Delays in diagnosis and associated factors among head and neck cancer patients presenting to Uganda Cancer Institute

Abstract

Introduction: Head and neck cancer (HNC) patients often present late resulting in delayed diagnosis. Delay in diagnosis may be due to delay in deciding to seek care, delay in reaching the healthcare facility and delay in obtaining investigations. In this study, we determined the time to definitive diagnosis and factors associated with delayed diagnosis among patients with HNC at Uganda Cancer Institute (UCI). Methods: A cross-sectional study, that included patients with HNC at UCI was carried out. Data collected included time from onset of symptoms to definitive diagnosis (recorded in months), and factors associated with delay like level of education, tumor stage etc. Factors associated with delayed diagnosis were analysed and a p-value<0.05 was considered statistically significant. Results: The study recruited 160 HNC patients, and 134 patients were analysed. The age range was 18-87 years, 94 being male. Reportedly, 48% had below secondary school education, household income was <54 USD in 48%, 56% were sole bread winners, bad access road condition to the nearest health unit in 33.6% and the commonest tumour stage was IV at 69%. Median time from onset of symptoms to definitive diagnosis was 8.1 months, range (1.1-263.5) and 87/134 (65%) of patients had delayed diagnosis. Good access roads, secondary school education, and household income > 136 USD were associated with lower odds delayed diagnosis by OR 0.26, 0.17, and 0.27 respectively with (P-value 0.006, 0.038, and 0.043 for road condition, secondary school education, and household income respectively). Being the sole bread winner increased the odds of delayed diagnosis OR 2.15 (Pvalue 0.05). Tumour stage, age, sex, tobacco smoking, and herbal medicine use were not associated with delayed diagnosis. Conclusion: Most of our HNC patients have delayed diagnosis. Public awareness campaigns to create awareness about HNC symptoms and signs and a national care pathway for patients with suspected HNC are required to mitigate diagnostic delay.