The Pathways to Seeking Treatment, Diagnose and Follow Up of Esophageal Cancer Patients in Arsi Zone, Oromia, Ethiopia: Qualitative Phenomenological Study

Abstract

Background:- Esophageal cancer patients experience multifaceted challenges but studies often focus on the prevalence and risk factors of esophageal cancer with no documentation of the lived experiences of patients. This study aimed at exploring the lived experiences of esophageal cancer patients with the concept of uncovering pathways to seeking treatment, diagnosis, and follow-up. Methods:- A qualitative phenomenological study was conducted from September 01 to October 30, 2019. Data were collected from 25 patients (14 males and 11 females) through in-depth interviews using semi-structured interview guides and audio recordings. The data collectors’ notes and audio recordings were transcribed verbatim. The transcribed data were translated into English and coded using Atlas.ti.7.0.71 version software. Data were analyzed by the inductive thematic analysis method. Results:- The study demonstrated four main themes; experiences of symptoms of esophageal cancer, pathways to seeking treatment and diagnosis, barriers to treatment follow-up, and challenges of survival with esophageal cancer. The pathways to seeking and diagnosis were described with the concepts of self-care, visiting traditional healers, and hierarchical layers of health care delivery systems. The barriers to treatment follow-up were related to inaccessible and unaffordable health care services, and attitudes towards treatment. The challenges of survival with esophageal cancer were designated as problems with food intakes, treatment side effects, reduced quality of life, psychological and physical impairments. Conclusion:- Esophageal cancer patients in this study experienced complex pathways to treatment-seeking, multidimensional obstacles to treatment follow-up, and live with unbearable challenges.

Spatiotemporal Distribution, Time to Treatment Outcome Clustering and Determinants of Esophageal Cancer in Ethiopia, a Scoping Study

“…Approximately 51.65% of the cases of esophageal cancer were females, while 48.35% were men. Nine out of the total articles reviewed reported a higher proportion (51.86% to 61.11%) of females with the disease, 51 , 54 , 55 , 57 , 59 , 61 , 63 - 65 whereas 8 studies reported that males were more commonly diagnosed with esophageal cancer, with the proportion ranging from 50.69% to 74.19%. 49 , 50 , 52 , 53 , 56 , 58 , 60 , 62 At the time of the initial diagnosis, the reported age range for the cases was 18 to 95 years old.…”

“… 52 The patients’ median age was 55 (IQR: 19) years old, 56 according to 1 study. Five studies 50 , 51 , 55 , 56 , 59 did not disclose the age range of the patients, whereas 4 other studies 49 , 61 , 62 , 65 did not disclose the average age at the time of initial diagnosis ( Table 2 ).…”

“… 51 - 61 Four works, 2 of which were preprints 62 , 63 and 2 of which were Addis Ababa University theses, 64 , 65 have not yet been published. Only 5 of the studies (29.41%) obtained primary data, 53 , 58 , 59 , 62 , 65 whereas most studies (58.82%) relied on secondary data. 49 - 52 , 54 - 57 , 61 , 64 Of the investigations, 2 (11.76%) gathered both secondary and primary data.…”

“…60 , 63 Six of the studies were case-control studies, of which half were matched case control studies, 49 , 53 , 58 and the other half were unmatched case control studies 51 , 54 , 60 ; 3 studies were cross-sectional 57 , 64 , 65 ; 2 studies were cohort studies, 1 of which was prospective, 59 the other retrospective 55 ; 1 study was qualitative phenomenology 62 ; and for 4 studies, a clear study design was not reported. 50 , 52 , 56 , 61 The studies were carried out in Addis Ababa City (ie, on patients from Tikur Anbessa Specialized Hospital (TASH), 52 - 55 , 59 , 63 - 65 Mexico Higher Clinic (MHC), 53 , 54 the Adera Higher Clinic (AHC), 51 , 53 , 54 6 health facilities from Addis Ababa, 60 and Addis Ababa Cancer Registry (AACR) (three governmental hospitals and 12 private facilities submitted cancer cases) 61 ) (64.71%), 51 - 55 , 59 - 61 , 63 - 65 Yirga Alem (on patients from Sidama Regional Hospital) (5.88%), 50 Arsi zone (patients from Asella Teaching and Referral Hospital and others) (23.53%), 49 , 57 , 58 , 62 and 10 referral hospitals f...…”

“…Patients with thoracic esophageal cancer, 49 all patients with esophageal cancer, 50 , 55 - 58 , 60 - 65 patients who underwent esophagectomy, 52 and esophageal tumor patients who were 18 years or older at the time of diagnosis 51 , 53 , 54 , 59 were the criteria employed to include cases in the studies. The total sample size for the studies was 3,583, of which 2848 participants had esophageal cancer.…”