Assessing the covariates of delay in seeking health care among patients with oral and oropharyngeal squamous cell carcinoma in Tanzania.

BACKGROUND

The 5-year survival rate for advanced-stage oral and oropharyngeal squamous cell carcinoma (OPSCC) is as low as 20%. The poor prognosis of OPSCC in Tanzania is attributed to delays in diagnosis and treatment. This study aimed to assess the patients’ perceived reasons for delay and the magnitude of delay in attending for care and diagnosis among OPSCC patients in Tanzania.

METHODS

A cross-sectional study was conducted at the Muhimbili National Hospital, in Tanzania. Information on delay in healthcare seeking was collected from 236 OPSCC patients. Magnitude of delay was recoded from initial symptom(s) to first consultation (Primary delay, PD), from first consultation to diagnosis (Secondary delay, SD), and from initial symptom(s) to diagnosis (diagnostic delay, DD). Factors contributing to PD and SD were recorded. Logistic regression analysis was conducted to identify the association of covariates with delays. The statistical significance was decided at p < 0.05.

RESULTS

Out of 236 OPSCC patients, 61% (n = 144) were males, and the mean age was 57.4 years. Primary delay (PD) had a median of 16 (IQR 4–20) weeks, with 86% delaying beyond 90 days. The median (range) of Secondary delay (SD) and diagnostic delay DD were 4 (IQR 2–10) weeks and 29 (IQR 10–64) weeks, respectively. Up to 89.4% of OPSCC patients perceived initial lesions as indolent and less worrisome. Factors contributing to PD were: lack of awareness (99.3%), lack of funds (75.8%), negligence (72.9%), and use of alternative therapies (56.8%). The use of alternative medicines, inadequate capacity to detect OPSCC by Primary Health Care Clinicians (PHCC), and the referral challenges were the main contributors to the SD. The covariates of PD were low financial capacity (aOR 2.474, 95% CI 1.076–51.684), while being single (aOR 0.379, 95% CI 0.161–0.888), and having poor Karnofsky Performance Scale (KPS) scores (aOR 0.320, 95% CI 0.106–0.968) were associated with a lower likelihood of PD.

CONCLUSION

Lack of awareness, financial constraints, and reliance on alternative medicine were major contributors to both primary and secondary delays, ultimately prolonging diagnostic delay. Raising community awareness, early detection of OPSCC lesions, and streamlining of referral process can assist in reducing delays.