Abstract
BackgroundCervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country’s first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical.MethodsThis qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women’s and providers’ perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data.ResultsProviders lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking.ConclusionsIn-service provider training should be intensified and should include discussions of cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities are also a priority. Expanded cervical cancer health education should focus on stigma reduction and emphasize a broad, wide-spread risk of cervical cancer.
Highlights
Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year
Few patients had been aware of cervical cancer before they were diagnosed and of those who were aware, many assumed that they were not at risk because they were not sexually active
Our findings suggest the need to intensify in-service training for providers, focusing initially on alerting them to cervical cancer symptoms
Summary
Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. Between 60 and 80% of cervical cancer cases are diagnosed in advanced stages (i.e., stages 3 and 4) [1, 6,7,8,9] Because of these limitations, the global incidence of cervical cancer continues to rise, with the overwhelming preponderance of the burden in low- and middle-income countries, where over 90% of deaths from cervical cancer occur [7, 10, 11]. In Ethiopia, it is estimated that over 6000 new cervical cancer cases and over 4700 cervical cancer deaths occur annually [12] These figures are acknowledged as underestimates due to the absence of systematic immunization or screening programs or a national cancer registry [13]. The plan institutes measures to strengthen diagnosis, referral, and treatment
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