Abstract 5511: Cancer care-seeking patterns in Kumasi, Ghana
Authors: Silpa S. Thaivalappil, Mawuli Gyakobo, Baffour Awuah, Ernest B. Osei-Bonsu, Evelyn M. Jiagge, Amr S. Soliman, Sofia D. Merajver
Journal: Cancer Research (2012)

Abstract Background and Objective: Data from each of the 32 sentinel hospitals within the 10 regions of Ghana indicate that cancer is among the top ten causes of death in the country and it also appears to be on the rise. Barriers that delay detection and treatment of cancer compound the untoward consequences of this rising incidence. Over 80% of cancer patients at Komfo Anokye Teaching Hospital (KATH) in Kumasi present to the hospital in Stage III or later, and data indicate that even those relatively rare patients who are identified through detection and screening in Ghana still present late to the hospital. Thus, understanding and addressing the causes of delayed or dropped treatment appears to be important steps that will guide policies for early detection and treatment. We conducted this study to identify the care-seeking and referral patterns of cancer patients before arriving at and within KATH to reach specialized cancer treatment. Methods: Semi-structured interviews with cancer patients were conducted between June-July 2011 at the Oncology Directorate at KATH, which is one of Ghana's two National Centers for Radiotherapy and Nuclear Medicine. Patients were asked about their care-seeking patterns from the beginning of their symptoms until their arrival at the Oncology Directorate, and about the barriers they faced during their care-seeking process. Abstraction of relevant clinical data from patient medical records was done to complement and validate data from the interviews. Preliminary Results: We attempted 224 interviews, with a final eligible sample size of 216 completed interviews. Over 56% of those interviewed were new patients first seen in the Oncology Directorate in 2011. Nearly 78% of the patients were females, consistent with the gender distribution of the Directorate. The most common cancers in our sample were: cervical and uterine (32.71%), breast (27.10%), head and neck (16.36%) and prostate (4.67%), approximately reflecting the different tumor types diagnosed in the Directorate overall. Patients interviewed came from all ten regions of Ghana, with 65.7% from the Ashanti region in which KATH is located. Patients reported visiting an average of 2 facilities before arriving at KATH, with an average time between initial symptoms and the first point of care being 4 months and a range of less than one month to over 6.5 years. Conclusions: Preliminary results suggest that the care-seeking patterns of cancer patients in Ghana might differ from what is commonly believed, with approximately 7% of the respondents reporting that they visited the facility of a traditional healer, herbalist or faith healer. Moreover, system-related delays may play a larger role in delayed care compared to patient-related delays. Further analysis from this study are ongoing and will help identify factors that impact the delay between the onset of cancer symptoms and presentation to treatment facilities and also factors that are amenable to modification within the Ghanaian health system. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5511. doi:1538-7445.AM2012-5511