Abstract
<strong>Background:</strong> In rural South Africa, most patients with oesophageal cancer have delayed presentations with debilitating symptoms and inoperable disease. This study was undertaken to quantify the delay between onset of symptoms and definitive treatment in a cohort of patients in rural South Africa, presenting to a state hospital in KwaZulu-Natal. The study also sought to establish reasons for delays in seeking medical attention and identify ways to encourage earlier presentation.<br /><strong>Methods:</strong> It was a two-armed study of patients with oesophageal cancer seen at Greys Hospital in Pietermaritzburg. One was a retrospective chart review establishing a timeline. The second part was a prospective study between June and November 2012 where data were collected by means of patient interviews.<br /><strong>Results:</strong> One hundred and thirteen charts were reviewed. The time from first symptoms to definitive management ranged from 2 to 14 months (average 7 months). Forty-six patients were interviewed. All experienced dysphagia but 83% were only prompted to seek help after weight loss. The duration of symptoms prior to first clinic or hospital attendance was 0–12 months (average 3 months). The reasons for the delay included the following: 41% of patients did not consider dysphagia a significant symptom, 24% had no money, 19% sought the help of traditional healers first and 15% said the hospital was too far away.<br /><strong>Conclusion:</strong> There are long delays in the management of oesophageal cancer in our setting. The delays are prehospital as well as within the health care system. Lack of knowledge about oesophageal cancer symptoms and limited access to health care contributed to delays in management. Targeted quality improvement interventions are necessary. Patient education and improved referral systems are vital in encouraging earlier presentation.
Highlights
There is evidence to suggest that the referral system for acute surgical illness in South Africa is inefficient and this translates into poor outcomes for diseases such as acute appendicitis.[1]
There has not been much research done on the situation with regard to surgical oncology
In this small cohort of South African patients, we have identified a that there is a significant delay from onset of symptoms to provision of definitive care
Summary
There is evidence to suggest that the referral system for acute surgical illness in South Africa is inefficient and this translates into poor outcomes for diseases such as acute appendicitis.[1]. Oesophageal cancer in South Africa is a significant problem. It is responsible for the second highest number of cancer-related deaths in the country and the most common cause of cancer-related mortality in African men.[2] Despite advances in its diagnosis and management, the overall prognosis remains dismal.[3,4,5,6] Most patients present late with inoperable disease and therapeutic interventions are directed at palliation rather than at cure. The objective of this study was to quantify the delay between the onset of symptoms and definitive treatment in our environment and to identify the reasons behind these delays. In rural South Africa, most patients with oesophageal cancer have delayed presentations with debilitating symptoms and inoperable disease. This study was undertaken to quantify the delay between onset of symptoms and definitive treatment in a cohort of patients in rural South Africa, presenting to a state hospital in KwaZulu-Natal. The study sought to establish reasons for delays in seeking medical attention and identify ways to encourage earlier presentation
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