Unveiling the Curtain of Cancer Delay: Understanding
Factors Influencing Presentation Interval in Malaysia
Ching Ee LOO* 1, Hoon Shien TEH 1, Tshewang GYELTSHEN 2, Wen Yea HWONG 1 and the DEDICATE study group.
1 Centre for Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, Malaysia.
2 Graduate School of Public Health, St. Luke’s International University, Tokyo, Japan.

Introduction

Methodology• Cancer is a global public health burden, with significant disparities
in survival rates and access to care between high-income and lowand middle-income countries (LMICs).1• In Malaysia, it is the fourth leading cause of death. 2• Early detection and prompt presentation are crucial for better
cancer outcomes. 3• This study aims to assess factors associated with prolonged
symptom onset to seeking care for common cancers mainly breast,colorectal, nasopharyngeal, and cervical in Malaysia.

• A multicentre, cross-sectional study across seven public hospitals inMalaysia.
• Involves Malaysian adult patients diagnosed with the following
primary tumours of either breast, cervical, colorectal ornasopharyngeal cancer.
• Data collection through self-administered questionnaires and medicalrecords.
• Prolonged symptom onset to seeking care is defined as an interval of >30 days.
• Sociodemographic characteristics, comorbidities, and health-seeking
behaviours were analysed with descriptive statistics and multivariablelogistic regression.

Results• Among 476 participants, breast cancer was the most prevalent (41.6%),
followed by colorectal (26.9%), nasopharyngeal (22.1%), and cervical(9.5%) cancers.
• The mean age was 55.2 years ± 12.33.
Figure 1. Presentation delay by patient characteristics (N=476)

Ethnicity

140120100806040200MalayChinesePI ≤30 days

IndianPI > 30 days

Others

Education level14012010080
604020• The overall median presentation interval was 66 days (Interquartilerange, IQR: 14 – 180). Increasing age was associated with a lower oddsof presentation delay (OR = 0.95, 95% CI: 0.93 – 0.98).
• Compared to Malay, Chinese patients had 2.34 times higher odds ofdelay in presentation (95% CI: 1.24 – 4.55).
• Patients with secondary or tertiary education were less likely toexperience presentation delay compared to those without formal
education (OR = 0.21, 95% CI: 0.04 – 0.79) and (OR = 0.19, 95% CI: 0.03– 0.88) respectively.
• Individuals earning between RM 3,001 – RM 6,000 had 4.01 times
higher odds of presentation delay compared to those earning morethan RM 6,000. (95% CI: 1.46 – 11.6)
Table 1. The distribution of Presentation Interval by patient characteristics
Characteristics

Odds Ratio (OR)

95% CI

P-value

Age, years
Ethnicity
MalayChinese
IndianOthers
Education level
Tertiary education
Secondary education
No formal educationHousehold income
RM 6,001 and above

0.95

0.93 – 0.98

<0.001

2.34
1.50
0.63

1.24 – 4.55
0.48 – 4.79
0.11 – 3.24

0.010
0.500
0.600

0.19
0.21
-

0.03 – 0.88
0.04 – 0.79
-

0.044
0.032
-

---

RM 3,001 – RM 6,000
RM 1,000 – RM 3,000
RM 0 – RM 999

4.01
1.91
1.71

1.46 – 11.6
0.71 – 5.33
0.55 – 5.54

0.008
0.200
0.400

Discussion and Conclusions

0Tertiary

SecondaryNo formal education
PI ≤30 days
PI > 30 days

Household income

1401201008060• This study identifies age, ethnicity and education level as potential
factors affecting delay in cancer presentation.
• Understanding these factors is crucial for implementing effective
interventions, reducing healthcare burden, and enhancing cancer carein Malaysia.
• Targeted interventions, including awareness campaigns are crucial toaddress prompt symptom presentation barriers and improve cancer
recognition particularly among high-risk groups such as younger
individuals and specific ethnic communities.
Acknowledgement40

We would like to thank the Director General of Health, Ministry of Health Malaysia for his approval to present
this poster. This study was registered with National Medical Research Registry and approved by the Malaysian
Medical Research Ethics Committee with MOH-NIH Grant Award. NMRR-19-727-47742

20References

0RM 6001 andabove

RM 3001-RM
6000
PI ≤30 days

RM1000-RM 3000
PI > 30 days

less than RM
1000

1. World Health Organization (2017) Guide to Cancer Early Diagnosis
2. National Cancer Registry, Natinal Cancer Institute, Ministry of Health Malaysia (2018). Malaysian Study onCancer Survival (MySCan).
3. Loud JT, Murphy J. Cancer Screening and Early Detection in the 21st Century. Semin Oncol Nurs. 2017
May;33(2):121-128. doi: 10.1016/j.soncn.2017.02.002.