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Abstract
Objective The aim of this study was to estimate the time intervals from first symptom recognition to pathological diagnosis among patients with oesophageal cancer in Ethiopia.
Design A cross-sectional study design was employed.
Settings and participants Patients with oesophageal cancer aged ≥18 years were included from Addis Ababa, Ethiopia (n=338) from February 2019 to August 2020. The participants were selected consecutively from six health facilities that provided cancer care nearly for 90% of patients.
Main outcomes and measurements The Aarhus statement criteria were applied to classify patient intervals (time from first symptom recognition to presentation) and diagnostic intervals (time from first presentation to diagnosis). Patient and diagnostic intervals >60 and >30 days were considered as delays, respectively. For tumour classification, the American Joint Committee on Cancer was used. Data were analysed using SPSS V.24. Descriptive statistics were applied to describe patients’ characteristics. Poisson regression with robust variance was used to compute prevalence ratios. In all statistical tests, significance was declared at a p value of <0.05.
Results The mean (SD) age of the participants was 54.30±12.49 years.
Approximately 78% of study participants had never heard of oesophageal cancer and thought they had gastritis. Dysphagia was the commonly mentioned symptom. About 76% of the cases were diagnosed at advanced stages (III and IV). Median patient interval was 108.5 (60.5–215) days and median diagnostic interval was 77.5 (39–133) days. After adjusting confounders, being single and unawareness of oesophageal cancer had association with consultation delay; cost of transportation and medical consultation had association with diagnostic delay; and patient delay of >2 months had association with late-stage diagnosis.
Conclusion Patients with oesophageal cancer in Ethiopia had prolonged patient and diagnostic intervals. Increasing awareness of symptoms of oesophageal cancer and shortening time to diagnosis will help to improve the outcome of oesophageal cancer care in Ethiopia.
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Data availability statement
Data are available upon reasonable request.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available upon reasonable request.
Footnotes
Contributors All authors contributed to the conception of idea up to data analysis and write-up. They also participated in drafting or revising of the article and have agreed on to which journal the article shall be submitted and have given final approval of the version to be published, and agreed to be accountable for all aspects of the work. Specifically, BD conceptualised the topic of interest and was involved in data collection, coding, cleaning, analysis, interpretation of the result and preparation of the manuscript. FE was involved in proposal development, planning the fieldwork and result section. RY, MA, SG and AA were involved in proposal development, data analysis, write-up and in critical reviewing of the manuscript. May 2022. The gaurantor and the responsible author for any request for this specific article is BD.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
The ethical clearance was obtained from the Institutional Review Board (IRB) of Addis Ababa University College of Health Sciences with a protocol number of 080/18/SPH. The study followed basic ethical principles of Helsinki Declaration for medical research involving human participants .All of the study participants were informed about the purpose and procedure of the research and their right to withdraw from the study at any time. Written informed consent was obtained from each of the study participants. Meanwhile, the study participants agreed to the extent that the finding of this study will be subjected to publication. Participants were well informed not to disclose their information to a third person. The information was kept secured and put confidentially by the first author.
Provenance and peer review Not commissioned; externally peer reviewed.