Diagnosis of cancer in the South and North of Nigeria: duration and causes of delay

Abstract

INTRODUCTION: Nigeria has a growing cancer burden, with late presentation and delayed diagnosis contributing to poor outcomes. We explored the durations and causes of the delay in the diagnosis of four common and treatable cancer types (breast, colorectum, head and neck, and uterine cervix) in Nigeria. METHODS: Retrospective study based on interviews with cancer patients following the Aarhus framework for designing and reporting such studies. The study focused on the first two of WHO's three main designated stages of cancer diagnosis: duration from symptom to presentation and presentation to histological diagnosis. Our hospital-based study involved 264 patients recruited from tertiary care facilities in the Northwestern (Kano) and Southwestern (Ibadan) regions of Nigeria. We obtained quantitative data to measure the duration of delay by stage, while interview data were collected to explore the causes of delay. We analysed the data by computing the median duration for the two stages of delay, and framework analysis was used to identify themes on the causes of delay. RESULTS: The median time to receive a cancer diagnosis after noticing the first symptoms was 12 months (interquartile range 5 to 27 months), with head and neck cancer patients reporting the most prolonged (15-month) delay. Patients waited a median of 3 months (interquartile range 12 months) before presenting their first cancer symptom to a healthcare professional. The median time for patients to receive a cancer diagnosis after the first presentation of symptoms to a formal healthcare professional was 5 months (interquartile range 12 months). There was wide variance for all time intervals. Patients reported visiting a median of 3 health facilities before diagnosis in a formal hospital setting. Qualitative findings identified two main reasons patients reported delays in cancer pathway to care: patient-related factors and health system issues. CONCLUSION: Long delays were observed, and more than half the delay followed presentation to the local health sector.