Mitra Srijeeta, Sahu Swaroop Kumar, Lakshminarayanan Subitha, Raja Kalaiarasi, V C Sunitha
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduation Medical Education and Research, Puducherry, India.
Department of ENT, Jawaharlal Institute of Postgraduation Medical Education and Research, Puducherry, India.
Indian J Med Res. 2024 Nov;160(5):457-465. doi: 10.25259/ijmr_34_24.
Background & objectives Cancer is a leading cause of death worldwide and constitutes a public health priority. Delays in diagnosis and treatment of cancer can adversely impact survival, recovery, and cost of treatment. The objective of this study was to estimate the proportion seeking timely care among those having early warning signals for oral, breast or cervical cancer and to explore the facilitators and barriers to early detection. Methods The study was conducted among 241 participants, including those having early signals for selected cancers and women who underwent opportunistic cervical cancer screening in the selected health facilities. Information regarding symptom appearance, presentation to any registered medical practitioner, confirmatory diagnosis, and treatment initiation were obtained from medical records. In-depth Interviews (IDIs) were conducted among six participants to explore facilitators and barriers to cancer detection. Results Among 7300 people screened using the Community Based Assessment Checklist (CBAC), 128 (1.7%) had warning signals for any one of the cancers. The percentage of people who sought medical care for oral, breast and cervical cancer symptoms were 80 per cent, 82 per cent and 57 per cent, respectively. Among those who underwent opportunistic cervical cancer screening in health centres (113), the screen positivity rate was 11 per cent, and adherence to referral for confirmation was 80 per cent. The median pre-diagnostic and diagnostic delays for the three cancers were 79 [Interquartile range (IQR): 44-126] and 27 (IQR: 13-73) days. One individual was diagnosed with oral cancer, and the treatment delay was 27 days. Facilitators identified for early seeking of care were encouragement by family and low-cost treatment at public facilities. Major barriers identified were neglect of symptoms by participants and their responsibilities towards family. Interpretation & conclusions Although very few people were identified to have early warning symptoms using CBAC, a substantial proportion of them sought medical care and underwent confirmatory diagnosis. Screen positivity rate and treatment-seeking behaviour were better among women undergoing opportunistic cervical cancer screening in the health centres. Measures need to be taken to improve health literacy among people to reduce diagnostic delay for cancers.
癌症是全球主要死因之一，是公共卫生重点关注领域。癌症诊断和治疗的延迟会对生存率、康复情况及治疗成本产生不利影响。本研究的目的是估计在出现口腔癌、乳腺癌或宫颈癌早期预警信号的人群中寻求及时治疗的比例，并探讨早期检测的促进因素和障碍。方法：该研究对241名参与者进行，包括有特定癌症早期信号的人群以及在选定医疗机构接受机会性宫颈癌筛查的女性。从医疗记录中获取有关症状出现、向任何注册医生就诊、确诊及开始治疗的信息。对6名参与者进行了深入访谈，以探讨癌症检测的促进因素和障碍。结果：在使用基于社区评估清单（CBAC）筛查的7300人中，128人（1.7%）有任何一种癌症的预警信号。因口腔癌、乳腺癌和宫颈癌症状寻求医疗护理的人群比例分别为80%、82%和57%。在健康中心接受机会性宫颈癌筛查的人群（113人）中，筛查阳性率为11%，转诊确诊的依从率为80%。这三种癌症的诊断前和诊断中位延迟时间分别为79天[四分位间距（IQR）：44 - 126]和27天（IQR：13 - 73）。1人被诊断为口腔癌，治疗延迟为27天。确定的早期寻求治疗的促进因素是家人的鼓励和公共设施的低成本治疗。确定的主要障碍是参与者对症状的忽视及其对家庭的责任。解读与结论：尽管使用CBAC识别出有早期预警症状的人很少，但其中很大一部分人寻求了医疗护理并接受了确诊。在健康中心接受机会性宫颈癌筛查的女性中，筛查阳性率和寻求治疗行为更好。需要采取措施提高人们的健康素养，以减少癌症的诊断延迟。
