[Qualitative study of late presentation among patients with cancer in Saudi Arabia]

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Literature Review

During the last 20 years, there has been a rising incidence in the number of patients presenting with advanced cancer in Saudi Arabia, and this has also been seen worldwide (Jones, et al. 1998) (Shah et al. 1997). Late presentation may be due to a delay in seeking medical attention, although results regarding the effect of patient delay on tumor stage are contradictory (Carvalho, et al. 2002) (Allison, et al. 1998) (Amir & Kwan, 1999). Studies showed that 25-30% of patients waited longer than three months before seeking medical care (Amir, & Kwan, 1999) (Vokes & Weichselbaum, 1993). Patients presenting with cancer in an advanced stage need extensive treatment, which may worsen their quality of life and survival after therapy (Vokes & Weichselbaum, 1993). Consequently, the identification of the factors relating to the delay is important for the purpose of preventing late presentations. The factors related to the tumor, e.g. the tumor location and the symptom's type that a patient experiences, also forms the basis for the delay. Additionally, variables relating to the socio-demographic, for instance socio-economic classes were also partly seen responsible for influencing patient delay (Tepp & Koivunen, 2003) (Dhooge, et al. 1996). The patients are most likely to delay in seeking help for the treatment, when they attribute the symptoms of the cancer to ageing (Prohaska et al. 1987).

Patients being treated for cancer are very busy with activities related to their care. Having a regular provider of primary health care usually made it easier for patients to obtain a prompt diagnosis and access to appropriate forms of treatment. Attending appointments for diagnostic testing, specialist consultations, surgeries and treatments was another time consuming dimension of health work (Montazeri, et al. 2003). Women visited numerous sites as their care plans unfolded. Health work and employment did not always fit together well. Patients are often primarily responsible for this. This delays cancer care. Some patients have to deal with so many demands on their time that they delay seeking care until they felt the time was “right”. Low income meant more health work as women searched and applied for various forms of assistance. An impending factor for early detection is patient delay in seeking medical care for head and neck cancer symptoms. Patients with low education and less knowledge about cancer were found to have delayed reporting their disease (Montazeri, et al. 2003).

Six patients had breast cancer; five patients had testicular cancer, six patients with colon cancer, and six patients with melanoma. One patient refused the referral until terminally ill as reported in a study investigating the effect of delays in primary care referral of women with ovarian cancer (Kirwan, et al. 2002). A few patients reported that fear from being told they had cancer, and one patient said she cancelled her appointment (Nooijer, et al. 2000). Although Corner et al attributed the delay to the patients, there is no information about when patients were diagnosed and ...