Barriers to Cancer Care in Northern Tanzania: Patient and Health-System Predictors for Delayed Presentation

Abstract

PURPOSE Cancer is a growing problem in Africa, and delays in receiving timely cancer care often results in poorer outcomes. The purpose of this study was to identify the patient and health-system factors associated with delayed cancer care in adults living in the Northern Zone of Tanzania. PATIENTS AND METHODS Between July 2018 and July 2019, we surveyed adult patients presenting to an oncology clinic in Northern Tanzania. Delayed presentation was defined as 12 weeks or longer from initial symptoms to presentation for cancer care. Multivariate logistic regression and adjusted relative risk (aRR) were used to identify factors predicting delayed presentation. RESULTS Among 244 adult patients with cancer who completed the survey, 78% (n = 191) had delayed presentation. Patient-related factors associated with delayed presentation included lower educational attainment ( P = .03), increased travel time ( P = .05), lack of cancer knowledge ( P < .05), and fear of cancer and cancer treatments ( P < .05) on multivariate analysis. On analysis of aRR, patients without private car and those with health insurance had higher risk of delayed presentation (aRR: 1.27; 95% CI, 1.02 to 1.32 and aRR: 1.15; 95% CI, 1.01 to 1.32). There was a strong association with increased number of visits before presentation at the cancer center and delayed presentation ( P = .0009). CONCLUSION Cancer awareness and prevention efforts targeting patients and community-level health care workers are key to reduce delays in cancer care in Northern Tanzania.

Use of Herbal Medicine Is Associated With Late-Stage Presentation in Tanzanian Patients With Cancer: A Survey to Assess the Utilization of and Reasons for the Use of Herbal Medicine

“…The fact that patients from rural areas are more likely (odds ratio 1.46) to use HM than those from urban areas indicates the importance of availability and geographical accessibility of treatment in specialized centers. 10 …”

“…The fact that patients from rural areas are more likely (odds ratio 1.46) to use HM than those from urban areas indicates the importance of availability and geographical accessibility of treatment in specialized centers. 10 By far, the highest share in the survey has been the socially expected answers of sociocultural factors of own belief, recommendation, and tradition. Use of HM appears as the common way of life.…”

“… 7 As most of the patients use alternative medicine before consulting a medical doctor (respectively a conventional health care facility), 8 it is likely that it contributes to the high number of late-stage presentation of patients with cancer in SSA. 3 , 9 , 10 But, data confirming this assumption are lacking.…”

Clinicopathology and Treatment Patterns of Head and Neck Cancers in Ethiopia

“…[13][14][15][16] Multiple factors influence the timely diagnosis of cancer in Africa such as cultural beliefs, educational level, transportation, and poverty. [17][18][19] However, unlike higher resource settings, wait time for initiation of treatment is long in Ethiopia, and during this period, a substantial proportion of patients are lost to follow-up and presumably died without receiving treatment. Long wait time are associated with worse outcomes in head and neck cancers; a study from Taiwan showed worse outcomes after a 40-day delay, and a larger Dutch study showed poorer outcomes after a 90-day delay.…”

International cooperation to fight cancer’s late-stage presentation in low- and middle-income countries

“…The reasons are manifold including limited financial resources both on patients and service provider side, poor knowledge about cancer also on the provider side resulting in misdiagnosis, and a generally low health literacy rate among the general population facilitating misbeliefs and trust in alternative and less effective medical practices [ 3 ].…”