Reliance on Self-Medication Increase Delays in Diagnosis and Management of GI Cancers: Results From Nepal

PURPOSE Patients with GI cancers in Nepal often present with advanced disease and poor outcomes. The purpose of the study was to determine the time to presentation, diagnosis, and treatment of GI cancer and the baseline factors that may be associated with delays. PATIENTS AND METHODS An institutional review board–approved study was performed in Kathmandu, Nepal, from July 2018 to June 2019. Patients with newly diagnosed GI cancers were asked to fill out a standardized questionnaire. Baseline factors such as residence, literacy, and use of self-medication were recorded. Patients were asked to report the time from first symptom to presentation, time from primary care visit to pathologic diagnosis, and time from diagnosis to surgery and/or treatment. Baseline factors were analyzed using 2-tailed t tests (Prism 8.0; GraphPad, La Jolla, CA) to determine whether any factors were associated with longer time delays in these 3 intervals. RESULTS The cohort comprised of 104 patients with a median age of 53.5 years (range, 22-77 years); 61.5% were men, 46.2% had upper GI cancers, and 83.7% presented with stage III or IV disease. The median time to presentation was 150 days, time to diagnosis was 220 days, and time to treatment was 50 days. There was no statistically significant difference in time intervals between upper and lower GI cancers. Use of self-medication (88.5%) was the only factor associated with longer time intervals to presentation, diagnosis, and treatment. CONCLUSION Patients in Nepal have long time intervals to presentation, diagnosis, and treatment of GI cancer. Self-medication led to longer delays. Reasons for self-medication and other potential barriers will be explored in future studies in the hopes of improving outcomes.

[1]  Soni,et al.  Self-medication among Cancer Patients in Mahavir Cancer Sansthan, Patna , 2019, Journal of Clinical & Experimental Pharmacology.

[2]  J. Emery,et al.  Rural–Urban Disparities in Time to Diagnosis and Treatment for Colorectal and Breast Cancer , 2018, Cancer Epidemiology, Biomarkers & Prevention.

[3]  Janak Adhikari,et al.  Earthquakes, Fuel Crisis, Power Outages, and Health Care in Nepal: Implications for the Future , 2017, Disaster Medicine and Public Health Preparedness.

[4]  A. Shrestha,et al.  TB: Barrier in access, diagnosis and treatment completion , 2016 .

[5]  S. Pita-Fernández,et al.  Effect of diagnostic delay on survival in patients with colorectal cancer: a retrospective cohort study , 2016, BMC Cancer.

[6]  V. Tiwari,et al.  Identifying the Factors Causing Delayed Presentation of Cancer Patients to a Government Medical College of Central India. , 2015, Journal of clinical and diagnostic research : JCDR.

[7]  A. Gillis,et al.  A patient-centred approach toward surgical wait times for colon cancer: a population-based analysis. , 2014, Canadian journal of surgery. Journal canadien de chirurgie.

[8]  R. Roetzheim,et al.  Lay Navigator Model for Impacting Cancer Health Disparities , 2014, Journal of Cancer Education.

[9]  G. Ramesh,et al.  Delay in Diagnosis of Upper Gastrointestinal Cancer: whose fault is it? , 2013, The Medical journal of Malaysia.

[10]  S. Tatebe,et al.  Clinicopathologic Characteristics and Prognosis of Gastric Cancer in Young Patients , 2012, Yonago acta medica.

[11]  S. Acharya,et al.  Oncology in Nepal , 2012, South Asian Journal of Cancer.

[12]  Lars Pedersen,et al.  Delay of diagnosis and treatment of colorectal cancer--a population-based Danish study. , 2008, Cancer detection and prevention.

[13]  S. Mousavinasab,et al.  Delay in diagnosis and treatment of gastric cancer: from the beginning of symptoms to surgery--an Iranian study. , 2007, The Turkish journal of gastroenterology : the official journal of Turkish Society of Gastroenterology.

[14]  V. Allgar,et al.  Delays in the diagnosis of six cancers: analysis of data from the National Survey of NHS Patients: Cancer , 2005, British Journal of Cancer.