Pathways to lung cancer diagnosis and treatment among patients in Ethiopia: A qualitative study

Abstract

Late-stage presentation remains a major challenge for cancer control in low- and middle-income countries, driven by limited cancer care infrastructure, diagnostic constraints, and the lack of organized lung cancer screening programs. Therefore, this study explored the pathways of lung cancer diagnosis and treatment, as well as patients’ experiences throughout this journey in Ethiopia. This multicenter qualitative study in three tertiary hospitals involved interviews with 33 primary lung cancer patients who had started at least one treatment and were analyzed thematically, beginning with a deductive approach guided by the pathways to the treatment model and followed by inductive approaches to capture emerging patterns. Six sequential but nonlinear steps were identified along the diagnostic and treatment pathways. The journey began with symptom recognition and appraisal, yet none of the participants initially suspected cancer; most attributed their symptoms to minor illnesses. Many waited before seeking care, opting first for self-management through wait-and-see, home remedies, herbal treatments, or holy water. Care seeking was eventually triggered by worsening symptoms or family encouragement. Navigating the health system was complex, marked by multiple referrals ranging from 2 to 12 different health facilities, repeated misdiagnoses (especially tuberculosis), and inappropriate treatments, even among smokers. Diagnosis is often late, and communication of the diagnosis is frequently unclear, with little psychosocial support. Treatment initiation was further hindered by the limited availability of oncology services and long waiting times of 3 months to nearly 2 years. Financial burdens were profound; patients reported selling assets, borrowing money, and incurring significant debts that affected entire families. The time taken at every step—from symptom recognition to treatment initiation—contributes significantly to the high burden of late-stage lung cancer. Urgent multilevel interventions are needed, including enhancing public awareness of lung cancer, strengthening diagnostic capabilities, improving referral coordination, training healthcare providers in compassionate communication, expanding access to cancer care, and reducing the financial burden on patients. Additionally, given that traditional and religious institutions are widely trusted and frequently consulted, integrating them can support early detection and psychosocial care.