DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20202489

Pathways to care and diagnostic delay among cervical cancer patients attending a tertiary care hospital in Puducherry: a cross-sectional study

Roshina Sunny, Sitanshu Sekhar Kar, Dasari Papa, Sujiv Akkilagunta, Jeby Jose Olickal

Abstract


Background: The high mortality among cervical cancer patients in India can be attributed to presentation at advanced stages. The varied and lengthy pathway taken up to diagnosis could be a major reason for advanced stage at presentation. Hence, we aimed to describe the care pathways and diagnostic delay among cervical cancer patients.

Methods: A hospital-based cross-sectional study was conducted among 101 cervical cancer patients attending a cancer clinic at a Regional Cancer Center. The histo-pathologically confirmed cases of cervical cancer, who registered in July to October 2018 were approached. Data were collected through personal interviews using a semi-structured questionnaire. Descriptive statistics were used to describe the number of providers visited and diagnostic delay.

Results: The median (range) number of providers visited by the patients up to diagnosis was 2 (1-5). As the first point of care, 14% of participants approached sub-center or primary care facilities, 27% approached secondary care facilities, 49% participants approached tertiary care facilities and 11% came directly to a regional cancer center. Diagnosis was made only in 24% of participants at secondary and tertiary care levels. The median (IQR) number of days to get diagnosed was 66 (30-130) days and three fourth of the patients had a diagnostic delay.

Conclusions: The diagnostic delay was higher among patients who consulted multiple providers. Implementing a protocol to be followed at all three levels of health care delivery system may enhance the early diagnosis.

 


Keywords


Diagnostic delay, Health care levels, Navigation pathways, Referral pathway

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References


New Global Cancer Data: GLOBOCAN 2018. Available at https://www.uicc.org/news/new-global-cancer-data-globocan-2018. Accessed 18 March 2020.

World Health Organisation: Human Papillomavirus and Related Diseases, Summary Report. World Health Organization; 2014.

Fitzmaurice C, Akinyemiju TF, Lami AFH, Alam T, Navaei AR, Allen C, et al. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016. JAMA Oncol. 2019.

Cervical Cancer. World Health Organization 2015. Available at https://doi.org/10.1007/978-1-4939-2013-6. Accessed on 18 March 2020.

Nandakumar A, Anantha N, Venugopal TC. Incidence, mortality and survival in cancer of the cervix in Bangalore, India. British J Cancer. 1995;71:1348-52.

Directorate General of Health Services. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). Available at https://dghs.gov.in/ content/1363_3_NationalProgrammePreventionControl.aspx. Accessed on 18 March 2020.

World Health Organization. Guide to cancer early diagnosis. World Health Organization; 2017.

Awolude O, Adewole I. Time of symptoms to Health-seeking among cervical cancer patients in Ibadan, Nigeria. Tropical J Obstetrics Gynaecology. 2016;33:10.

Deshmukh VL, Rathod AD. Delays in reporting of cancer cervix in rural India - sociodemographic and reproductive correlation. Int J Reproduction, Contraception, Obstetrics Gynecology. 2017;6:4516-21.

Mohamed B, Majdouline O, Ahmed Z. Sociodemographic factors and delay in the diagnosis of cervical cancer in Morocco. Pan African Med J. 2012;8688:1-8.

Gayle L, Mary N. Health Seeking Behaviours of Women with Cervical Cancer. J Community Med Health Education. 2012;2:4-9.

Macleod U, Mitchell ED, Burgess C, Macdonald S, Ramirez AJ. Risk factors for delayed presentation and referral of symptomatic cancer: evidence for common cancers. British J Cancer. 2009;101:92-101.

Ouasmani F, Hanchi Z, Rahou HB, Bekkali R, Ahid S, Mesfioui A. Determinants of Patient Delay in Seeking Diagnosis and Treatment among Moroccan Women with Cervical Cancer. Obstetrics Gynecology Int. 2016;2016:9.

Vandborg MP, Christensen RP, Kragstrup J, Edwards K, Vedsted P, Hansen DG, et al. Reasons for Diagnostic Delay in Gynecological Malignancies. Int J Gynecological Cancer. 2011;21:967-74.

Gyenwali D, Khanal G, Paudel R, Amatya A, Pariyar J, Onta SR. Estimates of delays in diagnosis of cervical cancer in Nepal. BMC Womens Health. 2014;14:1-9.