Pathway of Healthcare for Breast Cancer among Women in an Eastern State of India: A Mixed Method Cross-Sectional Study

Objective: Breast cancer is the most common cancer among women, however the majority of them visit hospitals at the advanced stage. Knowledge of the pathway of care will aid in timely intervention and better prognosis. Methods and analysis: A mixed method cross-sectional study was conducted at AIIMS Patna among breast cancer patients. A total of 171 breast cancer patients were enrolled in this study. Piloted study tools were used. Descriptive analysis for quantitative part and manual thematic analysis for the qualitative part were performed. Results: Out of total 171 participants, the majority 88.9% (83.3-92.77%) had visited AIIMS Patna indirectly. About 60(20.6%) visited informal providers/quacks and 60(39.5%) of the study participants visited more than one hospital before arriving at AIIMS Patna. The place of residence, treatment delay, and stage of cancer were found to be the independent predictor for the pathway of healthcare for breast cancer. The reasons behind seeking delayed definitive care were identified under two major themes: presentation delay (Misunderstanding/difficulty in identifying symptoms, neglect of disease, lack of awareness about the disease, family support, financial constraints) and treatment delay (misdiagnosis, multiple referrals, dissatisfaction with the treatment, COVID-19 lockdown, informal providers/quacks). Conclusion: 9 out of 10 breast cancer patients had not come directly for definitive care and among them, 3 out of 5 had visited multiple healthcare providers. So, it is important to educate the public on breast cancer, make systematized referral pathways, to orient private sectors, and to have trained manpower for screening purposes.