Document Type : Original Article
Authors
1 Department of Preventive and Community Oncology, Malabar Cancer Centre (Post Graduate Institute of Oncology Sciences and Research), An autonomous institution under the Health and Family Welfare Department, Government of Kerala. India
2 Sree Chitr Tirunal Institute for Medical Sciences and Technology
Abstract
Background
Oral cancer is one of the most common cancers in India and south-central Asia. It is often presented at late stages leading to poor treatment outcome and survival. The reasons for increased diagnostic interval in oral cancer are not fully understood. The objective of the present study was to identify the various factors associated with delayed presentation and diagnosis of oral cancer.
Methods
This qualitative study used the thematic analysis approach (Brown and Clark) to understand the diagnostic journey in oral cavity cancer patients in northern Kerala, India in 2020. In-depth interviews were conducted with 30 participants comprising oral cancer patients, healthcare providers, community leaders, and healthcare administrators selected using purposive sampling. In-depth interview checklists were prepared based on the preliminary quantitative study. Data were collected using direct patient interviews with the participants until data saturation. Data were analyzed using the method proposed by Brown and Clark.
Results
Five main categories were identified: 1) Individual-level factors, 2) Interpersonal factors, 3) Organizational factors, 4) Community-level factors, and 5) Policy factors. Sub-categories under Individual-level factors include Education, Income, Occupation, Fear, Symptom awareness, Health-seeking behaviors, and Denial. Sub-categories under Interpersonal factors consist of Financial Dependence, Communication, and Marital status. Access, Availability, and Affordability were the subcategories under the organizational-level factors. Social support and trust in the system were the subcategories under community-level factors. Sub-categories under the policy-level factors include Social security measures and Decentralization of care.
Conclusion
The findings indicate that various Individual, Interpersonal, Organizational, Community, and Policy-level factors were related to the diagnostic journey in oral cancer. Throughout the cancer diagnostic journey, the patient interacts with family, friends, and care providers regularly, and is influenced by community norms and healthcare policies. These interactions and influences affect the presentation and diagnosis in oral cancer patients.
Keywords
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