Timely diagnosis of breast cancer plays a vital role in improving treatment outcomes and increasing patient survival. However, contextual factors such as cultural beliefs, healthcare system structural limitations, and socioeconomic challenges can contribute to diagnostic delays. The qualitative study explores the barriers to timely diagnosis from the perspectives of Iranian women diagnosed with advanced breast cancer.

A qualitative study was conducted using in-depth, semistructured interviews to explore perceived barriers to timely diagnosis among Iranian women with advanced breast cancer. Data analysis were performed using MAXQDA software, V.20.

15 Iranian women [mean age 50.6±9.4 (range 38–72)] years with breast cancer diagnosed at an advanced stage.

Seven participants reported diagnostic delays that exceeded 7 months. Key factors contributing to perceived delays included poorly managed appointments and medical care, care not meeting patient expectations, deceptive marketing practices, cost of diagnostic procedures, lack of knowledge, fears, transcendent beliefs, competing priorities, insufficient support and diagnostic errors.

Understanding perceived barriers to timely diagnosis in women with advanced breast cancer is key to creating effective strategies that reduce preventable negative outcomes. Study findings have implications for patient education, healthcare quality, and enhancement of communication between providers and patients for delayed diagnosis prevention in respective treatment settings.

Dyspnoea affects 10% of the general population, and 12% of hospitalised patients report experiencing dyspnoea at rest. It is a common and distressing symptom experienced by people living with chronic obstructive pulmonary disease (COPD). Neuromodulation, which uses electrical stimulation to modulate neural pathways, is a validated clinical procedure offering a potential therapeutic approach. We speculate that non-invasive transcutaneous vagus nerve stimulation (tVNS) and trigeminal transcutaneous electric nerve stimulation (TENS) could improve dyspnoea management by targeting relevant neural circuits.

We will conduct a feasibility cross-over trial in people with severe COPD and significant exertional dyspnoea referred for pulmonary rehabilitation. Patients will be recruited following the prerehabilitation assessment visit comprising a clinical evaluation and a maximal cardiopulmonary exercise testing on ergocycle. Subsequently, two study visits will be conducted within 2 weeks apart from each other. Eight participants will perform a submaximal constant work rate at 80% workload of the VO₂ max, either with cervical tVNS (n=4) or trigeminal TENS (n=4). In a cross-over design, both patient groups will undergo sham and active treatment of the neuromodulation technique in a randomly assigned order. The main outcome will be feasibility, assessed by the percentage of patients who attend all visits and complete all tests. Secondary outcomes include other feasibility endpoints, the acceptability and suitability of the interventions (including an evaluation of sham as an exploratory outcome), and the incidence of adverse or undesirable events related to the procedures. Exploratory outcomes include changes in dyspnoea symptoms, measured using standardised questionnaires, such as Borg scale and the Visual Analogue Scale.

The protocol is approved by the institutional research ethics committee of the Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie—CHUS, Sherbrooke, Quebec, Canada (#2025-5604) and follows 2013 Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Results will be communicated in international meetings and submitted to peer-reviewed journals with respect to the 2010 CONsolidated Standards Of Reporting Trials (CONSORT) statement for feasibility studies.

NCT06985628.