witnessed a rise in cancer cases, particularly among the younger population. This study aligns with Malaysia's National Strategic Plan for Cancer Control Programme 2021–2025, emphasizing primary prevention and early detection to address cancer's impact. Therefore, we aim to describe the timeliness of cancer care for symptom presentation, socio-demographic, patient, as well as organizational-related factors among patients in Malaysia diagnosed with breast, colorectal, nasopharyngeal, and cervical cancer. Methods: This cross-sectional study enrolled adult cancer patients diagnosed with breast, cervical, colorectal, or nasopharyngeal cancer from 2015 to 2020 in seven public hospitals/oncology centres across Malaysia. Data were collected through patient-administered surveys and medical records. Presentation delay, defined as the duration between symptom onset and the patient's first visit to a healthcare professional exceeding 30 days, was the primary outcome. Statistical analysis included descriptive statistics and chi-square tests. Results: The study included 476 cancer patients, with breast cancer (41.6%), colorectal cancer (26.9%), nasopharyngeal cancer (22.1%), and cervical cancer (9.5%). Over half (54.2%) experienced presentation delays with a median interval of 60 days. Higher proportions of presentation delay were observed among nasopharyngeal cancer patients, employed patients with lower socioeconomic statuses, and those without family history of cancer. Most patients self-discovered their first cancer symptoms (80%), while only one-third took immediate action for medical check-ups. Emotional and organizational factors, such as long waiting times during doctor's visits (47%), were potential barriers to seeking cancer care. Conclusion: This study highlights the significant problem of presentation delay among cancer patients in Malaysia. The delay is influenced by various factors encompassing sociodemographic characteristics, health-seeking behaviours, and healthcare system-related issues. A comprehensive approach addressing both individual barriers and institutional obstacles is imperative to mitigate this presentation delay and improve cancer outcomes. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) continues to pose a notable public health issue not just within India but on a worldwide scale. Analyzing the causes of presentation, management, and treatment delays of tuberculosis can offer valuable understanding into local trends and aid in crafting specific approaches for the successful management of TB. This research involves a cross-sectional examination conducted among TB patients residing in the regions served by the District Tuberculosis Centre, Wardha, and the directly observed treatment short course center in Sawangi. Information will be collected using a standardized questionnaire endorsed by the World Health Organization.

Objective: Greater time that patients take to present symptoms to health care providers (HCPs) increases the likelihood of later stage cancer, which increases mortality and morbidity in symptomatic cancers. The common-sense model (CSM) is used to understand time to first consultation with a healthcare provider, but inconsistencies exisy between its current use and important empirical findings.Method: To resolve inconsistencies, we conducted a qualitative examination to determine how the CSM could be revised to better account for these findings. We conducted in-depth interviews of a consecutive sample of 38 recently diagnosed patients who described events from first noticing symptoms to first consultation. Framework analysis was used to develop a theoretical model of processes leading to presentation or non-presentation.Results: Patients reported median presentation times of 3-4 weeks. Early presentation was facilitated by pre-symptomatic perceptions of vulnerability to serious illnesses and beliefs that early intervention could mitigate illness. These patients rarely tried to identify symptoms. They responded inductively, seeking help because symptoms were unusual. Where patients did not describe pre-symptom perceptions of vulnerability, many deductively tried to identify symptoms but misattributed them to minor conditions. Pre-symptomatic perceptions of vulnerability could also prolong presentation. When vulnerability was characterized by intense fears of cancer and cancer treatment, patients tended to avoid thinking about symptoms which extended presentation time.Conclusion: Risk perception theories explain how participants' pre-symptomatic perceptions of vulnerability and potential treatment outcomes influence presentation time. Incorporating risk perception perspectives into the CSM can improve its ability explain responses to ambiguous symptoms. [ABSTRACT FROM AUTHOR]

Purpose: Colorectal cancer (CRC) ranked first among cancers reported in males and second among cancers reported in females in Jordan in 2010. There has been no specific CRC-control programme in Jordan. Additionally, there has been no published study from Jordan or its neighbours on patient delays in presentation, diagnosis or treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for CRC and to provide baseline data for future health promotion programmes for CRC in Jordan. Methods: This project was a cross-sectional study on CRC patients at Al Bashir Hospital, Ministry of Health, and at the Military Oncology Centre of the Jordanian Royal Medical Services. Results: The total number of participants was 189. The proportion of patients with presentation delay, diagnosis delay or treatment delay was 33.9, 68.1 and 32.6 %, respectively. The main reasons reported for delay in presentation were lack of knowledge that symptoms were suggestive of cancer (58.5 %), misdiagnosis by physicians or pharmacists (38.4 %) or the patient did not want to visit a doctor (3.1 %). Predictors of delay and mean time for presentation, diagnosis and treatment were identified. Conclusions: Our results revealed that CRC patients in Jordan experience delays in presentation, Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation diagnosis, and, to a lesser degree, in treatment. This could justify the advanced stages at diagnosis and poor outcomes for CRC patients. Our findings provide baseline information for future CRC-control programmes in Jordan. We recommend that CRC prevention programmes in Jordan focus on early detection of CRC and target both patients and physicians. [ABSTRACT FROM AUTHOR]

Background and Aims: Ataxia telangiectasia (A-T) is a rare progressive, multisystem genetic disease. Families of children with ultra-rare diseases often experience significant diagnostic delays. We reviewed the diagnostic process for A-T in order to identify causes of delay in an attempt to facilitate earlier identification of A-T in the future.Methods: A retrospective case note review of 79 children at the National Paediatric A-T clinic seen since May 2009. Data were collected on the nature and age of initial symptoms, the age at first presentation, measurement of alpha feto-protein (AFP) and age of genetic diagnostic confirmation.Results: At presentation, 71 children (90%) had ataxia. The median presentation delay (from first parental concern to presentation) was 8 months (range 0-118 months), and the median diagnostic delay (genetic confirmation of diagnosis) was 12 months (range 1-109 months).Conclusions: There are significant delays in presentation and diagnostic confirmation of A-T. A greater awareness of A-T and early measurement of AFP may help to improve this. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the leading cause of cancer mortality among women in Malaysia. Delayed diagnosis is preventable and has major effects on patients' prognosis and survival. The objectives of our study were to identify the magnitude of delayed diagnosis and its associated factors in women with breast cancer in Malaysia. Methods: This study had a cross-sectional design. Respondents had histologically confirmed breast cancer and were registered at five medical centres between 2005 and 2007. All breast cancer patients who attended hospital clinics at the East Coast were included. Patients at Kuala Lumpur hospitals were selected by systematic sampling. A standardised questionnaire was developed to interview respondents. We measured the time from the first recognition of symptoms to the first general practitioners' consultation and to the histological diagnosis of breast cancer. Diagnosis delay was defined when there was more than 6 months from the recognition of symptoms to the histological diagnosis. Multiple logistic regression was used for analysis. Results: In total, 328 respondents were included. The mean (standard deviation) age was 47.9 (9.4) years. Most respondents were of Malay ethnicity, were married housewives with a median family income of RM1500 a month. Most respondents had ductal carcinoma (89.3%) and the stage distribution was as follows: 5.2% stage I, 38.7% stage II, 44.8% stage III and 11.3% stage IV. The median time to consultation was 2 months and the median time to diagnosis was 5.5 months. The frequency of diagnosis delay of more than 3 months was 72.6% and delay of more than 6 months occurred in 45.5% of the cases. The factors associated with diagnosis delay included the use of alternative therapy (odds ratio (OR) 1.77; 95% confidence interval (CI): 1.06, 2.94), breast ulcer (OR 5.71; 95% CI: 1.59, 20.47), palpable axillary lymph nodes (OR 2.19; 95% CI: 1.23, 3.90), false-negative diagnostic test (OR 5.32; 95% CI: 2.32, 12.21), non-cancer interpretation (OR 1.68; 95% CI: 1.01, 2.78) and negative attitude toward treatment (OR 2.09; 95% CI: 1.15, 3.82). Conclusions: Delays in consultation and diagnosis are serious problems in Malaysia. Diagnosis delay was influenced by complex interactions between many factors. Breast awareness and education are required to promote early detection, diagnosis and treatment before the tumours enlarge and metastasis. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that manifests in affected individuals with a variety of clinical features and involves multiple organs. Despite recent advances over the past decades, higher morbidity and mortality have been reported by studies in patients with childhood-onset systemic lupus erythematosus (cSLE) compared to patients with adult-onset. The interplay of several factors can cause diagnostic delays resulting in worse disease activity, multiple organ damage, increased risk of hospitalization, and management with aggressive treatment. Significant factors include demographic, clinical, and socioeconomic characteristics of patients with cSLE. Moreover, despite recent advances in lupus treatment, prolonged disease duration in these young patients can result in debilitating psychosocial outcomes and can significantly impact their health-related and general quality of life (QOL). Important domains affected include patient self-esteem, education, employment, healthcare utilization, and mental health. In this review, we examined the barriers that lead to a delay in diagnosing lupus in the pediatric population and addressed cSLE morbimortality and its long-term impact on patient health-related and general QOL., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Hussain et al.)

Bronchoscopy is a common and safe procedure with low mortality rates and complications. The risk of pneumothorax (PTX) post bronchoscopy is estimated to be 0.1% but increases to 1-6% with the addition of transbronchial lung biopsy (TBB) to the procedure. Studies have shown that a short observation period is adequate after TBB, and the usual practice is to perform a portable chest radiograph (CXR) to rule out PTX. Delayed PTX is a rare complication post-TBB and very few cases have been reported in the literature. In this report, we discuss a patient with delayed PTX 48 hours post-TBB. A 71-year-old male with a history of malignancy of unknown primary with metastasis to the sacrum and vertebral column presented with lower limb weakness status post-palliative radiation to the spine. His sacral lesion biopsy was inconclusive. He was currently on oral steroids. He was noted to have a left upper lobe lung nodule on a CT scan of the chest. He underwent bronchoscopy with TBB to determine if it was a primary lung malignancy. He was stable post-procedure with an unremarkable CXR for PTX and was discharged with outpatient follow-up. Two days later, he presented to the emergency department with shortness of breath and hypoxemia. A CXR was performed, which showed a left-sided PTX. A chest tube was placed, and a follow-up CXR showed lung immediate re-expansion. The chest tube was removed after two days and the patient was discharged home after a total of four days of hospitalization. Iatrogenic PTX can be due to diagnostic and/or therapeutic interventions. PTX after procedures can be classified as acute (one to four hours post-procedure) or delayed (>4 hours post-procedure). It is recommended to have a CXR within an hour post-TBB. To our knowledge, very few cases of delayed PTX post-TBB have been reported, mostly among lung transplant patients and those with chronic infections such as tuberculosis. In prior reports, it has been speculated that a visceral pleural defect might occur during a biopsy, but is protected by blood clot formation in the proximal bronchus. A PTX then occurs after fibrinolysis of the blood clot. Low immunity and poor wound healing due to chronic inflammation or steroid use can play a role in causing a delayed PTX. Also, the use of pain drugs such as opioids is associated with iatrogenic PTX. Patients with underlying lung disease such as emphysema are more prone to developing a PTX. Another hypothesis is that a tissue flap is created after the biopsy, which obstructs the airflow during exhalation, thereby resulting in a PTX. On the other hand, it is known that lung malignancies, either primary or metastatic, can increase the risk of secondary PTX. In our case, the temporal relationship of the delayed PTX with bronchoscopy makes it more likely that it was related to the lung biopsy (in our case, poorly differentiated non-small cell carcinoma). The underlying malignancy with low immunity, chronic tissue inflammation, and current steroid use may have resulted in delayed lung healing at the biopsy site. This case report highlights the importance of considering delayed PTX among high-risk patients who undergo such procedures. Delayed PTX is a rare complication post-TBB and should be considered in patients who are stable post-procedure but present with dyspnea and/or hypoxemia even days after the procedure., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Alsaggaf et al.)

Breast cancer (BC) is a disease that has improved prospects for survival if detected and treated early. Delayed help-seeking behavior, with poor survival as a consequence, is an important public health issue in the Middle East. More than 75% of breast cancer patients in the United Arab Emirates (UAE) seek medical advice after experiencing a sign or symptom of the disease and many seek such advice late. Our aim was to explore factors influencing delayed presentation for treatment after self-discovery of symptoms consistent with breast cancer in Arab women in the United Arab Emirates (UAE), and to explore facilitators and barriers of women's health seeking behavior in the complex religiously dominated society of the UAE. A qualitative descriptive approach using semi-structured interviews was used. We interviewed nineteen BC survivors aged 35-70 who have experienced delayed presentation to treatment after symptomatic recognition of BC. The time interval between initial experience of symptoms consistent with BC, and taking action to seek medical help was between three months to three years. The key themes that emerged from the interviews were varying responses to symptom recognition, fear of societal stigmatization, and concerns regarding abandonment by spouse because of BC. Culture has a strong influence on the decisions of women in the UAE society. The lack of awareness about signs and symptoms of BC and routine screening has an important effect on symptom appraisal and subsequently decision making regarding options for treatment.