Perceived barriers to seeking cancer care in the Gaza Strip: a cross-sectional study

Abstract

Background Several factors might contribute to the delay to get cancer care including poor cancer awareness and having barriers to seeking help. This study described these barriers in Gaza and their association with recalling and recognizing cancer symptoms and risk factors. Methods A cross-sectional study was conducted in Gaza. Adult visitors (≥18 years) to the largest three governmental hospitals and adolescent students (15–17 years) from ten high schools were recruited. A translated-into-Arabic version of the validated Cancer Awareness Measure (CAM) was used to collect data in face-to-face interviews. It described demographic data, barriers to seek cancer care as well as recall and recognition of cancer symptoms and risk factors. Responses were compared between adults and adolescents as well as males and females. Results Of 3033 participants approached, 2886 completed the CAM (response rate= 95.2%). Among them, 1429 (49.5%) were adult (702 females; 49.1%) and 1457 (50.5%) were adolescent (781 females; 53.6%). The mean age± standard deviation (SD) of adult and adolescent participants was 33.7±11.7 years and 16.3±0.8 years, respectively. Emotional barriers were the most common barriers with ‘feeling scared’ as the most reported barrier (n=1512, 52.4%). Females and adolescents were more likely to report ‘feeling scared’ as a barrier than males and adults, respectively. Higher recall scores for cancer symptoms were associated with lower likelihood to report ‘embarrassment’, ‘worry about wasting doctor’s time’ and ‘difficulty arranging transport’. This was also seen for recalling risk factors, where ‘embarrassment’ and all practical barriers showed significant inverse associations with higher scores. In addition, greater recognition scores of cancer risk factors were inversely associated with reporting ‘embarrassment’ and ‘feeling scared’. Conclusions The most commonly perceived barriers to seeking cancer care were ‘feeling scared’ and ‘feeling worried about what the doctor might find’, followed by practical and service barriers. Females and adolescents were more likely to report ‘fear’ as a barrier to seek medical advice. Having a higher recall of cancer symptoms and risk factors was inversely associated with reporting most barriers. To improve patient outcome, early presentation can be facilitated by targeting barriers specific to population groups.

Knowledge of Palestinian women about cervical cancer warning signs: a national cross- sectional study

“…To minimize the possibility of participants answering questions randomly, the questions in the original CeCAM with yes/no/unknown responses were modified into 5-point Likert scale questions. Meanwhile, the participants' responses were converted to correct/incorrect responses similar to what was done in previous studies [11,12]. The sign of 'extreme generalized fatigue' was added to the questionnaire since it was mentioned in other forms of the Cancer Awareness Measure [22,23], and it was thought that it would be helpful to include it in the context of CC.…”

“…In the absence of screening as well as HPV-vaccination programs, early detection and treatment of CC could be the most effective strategy to reduce resulting mortality and morbidity. Furthermore, multiple barriers to early presentation with cancer warning signs exist among Palestinian women, including financial restrictions, scarcity of female specialists, negative cancer beliefs, and paucity of treatment opportunities [12,[35][36][37][38][39][40]. Among these barriers, lack of knowledge and awareness is only one factor, but this one can be addressed by effective educational interventions [11,41].…”

“…11 Alia Hospital, Hebron, Palestine. 12 Al-Shiffa hospital, Gaza, Palestine. 13 Faculty of Nursing, Islamic University of Gaza, Gaza, Palestine.…”

“…Therefore, early diagnosis is crucial to decrease mortality related to CC. Several factors were reported to play a role in delaying the diagnosis of CC including low awareness of CC warning signs, limited access to healthcare services, and emotional barriers to seek medical advice (e.g., feeling scared) [9][10][11][12].…”

“…In Palestine, there are no screening programs for CC or vaccination program for the main cause of CC, human papillomavirus (HPV) [13]. This further increases the importance of determining women's knowledge of CC warning signs as it may impact their decision to visit doctors [12,14]. In addition, assessment of the existing awareness of CC warning signs will help to guide future educational interventions aiming to increase public awareness [14,15].…”