Delay from Onset of Symptoms to Reporting at a Cancer Care Facility and the Impact of Alternate Medicine Usage as a Contributing Factor

Abstract

Cancer patients often present after a period of certain delay from onset of symptoms. By tradition, alternate medicine has been the commonly sought after remedy for them. The objective of this study was to evaluate the delay in presentation to a cancer care facility, with respect to advanced stage at diagnosis and the use of alternate medicine. A cross-sectional study was undertaken in a tertiary care hospital from eastern India over 5 months where patients with cytological or histological proof of malignancy were interviewed using a pretested questionnaire. Comparative analysis was done with cross tables along with Kruskal–Wallis test for association between delay and the independent variables (demographic parameters and alternate medicine usage). Predictors for delay were assessed with logistic regression analysis. Spearman's rank test was used to measure the direction and strength of correlation of delay and alternate medicine use against stage at presentation. One-thousand twenty-two subjects were interviewed of whom 61.44% presented in advanced stage (either stage III and IV). About 56.1% patients had 4 to 6 months delay, while 19.1% patients presented after more than 6 months. About 27.5% patients had history of initial alternate medicine usage. Progressive increase in subjects presenting in advanced stage was observed with corresponding increase in delay, from 62.63% in more than 1 month delay to 80.48% in more than 3-month delay and 98.47% in those having more than 6-month delay. More of alternate medicine users presented with significant delay versus who did not (96.08 vs. 67.34% for >3 months delay) and the difference further increased with longer delay. About 89.67% of those who had used alternate medicine presented in advanced stage. Among them, this percentage progressively escalated with increase in delay period. Positive correlation between delay (ρ = 0.742 for total sample) and (ρ = 0.592 for alternate medicine users) advanced stage was observed. This study found a considerably high occurrence of delay in presentation among cancer patients after onset of symptoms. This delay was strongly associated with advanced stage at diagnosis and alternate medicine use initially. It provides substantial information to formulate policies for implementing awareness on symptoms of cancer and benefits of its early detection.