Predictors of delay in the cervical cancer care cascade in Kampala, Uganda.

BACKGROUND

Cervical cancer is the fourth most common cancer among women with significant global disparities in disease burden. In lower-resource settings, where routine screening is uncommon, delays in diagnosis and treatment contribute to morbidity and mortality. Understanding care delays may inform strategies to decrease time to treatment, improving patient outcomes.

METHODS

We collected sociodemographic, reproductive health and care journey data from 268 Ugandan women newly diagnosed with cervical cancer. We explored the influence of patient, health provider, system, and disease factors on time to presentation (patient interval), diagnosis (diagnostic interval) and treatment (treatment interval) using survival analysis.

RESULTS

Median patient, diagnostic and treatment intervals were 74 days (IQR 26-238), 83 days (IQR 34-229), and 34 days (IQR 18-58), respectively. Patient interval was delayed by belief that symptoms would resolve (aHR 0.37, 95% CI 0.24-0.57), confusion about where to seek care (aHR 0.64, 95% CI 0.47-0.88), and utilization of traditional care (aHR 0.70, 95% CI 0.51-0.96). Patient interval facilitators included perceiving symptoms as serious (aHR 2.14, 95% CI 1.43-3.19) and suspecting cancer (aHR 1.82, 95% CI 1.12-2.97). Diagnostic interval delays included symptomatic bleeding (aHR 055, 95% CI 0.35-0.85) and visiting > 2 clinics (aHR 0.69, 95% CI 0.49-0.97); facilitators included early-stage disease (aHR 1.41, 95% CI 1.03-1.95) and direct tertiary care presentation (aHR 2.13, 95% CI 1.20-3.79). Treatment interval delays included anticipating long waits (aHR 0.68, 95% CI 0.46-1.02) and requiring blood transfusions (aHR 0.63, 95% CI 0.37-1.07); no facilitators were identified.

CONCLUSIONS

We identified potentially modifiable barriers and facilitators along the cervical cancer care cascade. Interventions targeting these factors may improve care timeliness but are unlikely to significantly improve morbidity or mortality. Expanding cervical cancer screening and vaccination are of utmost importance.