TITLE:
Delayed Presentation of Patients with Gynaecological Malignancies in Kano, North-Western Nigeria
AUTHORS:
Natalia Adamou, Usman Aliyu Umar
KEYWORDS:
Delayed Presentation, Gynaecological Cancers, Nigeria
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.5 No.6,
June
17,
2015
ABSTRACT: The diagnosis and management of gynaecological cancers are still
challenging in low- and middle-income countries. In patients with
gynaecological malignancies delay at any point increases morbidity and
mortality. This study evaluated the factors that may delay presentation,
diagnosis and treatment of patients with malignant gynaecological cancers, and
described the duration of each delay. It was a prospective cross-sectional
study. A total number of 96 patients diagnosed to have gynaecological malignancy
were enrolled in the study between the April 2014 and April 2015. The median
age was 47.5 years (range of 18 - 84 years). The diagnoses on admission were
cervical malignancy 34 (35.42%), ovarian malignancy 32 (33.33%), chorio
carcinoma 15 (15.63%), cancers of uterine body (endometrial and leiomyosarcoma)
10 (10.42%) and vulval malignancies 5 (5.2%). Majority of the patients 65 (67.7%)
presented late at either stage III or IV. At presentation, 36 patients (37.5%)
had severe anaemia; 10 patients (10.41%) had obstructive uropathy; 3 (3.13%)
developed fistula; 19 (19.79%) died on admission from complication of their
disease. Most patients 61 (63.54%) had delayed presentation of more than 90
days (“patients delay”). Time in decision ranged between 3 days to maximum of
2920 days and median of 150 days. 58 (60.42%) gave a reason for such delay as
lack of knowledge of their presenting symptoms, as a warning sign of possible
malignancy; 80 (83.33%) had delay in diagnosis (“doctor delay”); 40 (41.67%)
reported that the medical practitioner did not make referral to the center with
available gynaecological services; “hospital delay” was observed in 66 (68.75%)
of patients. The reason for delayed treatment in 35 (36.46%) of patients was
severe patients condition that warrant stabilization (blood transfusion and
dialysis) and 29 (30.21%) could not afford the treatment. Late presentation is
a great problem in the management of oncological patients in this environment.
High cost of care is the major challenge for the patients and gynaecologist in north-western
part of Nigeria.