Thegesha Naidoo^1,, Modise Zacharia Koto¹, Branny Mthelebofu¹, Matlou Mabitsela¹

Background: Breast cancer remains the main cause of cancer-related deaths in Africa, despite having a lower incidence rate compared to the western world. This poor survival rate can be attributed to numerous factors such as poverty and poor infrastructure, to name a few. South Africa, having such a diverse population, tends to face many difficulties in healthcare with regard to patient- and provider-related delays. Patient delays are complex and therefore difficult to quantify. Aims: To compare the provider delays experienced by newly diagnosed breast cancer patients treated in two public hospitals in South Africa. Settings and Design: A multicentre retrospective file review of newly diagnosed breast cancer cases at Doctor George Mukhari Academic Hospital (DGMAH) located in the Tshwane Metro Municipality and Robert Mangaliso Sobukwe Hospital (RMSH) located in the Sol Plaatje Local Municipality, Kimberley, from January 2016 to December 2017. Methods and Materials: Data extraction included the age of the patient, date of first consultation, date and number of biopsies taken, date of histological confirmation, types of imaging requested with dates of request/released reports, type of definitive management with dates of booking/commencement of treatment. A standardised data collection method was applied. Statistical analysis used: SAS (SAS Institute Inc, Carey, NC, USA), Release 9.4 or higher, running under Microsoft Windows for a personal computer. Results: A total of 69 patients were included in the study (64 from DGMAH, 5 from RMSH). The mean number of days of delay was greater in RMSH versus DGMAH with regard to the interval between first consultation and first biopsy (83;30); DGMAH versus RMSH with regard to the interval between first consultation and histological confirmation (122;113); DGMAH versus RMSH with regard to the interval between first consultation and delivery of mammogram reports (54;6); DGMAH versus RMSH with regard to the interval between first consultation and surgical intervention (374;191); DGMAH versus RMSH with regard to the interval between first consultation and commencement of neo-adjuvant chemotherapy (233;144); DGMAH versus RMSH with regards to the interval between request and date of released report of mammograms (52;1). Of the 64 patients from DGMAH, 7 required repeat biopsies (10.9%). Surgical procedures were performed on 42 of the 64 patients at DGMAH, ranging from modified radical mastectomies n=33 (78.6%), simple mastectomies n=6 (14.3%), and toilet mastectomies n=3 (7.1%). Of the 5 patients from RMSH, 5 were offered modified radical mastectomies n=5 (100%). Conclusions: The study shows that significant provider delays occur in the two public hospitals mentioned in the study and are exceedingly long when compared to international recommendations of a total time delay of 6 weeks. The study found that certain provider delays, namely biopsy taking/histological confirmation, imaging, definitive surgical intervention, and access to oncological services are significant areas of delay in both hospitals. The researcher recommends creating formal guidelines in both public hospitals with regard to the workup of patients so as to decrease the aforementioned provider delays and ultimately improve breast cancer care for patients at these institutions.