Please use this identifier to cite or link to this item: http://hdl.handle.net/10311/2184
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dc.contributor.authorIyer, Hari S.-
dc.contributor.authorKohler, Racquel E.-
dc.contributor.authorRamogola-Masire, Doreen-
dc.contributor.authorBrown, Carolyn-
dc.contributor.authorMolebatsi, Kesaobaka-
dc.contributor.authorGrover, Surbhi-
dc.contributor.authorKablay, Irene-
dc.contributor.authorBvochora-Nsingo, Memory-
dc.contributor.authorEfstathiou, Jason, A.-
dc.contributor.authorLockman, Shahin-
dc.contributor.authorTapela, Neo-
dc.contributor.authorDryden-Peterson, Scott L.-
dc.date.accessioned2021-10-08T13:19:49Z-
dc.date.available2021-10-08T13:19:49Z-
dc.date.issued2019-06-06-
dc.identifier.citationIyer 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.en_US
dc.identifier.issn1932-6203 (electronic)-
dc.identifier.urihttp://hdl.handle.net/10311/2184-
dc.description.abstractPurpose 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.en_US
dc.description.sponsorshipFunding: Hari Iyer was supported in part by the National Institutes of Health research training grant (NIH, T32 CA 009001). The Thabatse Cancer Cohort has been supported by the National Institutes of Health (P30AI060354, P30CA006516- 50S4, P20CA210283, C06CA059267, K23AI091434, P30AI045008) and Paul G. Allen Family Foundation (11689).en_US
dc.language.isoenen_US
dc.publisherPublic Library of Science, http://www.plosone.org/en_US
dc.rightsThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_US
dc.subjectCancer patientsen_US
dc.subjectOncology treatmenten_US
dc.subjectCancer symptomen_US
dc.subjectTreatment initiationen_US
dc.subjectMenen_US
dc.subjectWomenen_US
dc.subjectDisparitiesen_US
dc.subjectBotswanaen_US
dc.titleExplaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort studyen_US
dc.typePublished Articleen_US
dc.rights.holderIyer et al.en_US
dc.linkhttps://doi.org/10.1371/journal.pone.0218094en_US
Appears in Collections:Research articles (Dept of Obstetrics & Gynaecology)



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