Abstract 976: Evaluation of causes of late presentation among female cancer patients in a tertiary cancer center in Nepal: Mixed method study
Authors: Shweta Baral, Ashim Khadka, Deep Lamichhane
Journal: Cancer Research (2025)

Abstract Introduction: Gender disparity in cancer diagnosis and treatment is prevalent in LMICs. Late presentation among female cancer patients is of the challenging issue here leading to poorer treatment outcomes. This study is first of kind in Nepal to investigate factors contributing to delayed presentation for treatment. Methodology: A convergent mixed-method design was conducted in a government cancer center to evaluate the factors contributing to the late presentation among female cancer patients with an average age of 54.19 years. The quantitative component surveyed 200 late presenting female cancer patients and 15 patients who were purposefully chosen to participate in a focus group discussion to examine socioeconomic and demographic factors. Descriptive statistics, Chi-square tests and logistic regression were used to identify the factors associated with late presentation. Results: Among the 200 patients surveyed, 88 presented in a locally advanced stage without much symptoms, and 58% patients (116/200) delayed seeking treatment after being symptomatic. Quantitative analysis showed that the following factors were significantly linked to late presentation among delayed treatment seeking patients : rural residency (Odds Ratio [OR] = 2.15, 95% Confidence Interval [CI]: 1.42-3.25), education below 12th grade (OR = 3.76, 95% CI: 2.10-6.72), extended joint family living (OR = 1.85, 95% CI: 1.12-3.04), and unemployment (OR = 2.54, 95% CI: 1.63-3.97). Chi-square analysis also showed significant associations between late presentation and factors like rural residency (p &amp;lt; 0.01), education below 12th grade (p &amp;lt; 0.01), joint family living (p &amp;lt; 0.05), and unemployment (p &amp;lt; 0.01). A majority of late presenters (63.79%, 74/116) hid their symptoms for an average of 15 months, while 24.13% (28/116) postponed their visit due to financial difficulties, and 12.06% (14/116) were ignored by family members until their symptoms worsened. Four major themes emerged from the focus group discussions that contributed to the presentation's delay: 1) fear of destabilizing the family due to illness, 2) financial hardship in covering treatment costs, 3) underestimating the seriousness of symptoms, and 5) fear of abandonment after receiving a cancer diagnosis, especially by spouses and in-laws. Conclusion: This study highlights the need for interventions addressing both the socioeconomic and cultural barriers that delay timely healthcare access for female cancer patients in Nepal. Enhancing community awareness, improving healthcare accessibility, and providing financial support could mitigate the identified challenges, potentially leading to better outcomes for women. Citation Format: Shweta Baral, Ashim Khadka, Deep Lamichhane. Evaluation of causes of late presentation among female cancer patients in a tertiary cancer center in Nepal: Mixed method study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 976.