Breaking Barriers in Cancer Screening: Understanding Participant Dropout in Breast and Cervical Programs in Morocco

Abstract

OBJECTIVE: This study aimed to investigate loss to follow-up (LFU) rates within breast and cervical cancer screening programs in Kenitra-Morocco, identifying contributing factors from both patient and healthcare worker perspectives to enhance care continuity. METHODS: The study was a non-experimental, mixed-methods design conducted in three-phases. We started by identifying LFU women and their characteristics from medical records, interviewing LFU women to ascertain reasons for discontinuation, and surveying healthcare workers for perceived determinants of LFU through semi-structured questionnaires. The study covered primary healthcare centers, the Reproductive Health Reference Center (RCRH) in Kenitra, and the National Institute of Oncology (NIO) in Rabat. RESULTS: Of 1,225 women studied, 94 cancer cases were diagnosed, with LFU rates varying across care stages. Key factors associated with LFU included age (p<0.005, OR=1.67, CI[1.2-2.4]), marital status (p<0.03, OR=0.8, CI[0.65-0.98]), distance from healthcare facilities (p<0.00, OR=2, CI[1.3-4.0]), and medical coverage (p<0.03, OR=2.3, CI[1.3-4.0]). Healthcare workers cited poor communication, organizational issues, and staffing shortages as barriers to follow-up. CONCLUSIONS: The study underscores LFU's multifaceted reasons in Kenitra's cancer screening programs, suggesting improvements in communication after a positive screening test, re-engagement strategies, and financial accessibility. Addressing these issues is essential for reducing LFU rates, enhancing cancer care outcomes, and decreasing breast and cervical cancer mortality in Morocco.