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Introduction Breast cancer remains a leading cause of cancer-related mortality globally. This study aims to examine the demographic variables and effects of different treatment modalities and treatment delays on overall and relative survival rates of breast cancer patients in Brunei Darussalam. Methods This retrospective study analysed data from the Brunei Darussalam Cancer Registry on breast cancer cases diagnosed and treated between 2013 and 2022. Statistical analyses included descriptive statistics to characterise the study population, Kaplan-Meier estimates to compare survival curves of different groups, Log rank tests to determine significant differences in survival rates among groups, and Cox Proportional Hazard (PH) models to estimate hazard ratios (HRs) and identify predictors of survival outcomes. Overall survival (OS) and relative survival (RS) rates were calculated. Results Out of the 431 women treated for breast cancer, the majority were diagnosed at the regional stage (45.7%), with 39.0% at the localised stage. Over half (55.4%) of the diagnoses occurred in women aged 40 to 59, while about a quarter (25.5%) were in the 60–69 age group. Surgery was the most common first-line treatment modality (55.9%), with a median time to treatment of 37 days, followed by chemotherapy (30.6%). More than half of the patients (62.9%) were treated within 60 days of diagnosis. Treatment varied by age and cancer stage, with younger patients more likely to undergo surgery and older patients more likely to receive chemotherapy or hormonal therapy. Survival rates were high for patients receiving only surgery (5-year RS: 98.7%, OS: 92.3%), and significant survival differences were found for cancer stage and treatment delay, with a HR of 2.5 for delays over 60 days. Multivariate analysis showed that patients with distant stage cancer had a significantly higher risk of death (HR = 15.3) compared to localised stage. Conclusion This study highlights the impact of treatment modalities and delays on breast cancer survival in Brunei Darussalam, emphasising the need for timely treatment to improve survival rates. Our findings suggest that ensuring breast cancer treatment initiation within two months post-diagnosis may enhance patient outcomes, supporting potential policy targets for timely access to care.

Objective This study investigated the prevalence of treatment delays among preschoolers with dental caries, identified the associated influencing factors, and predicted the risk of delayed treatment. The findings of this study provide an evidence base for future interventions designed to reduce treatment delays in this population. Methods A convenience sample of 264 preschool children with dental caries and their parents who visited the paediatric dental department between October 2023 and May 2024 was surveyed. Data were collected using a general information questionnaire, a medical status questionnaire, the Children’s Fear Survey Schedule-Dental Subscale, the Modified Version Dental Anxiety Scale, the Short-Form Health Literacy Dental Scale, and the Illness Perception Questionnaire Revised for Dental. Influencing factors were analysed using univariate analysis and binary logistic regression, whereas the risk of occurrence was predicted using the receiver operating characteristic (ROC) curve. Results The prevalence of delayed treatment among preschool children with dental caries was 71.21%, with an average delay of 117.5 days. Binary logistic regression analysis identified several independent factors significantly associated with delayed treatment ( P  < 0.05), including the primary caregiver, initial symptom recognition, children’s dental fear, parental dental anxiety, and parental oral health literacy. Predictive analyses indicated that children’s dental fear (AUC: 0.765, 95%CI: 0.707–0.823) and parental oral health literacy (AUC: 0.738, 95%CI: 0.673–0.802) demonstrated relatively high predictive values for delayed treatment. Conclusion Efforts to reduce delayed treatment should prioritise addressing children’s dental fear and improving parental oral health literacy. Targeted and effective strategies in these areas may facilitate early prevention, diagnosis, and intervention, thereby minimising treatment delays, reducing disease burden, and promoting oral health among preschoolers.

Purpose While previous research has highlighted treatment delay inequities in early-stage breast cancer and identified potential contributing factors, there is limited research on disparities in treatment delays for metastatic breast cancer (MBC). This study investigates these disparities in MBC treatment initiation, aiming to identify key factors crucial for improving timely access to care. Method Nationwide Flatiron Health electronic health records-derived deidentified database, including females aged 18+ diagnosed with either De novo or relapsed MBC in the U.S. between 2011 and 2022. Treatment delay, defined as > 60 days between diagnosis and first-line treatment, was assessed as a binary variable. T-tests and chi-squared tests analyzed patient characteristics (age, race, insurance, diagnosis stage, metastasis site, phenotypes, etc.) among delayed and non-delayed groups. Logistic regression evaluated the association between clinical and non-clinical factors and treatment delays. Results Among 20,617 patients with MBC, nearly 27% experienced treatment delays. These patients were generally younger, uninsured, historically marginalized, and newly diagnosed. Risk ratio analysis showed patients with only Medicare without secondary coverage (RR: 2.34, 95% CI [1.06, 5.16]) and uninsured (RR: 2.18, 95% CI [1.01, 4.76]) had higher risk of delays compared to those with commercial insurance. Historically marginalized patients had higher delay risk, ranging from 6% for Black patients to 12% for patients with not documented race/ethnicity background ( p  = 0.03) compared to White patients.\" Conclusion Our study highlights significant disparities in MBC treatment delays. Patients from historically marginalized groups and those without health insurance coverage or with only Medicare coverage are highly likely to experience delays. Addressing these disparities is essential for equitable healthcare and improved outcomes.

The purpose of this study was to determine socioeconomic and demographic factors which may contribute to inequities in time to treat thyroid cancer. We used data from the National Cancer Database, 2004-2019, to conduct an analysis of thyroid cancer patients. All (434,083) patients with thyroid cancer, including papillary (395,598), follicular (23,494), medullary (7,638), and anaplastic (7,353) types were included. We compared the wait time from diagnosis to first treatment, surgery, radiotherapy, and chemotherapy for patients based on age, race, sex, location, and socioeconomic status (SES). A total of 434,083 patients with thyroid cancer were included. Hispanic patients had significantly longer wait times to all treatments compared to non-Hispanic patients (first treatment 33.44 vs. 20.45 days, surgery 40.06 vs. 26.49 days, radiotherapy 114.68 vs. 96.42 days, chemotherapy 92.70 vs. 58.71 days). Uninsured patients, patients at academic facilities, and patients in metropolitan areas also had the longest wait times to treatment. This study identified multiple disparities related to SES and demographics that correspond to delays in time to treatment. It is crucial that this topic is investigated further to help mitigate these incongruities in thyroid cancer care in the future.

Background Malaria is a significant public health issue in sub-Saharan Africa, especially in Apac District, Uganda, where it greatly affects children under five. Despite its high rates of morbidity and mortality, there is limited understanding of how communities manage malaria and seek treatment. This study aimed to identify the factors that influence treatment-seeking behaviour among caretakers of young children in Apac District. Methods A cross-sectional analytical study was conducted using quantitative methods, with data collected from 240 households through simple random sampling. Caregivers completed structured questionnaires, and Cox proportional hazards regression analysis was performed in R to examine the socio-economic, demographic, and behavioural factors influencing the time taken by caretakers to seek malaria treatment for their children. Results All caregivers sought treatment for their children and out of the 240 caregivers, (70%) are female. The Cox proportional hazards model identified key factors affecting treatment-seeking time: secondary education significantly increased the likelihood of time for treatment seeking (HR = 1.67, p = 0.044). Significant delays were associated with no medicine at the hospital (HR = 0.61, p = 0.001) and financial constraints (HR = 0.49, p < 0.001). Conclusion To ensure timely malaria treatment for young children, it is crucial to improve drug supply at hospitals and through Village Health Teams, and to educate caregivers on early treatment. Expanding education financing and promoting NGO involvement in caregiver education are essential. Efficient medicine distribution and caregiver education on prompt treatment are key to improving health outcomes for children under five.

Introduction Children in low- and middle-income countries face barriers to timely access to cancer care. Between January and June 2023, an awareness campaign in Bungoma County, Kenya, aimed to address this issue. This study describes sociodemographic and clinical characteristics of children diagnosed with cancer after the campaign, explores health-seeking behaviors and delays, and compares cancer referrals pre- and post-campaign. Methods Parental interviews were conducted for all children newly diagnosed with cancer from Bungoma County at Moi Teaching and Referral Hospital between January 2023 and December 2024 using structured questionnaires. Hospital registry data from January 2014 to December 2024 were analyzed to compare referrals pre- and post-campaign (2014–2022 versus 2023–2024). Results Following the campaign, 30 children were diagnosed with cancer (40% female, median age 5.5 years). Diagnoses included hematological cancers (23%), solid tumors (60%), rare solid tumors (7%), and brain tumors (10%), with 57% of solid tumors presenting at advanced stages. Delays were substantial: the median patient-, physician-, diagnosis-, treatment-, health system-, and total delays were 30, 104, 114, 6, 114, and 146 days, respectively. Barriers included the use of traditional medicine, cultural beliefs, financial strain, travel costs, lack of insurance, income loss, and fear. Annual referral rate before and after the campaign (2014–2022 versus 2023–2024) showed no statistically significant difference (Chi-square test, p  = 0.071; Fisher’s exact test, p  = 0.063). Conclusion The campaign did not increase cancer diagnoses, highlighting ongoing barriers to timely access to childhood cancer care. Addressing these barriers is essential for improving access to childhood cancer care. Factors such as healthcare worker strikes, supply shortages, and treatment seeking at other facilities may have contributed to the lower-than-expected numbers.

Background Delaying healthcare after episodes of violence can allow hidden injuries and trauma in older adults to worsen. It increases the risk of complications, prolonged recovery, and reduced functional independence. Such delays also heighten emotional distress, potentially leading to anxiety, depression, or long-term psychological harm. Objective To investigate associated factors for delayed healthcare-seeking among older adults victims of violence in Brazil, from 2016 to 2022. Methods A cross-sectional analysis was conducted using 154,991 reported cases of violence against individuals aged 60 years and older, extracted from Brazil’s national Notifiable Diseases Information System. Delay was defined as notification to health authorities occurring ≥ 24 h after the episode (used as a proxy for delayed healthcare-seeking and system responsiveness). Multivariate logistic and spatial cluster analysis were applied to assess associated factors and regional patterns. Results Nearly half of the cases involved delayed healthcare-seeking. Increased likelihood of delay was associated with being female, Indigenous, mixed-race, having behavioral or mental disorders, experiencing sexual or psychological violence, episodes involving multiple perpetrators, and those occurring at night or on weekends. In contrast, delays were less likely among individuals with physical or intellectual disabilities, those identifying as bisexual, and cases involving physical violence or self-harm. Spatial analysis revealed significant geographic disparities, with hotspots of delay concentrated in the North and Northeast regions. Conclusions Delayed access to healthcare among older victims of violence is widespread and shaped by intersecting demographic, psychosocial, and structural vulnerabilities. Strengthening community-based care, improving health system responsiveness, and addressing systemic inequities are essential to ensuring timely support for this at-risk population.

Introduction: timely initiation of colorectal cancer (CRC) treatment is essential for optimal patient outcomes. However, delays remain a major challenge in Ethiopia. This study aimed to assess the prevalence and determinants of late time to treatment initiation among CRC patients in oncology centers of the Amhara Region, Ethiopia. Methods: a multicenter cross-sectional study was conducted from March 30 to April 20, 2024, at Dessie, Gondar, and Felege Hiwot Oncology Centers. Data were extracted from the medical records of CRC patients diagnosed between July 1, 2018, and June 30, 2023. Bivariable and multivariable logistic regression analyses were performed. A p-value <0.05 was considered statistically significant. Results: among 464 CRC patients, 260 (56.0%; 95% CI: 51.4-60.0%) experienced delayed treatment initiation (>60 days after diagnosis). Distance from the treatment center (>81 km; AOR=3.54, 95% CI: 2.23-5.60), lack of health insurance (AOR=1.83, 95% CI: 1.20-2.78), good performance status (AOR=2.55, 95% CI: 1.53-4.24), and non-metastatic disease (AOR=1.67, 95% CI: 1.08-2.58) were significantly associated with treatment delay. Conclusion: late treatment initiation is common among CRC patients in the Amhara region. Geographic distance, lack of insurance, and certain clinical factors contribute to this delay. Efforts to decentralize oncology care and strengthen financial protection are essential to improve timely access to treatment.

Background: Mseleni joint disease (MJD) is a degenerative chondrodysplasia of unknown aetiology that is endemic to uMkhanyekude in KwaZulu-Natal, South Africa. Delayed treatment-seeking for MJD results in severe joint pain, which commonly progresses to permanent loss of mobility and reliance on caregivers. Aim: This study aimed to identify systemic, social and cultural barriers to MJD treatment-seeking from the perspectives of patients and healthcare providers. Setting: The research was conducted at the Mseleni Hospital in KwaZulu-Natal, South Africa. Methods: A multistage mixed methods study was conducted. Stage One involved quantitative analysis of patient medical records (n = 53) and administration of questionnaires to patients (n = 37). Stage Two involved a thematic analysis of interviews with MJD patients (n = 6), nurses (n = 7) and treating MJD (n = 9). Findings from both stages were analysed thematically to barriers to treatment-seeking for MJD. Results: Treatment-seeking barriers fell into three domains: (1) current approaches to treatment and self-management, (2) aetiological perspectives and (3) systemic barriers to healthcare access. Treatment and self-management through traditional medicine and delays in the primary healthcare system were cited as reasons for latent treatment-seeking. Healthcare providers highlighted structural barriers including unstandardised record-keeping, poor cross-facility communication and limited resources, while MJD patients emphasised failed treatments, pain and immobility and inadequate care as key obstacles. Variable aetiological perspectives between MJD patients and healthcare providers were reflected in appraisals of treatment. Gender disparities in sociocultural expectations and stigma-linked to symptoms restricted women’s access to care. Conclusion: Differing perspectives between MJD patients and healthcare providers contributed to delayed treatment-seeking and hindered the management of MJD. Patients discussed barriers to MJD relative to traditional knowledge, beliefs and lived experience, while healthcare providers discussed barriers relative to systemic and structural factors through a biomedical lens. Contribution: This study highlights the need to align clinical approaches to treating MJD with patient and provider experiences of this disease to address both individual and systemic barriers to treatment.

Background Re‐designing services and processes to meet growing demands in chemotherapy services is necessary with increasing treatments. There is little evidence guiding the timing and thresholds to be attained of pre‐chemotherapy blood assessments, namely neutrophils. Methods A survey was developed and distributed to health professionals in the United Kingdom (UK) to examine current practice in timing and threshold values of neutrophils and platelets before treatment administration. This was followed by a retrospective cohort study, using data from electronic patient record systems; including patients initiating treatment between January 2013 and December 2018, to determine a safe timeframe for blood assessments; comparing neutrophil, platelet, creatinine and bilirubin levels at different time points. Results The survey captured 25% of hospitals in the UK and variations were apparent in both the timing of assessments and thresholds needed, particularly for neutrophils. 616 (6.5%) of 4007 patients included had neutrophil levels measured twice within 7 days of treatment (with the first level taken beyond 3 days and the second test being within 3 days of treatment‐ the UK standard). Of the patients that attained an acceptable neutrophil level at their first test, five of the 616 (0.8%) became ineligible for administration from the test 2 level. 23% of patients improved their grade and became eligible for treatment. Little difference was observed for platelets. Conclusions We have demonstrated that extending the timeframe for blood tests can be safe, however, this practice may cause unnecessary delays for patients if only an early test is relied on for eligibility. There is a dearth of evidence supporting the correct timing of blood tests prior to chemotherapy, leading to patients receiving numerous unnecessary tests. We aimed to provide this evidence, utilising data from electronic prescribing systems and showed that extending periods were safe but in the case of neutrophil assessments could lead to unwarranted delays.