Akihiko Ozaki1, Shuhei Nomura2, Claire Leppold3, Masaharu Tsubokura4, Toyoaki Sawano5, Manabu Tsukada6, Tomohiro Morita7, Tetsuya Tanimoto8, Shigehira Saji9, Shigeaki Kato10, Kazue Yamaoka11, Yoshinori Nakata11, Hiromichi Ohira6. 1. Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan; Graduate School of Public Health, Teikyo University, Itabashi-ku, Tokyo, Japan. Electronic address: aozaki-tky@umin.ac.jp. 2. Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan; Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan. 3. Global Public Health Unit, School of Social and Political Science, University of Edinburgh, George Square, Edinburgh, United Kingdom. 4. Research Center for Community Health, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan; Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan. 5. Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan; Department of Public Health, Fukushima Medical University School of Medicine, Fukushima, Japan. 6. Department of Surgery, Minamisoma Municipal General Hospital, Minamisoma, Fukushima, Japan. 7. Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan. 8. Department of Internal Medicine, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan. 9. Department of Medical Oncology, Fukushima Medical University School of Medicine, Fukushima, Japan. 10. Research Institute of Innovative Medicine, Jyoban Hospital of Tokiwa Foundation, Iwaki, Fukushima, Japan. 11. Graduate School of Public Health, Teikyo University, Itabashi-ku, Tokyo, Japan.
Abstract
BACKGROUND: Minimizing the interval from symptom onset to treatment commencement is essential for a favorable outcome among breast cancer (BC) patients. This study examined whether provider interval (time elapsed from first consultation to treatment initiation) lengthened among BC patients after Japan's 2011 earthquake, tsunami, and nuclear disaster in Fukushima. Factors associated with the length of postdisaster interval and whether the interval was associated with BC stage were also investigated. PATIENTS AND METHODS: So-so District (study site) was an area damaged by the 2011 disasters. Data of all BC patients who made their first medical consultation and received initial treatment at the core medical institutions in the area 5 years before or after the disaster were extracted from patient medical records. We used several regression approaches to fulfill our study objectives. RESULTS: We included 263 (140 predisaster and 123 postdisaster) patients. After adjustment for covariates, the interval did not significantly change after the disaster compared to before the disaster. Those with 4 or 5 cohabiting family members experienced a shorter interval after the disaster than those with 0 or 1 cohabiting family members (relative length, 0.47; 95% confidence interval, 0.28-0.78). Those with an interval of > 60 days had lower odds of stage III or IV cancer after the disaster than those with an interval of < 30 days (odds ratio, 0.09; 95% confidence interval, 0.01-0.84). CONCLUSION: Overall, provider interval did not lengthen after the disaster. However, those with fewer cohabiting family members might have experienced a longer total interval. Cancer stage may not necessarily reflect the influence of interval on patient outcome.
BACKGROUND: Minimizing the interval from symptom onset to treatment commencement is essential for a favorable outcome among breast cancer (BC) patients. This study examined whether provider interval (time elapsed from first consultation to treatment initiation) lengthened among BCpatients after Japan's 2011 earthquake, tsunami, and nuclear disaster in Fukushima. Factors associated with the length of postdisaster interval and whether the interval was associated with BC stage were also investigated. PATIENTS AND METHODS: So-so District (study site) was an area damaged by the 2011 disasters. Data of all BCpatients who made their first medical consultation and received initial treatment at the core medical institutions in the area 5 years before or after the disaster were extracted from patient medical records. We used several regression approaches to fulfill our study objectives. RESULTS: We included 263 (140 predisaster and 123 postdisaster) patients. After adjustment for covariates, the interval did not significantly change after the disaster compared to before the disaster. Those with 4 or 5 cohabiting family members experienced a shorter interval after the disaster than those with 0 or 1 cohabiting family members (relative length, 0.47; 95% confidence interval, 0.28-0.78). Those with an interval of > 60 days had lower odds of stage III or IV cancer after the disaster than those with an interval of < 30 days (odds ratio, 0.09; 95% confidence interval, 0.01-0.84). CONCLUSION: Overall, provider interval did not lengthen after the disaster. However, those with fewer cohabiting family members might have experienced a longer total interval. Cancer stage may not necessarily reflect the influence of interval on patient outcome.