Correlates of the Stage of Esophageal Cancer at Diagnosis Among Patients: A Mixed-Methods Cross-Sectional Study.

INTRODUCTION

Late-stage presentation is common in patients with esophageal cancer (EC). Sadly, it is a predictor of poor health and survival outcomes in these patients.

AIM: To examine the stage of esophageal cancer at diagnosis and associated factors.

SETTING AND

DESIGN

A mixed-method cross-sectional study was conducted at a Hospice and Cancer Treatment Center in South western Uganda.

PARTICIPANTS

Health workers, caregivers and patients were purposively sampled during their clinic appointments. Patients' records were consecutively sampled.

METHODS

Quantitatively, 150 patients' records were reviewed and analyzed using percentages, chi-square and poison multivariate regression. Qualitatively, 13 key informant interviews were conducted and data were analyzed using thematic analysis.

RESULTS

Late stage was found in 79% patients. Tribes and patients who smoked were associated with late-stage [p = 0.011] and [p = 0.017], respectively. Significant correlates of late-stage diagnosis included age ranges 40-49 (95% CI 0.28-0.95, p = 0.032), 50-59 (95% CI 0.39-0.91, p = 0.016), and 70-79 (95% CI 0.39-0.92 p = 0.02), ethnicity (95% CI 4.44-5.4 p = 0.0001), time between symptom onset and diagnosis of chest pain of 7-12 months and 13-18 months (95% CI 1.030-2.13 p = 0.034; 95% CI, 1.05-1.92; p = 0.02), time between symptom onset and diagnosis of dysphagia of 13 months and above (95% CI 2.08-3.5, p = 0.0001). Three major themes emerged: knowledge gaps about esophageal cancer, health system-related barriers and challenges, and the demographic factors of patients.

CONCLUSION

Seventy-nine percent of esophageal cancer patients present in late-stage at diagnosis, more associated with patient's age, ethnicity, and the time spent with symptoms of chest pain and dysphagia before staging. Furthermore, knowledge about esophageal cancer and health system factors plays a large role in late presentation of patients.