Delayed Health-seeking Among Women With Advanced Breast Cancer at the Cancer Treatment Centre at Kenyatta National Hospital

Abstract

Background: Eighty percent of women with breast cancer in Sub-Saharan Africa are diagnosed at an advanced stage (stage III and IV) of the disease. The stage at diagnosis is critical in determining survival rates with better prognosis among those diagnosed at earlier stages. In Kenya, the prevalence of breast cancer is estimated at 7% with most being diagnosed in advanced stages. Despite the various campaigns carried out to improve knowledge about breast cancer, diagnosis of the disease at late stages is still problematic. Objective: This research aimed to determine the reasons for delayed health-seeking among women with advanced breast cancer at the Cancer Treatment centre at Kenyatta National Hospital (KNH). Methodology: This was a cross-sectional descriptive study that employed a generic qualitative approach carried out among women with advanced breast cancer. The sample size was determined by saturation of data which was achieved. Purposive sampling was used to select the study participants. An interview guide was used to collect data. Pretesting of the study tools was done in the female oncology wards of KNH. Findings obtained from the study were analyzed into themes and presented in narration format. Poignant quotes were selected and presented in italics to support the themes. Ethical approval was sought from Kenyatta National Hospital-University of Nairobi Ethics and Research Committee and permission to conduct the study from the hospital management. The study findings will be shared with hospital management, the university and published in peer-reviewed journals. Results: Fourteen women were interviewed with an age range of 28 – 65 years. Out of the fourteen, twelve were diagnosed at stage III while two were diagnosed at stage IV. Delay time ranged from 3 - 12 months. Breast lump was the first symptom identified by most women. Since these symptoms did not affect their daily functions they were labeled as not serious and not requiring medical attention. Misdiagnosis, poor communication about the required investigations led delay in seeking medical care. The trigger to seek medical help was the worsening of their symptoms such that their daily functions were affected. At this stage, the women were willing to do whatever was required to access healthcare. Conclusion: Women considered their breast symptoms as not requiring medical attention until they got worse despite having been exposed to breast cancer health messages. The distress brought about by these worsening symptoms provoked them to urgently seek care and this is what set the women on the health-seeking journey. As the women sought medical help, their experiences and engagement with health care providers influenced the time taken to arrive at the Cancer Treatment center for treatment. Recommendation: Opportunities at any point these women present in the hospital need to be explored to educate women with an emphasis on screening and early presentation of symptoms. 1