Please use this identifier to cite or link to this item: http://hdl.handle.net/10311/2184
Title: Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study
Authors: Iyer, Hari S.
Kohler, Racquel E.
Ramogola-Masire, Doreen
Brown, Carolyn
Molebatsi, Kesaobaka
Grover, Surbhi
Kablay, Irene
Bvochora-Nsingo, Memory
Efstathiou, Jason, A.
Lockman, Shahin
Tapela, Neo
Dryden-Peterson, Scott L.
Keywords: Cancer patients
Oncology treatment
Cancer symptom
Treatment initiation
Men
Women
Disparities
Botswana
Issue Date: 6-Jun-2019
Publisher: Public Library of Science, http://www.plosone.org/
Citation: Iyer H.S et al. (2019) Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: a cohort study. PLoS ONE, Vol. 14, No. 6, 14p.
Abstract: Purpose Men in Botswana present with more advanced cancer than women, leading to poorer outcomes. We sought to explain sex-specific differences in time to and stage at treatment initiation. Methods Cancer patients who initiated oncology treatment between October 2010 and June 2017 were recruited at four oncology centers in Botswana. Primary outcomes were time from first visit with cancer symptom to treatment initiation, and advanced cancer (stage III/IV). Sociodemographic and clinical covariates were obtained retrospectively through interviews and medical record review. We used accelerated failure time and logistic models to estimate standardized sex differences in treatment initiation time and risk differences for presentation with advanced stage. Results were stratified by cancer type (breast, cervix, non-Hodgkin’s lymphoma, anogenital, head and neck, esophageal, other). Results 1886 participants (70% female) were included. After covariate adjustment, men experienced longer excess time from first presentation to treatment initiation (8.4 months) than women (7.0 months) for all cancers combined (1.4 months, 95% CI: 0.30, 2.5). In analysis stratified by cancer type, we only found evidence of a sex disparity (Men: 8.2; Women: 6.8 months) among patients with other, non-common cancers (1.4 months, 95% CI: 0.01, 2.8). Men experienced an increased risk of advanced stage (Men: 67%; Women: 60%; aRD: 6.7%, 95% CI: -1.7%, 15.1%) for all cancers combined, but this disparity was only statistically significant among patients with anogenital cancers (Men: 72%; Women: 50%; aRD: 22.0%, 95% CI: 0.5%, 43.5%). Conclusions Accounting for the types of cancers experienced by men and women strongly attenuated disparities in time to treatment initiation and stage. Higher incidence of rarer cancers among men could explain these disparities.
URI: http://hdl.handle.net/10311/2184
ISSN: 1932-6203 (electronic)
Appears in Collections:Research articles (Dept of Obstetrics & Gynaecology)



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