Evaluation of the Timeliness of Treatment Initiation among Cervical Cancer Patients at the National Centre for Radiotherapy and Nuclear Medicine, Korle-Bu

Abstract

Background Cancer of the cervix is the second most common of all cancers which affect women and also a major burden among women in most low and middle income countries. However, the average duration between onset of symptoms and initiation of treatment among cervical cancer at the National Radiotherapy Centre in Ghana is unknown. The study sought to evaluate the timeliness of cervical cancer treatment initiation among patients with cervical cancer. Methods It was cross- sectional quantitative study conducted at the National Centre for Radiotherapy and Nuclear Medicine, Korle-Bu from May to June 2018. Data collection was done with the use of structured questionnaire among patients with cervical cancer receiving treatment at the unit. Clinical information about patients were extracted from patients’ folders to complete clinical information. Median timeliness of symptoms, diagnosis and treatment initiation were determined as well as the assessment of the risk factors for delayed treatment initiation. The socio-demographic and clinical data were summarised using frequencies, means and proportions. Associations between the outcome and independent variables were determined using Fisher’s exact and Pearson’s chi-square. Significance levels were determined at a confidence level of 95% with a margin of error 5% and p-value < 0.05. Results A total of 117 respondents’ participated in this study. The study identified timeliness of symptoms, diagnosis and treatment initiation blocks which can be used in establishing interventions to address delays in the timeliness of treatment initiation. The median patient and treatment initiation timeliness were 28 and 31.5 weeks respectively while the mean diagnostic timeliness was 1.62 weeks. About 99 (85%) of the patients experienced total delay. The initial choice of treatment patients opted for and patient delay were significantly associated with total delay (p< 0.001). Significant associations were observed between secondary delay and the number of repeated visits to a health facility before diagnosis and the facility that diagnosed (p<0.001). The commonest tumour morphology identified was squamous cell carcinoma (86.32%) with 44.46% being diagnosed at stages III and IV of cervical cancer. Unaware of severity of symptoms 87 (74.4%) and perceived cost of treatment 66 (56.4%) were cited as the major reasons patients delayed in presenting to a health facility for treatment. Conclusion The results from this study revealed that majority of the patients (84.6%) experienced total delays from the onset of initial symptoms till treatment commencement even though most of them first sought treatment from a health facility. Notable among the factors responsible for the late presentation of patients for definitive diagnosis and treatment were lack of awareness of the severity of the cervical cancer related symptoms and perceived cost of treatment. Educational activities such as health talks among women groups, public and targeted outreach to under privileged women should aim at promoting early detection for prompt treatment through raising of awareness among the public, since cervical cancer is curable when detected early.