Timing of diagnosis and treatment among patients with prostate cancer at the Uganda Cancer Institute

Abstract

Background: Late reporting for diagnosis of prostate cancer is common in Uganda and elsewhere. Many patients don’t recognize its symptoms and therefore report late for diagnosis when the disease is in an advanced stage with incurable tumors. We aimed to estimate the timing of diagnosis and treatment among prostate cancer patients at the Uganda Cancer Institute (UCI) and the associated factors. Methods: This was a cross section study where we reviewed 280 patient records at UCI from January 2016 to December 2017 to calculate the timing of diagnosis. Six key informants and ten in depth interviews were conducted to understand the health seeking behavior of the patients as well as the health system factors influencing prostate cancer diagnosis and treatment. Modified Poisson regression and thematic content analysis were used to identify factors associated with timing of diagnosis and treatment among prostate cancer patients. Results: Majority of the patients (80%) were diagnosed late and their median time to diagnosis was 12 months. Late diagnosis was mainly due to late presentation of the patients to the hospital. Time to seek care was associated with timing of diagnosis and treatment among prostate cancer patients (adjusted PR 1.31, 95% CI 1.10-1.56). Health seeking behavior of an individual was mainly influenced by; regular medical checkup presence of symptoms, use of traditional herbs and screening. Other factors that were found to be influencing timing of diagnosis and treatment were; stigma, cultural beliefs, inadequate human resource, perceived threat by patients, distance to the facility, lack of awareness, cost of treatment and language barrier. Conclusion: Most patients were diagnosed late. Only time to seek care was associated with timing of diagnosis and treatment of prostate cancer. Cultural beliefs and stigma as well as health system factors such as; inadequate human resource, drug stock outs and distance to the facility were found to be important barriers to timely diagnosis of prostate cancer. Efforts to promote early seeking of care such as prostate cancer screening are vital for early diagnosis of prostate cancer.