Delays to Cancer Care, Exploring the Factors Associated with Barriers to Accessing Comprehensive Cancer Care in Eswatini: A Qualitative Study

Abstract

Background: Cancer care in low-middle income countries is very poor. About 85% of preventable cancers such as cervical cancers are contributing factors to mortality rate which is 18 times higher in low middle-income countries. This is partly due to observed delays and underutilization of prevention, diagnosis, and treatment services in developing countries, and delays in seeking health care when symptoms start or inadequacy or lack of services. Similar trends in delays are observed in Eswatini, and this study was conducted to identify the causes of such delays in Eswatini. Methods: A qualitative phenomenological study was conducted among cancer survivors and health workers. Focused group discussions were conducted among the cancer survivors from all four regions in the country using a focus group discussion topic guide. The health workers were enrolled as key informants and face-to-face interviews were conducted using a key informant interview guide. The key informants were hospital managers such as Hospital Administrators, Hospital Matrons, and Hospital Senior Medical Officers from all major hospitals and health centres in the country. Results: The findings showed that causes of cancer delays were due to patient related delays which include fear of cancer diagnosis and denial that led to delay in seeking care; shock, disbelief, and fear at time of diagnosis which delayed use of treatment services. Part of the delays were due to health system related delays which include lack of knowledge by health care workers; inadequacy of infrastructure and skill for delivering cancer services in the health system; delays in being (properly) diagnosed and treated for cancer. Conclusion: Cancer care delays in Eswatini relate to both the patient and the health system. These findings should be using in developing strategies to improve cancer care in Eswatini and to replan cancer programs so that they meet the needs of cancer patients.