FACTORS ASSOCIATED WITH LATE PRESENTATION OF SYMPTOMATIC CANCERS AMONG HIV INFECTED PERSONS

(A CASE STUDY OF JOS, PLATEAU STATE)

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Author

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Department of Medicine

ABSTRACT
Cancer is a disease defined to be a tissue growth that continues even after cessation of the stimulus that first evoked it. The cancer symbol is synonymous with the animal Crab which has many fingers depicting the multidirectional spread of the disease. Late presentation is the most important factor responsible for high morbidity and mortality due to cancer in Nigeria. Site based studies show the proportion of late stage presentation range between 60-92% in the last 10years. It is predicted that by 2020, new cases of cancer in the world will increase to over 15 million while deaths attributable to cancers about 12 million. Much of the burden of cancer morbidity and mortality will occur in the developing world because of cancer associated infectious diseases of which HIV infection carries a large proportion and late diagnosis of cancer. Nigeria has the second highest HIV burden worldwide, Plateau State ranked 6th in the country sentinel survey of the year 2010. A mixed method study consisting of quantitative and qualitative component, was carried out and data collected. Variables on type of cancer, Patient and health service factors associated with late presentation of cancers among the respondents were carried out. Quantitative data was analyzed using Epi-info version 3.5.3 and Microsoft Excel while thematic analysis was done for qualitative data. There were 503 respondents, males 252(50.1%) and females 251(49.9%). The mean age was 48.7±13.5years. Majority 432(85.9%) of the respondents were married and only 71(14.1%) were single. Approximately 362(74%) of the respondents were self-employed and 141(26%) were government workers. Among the respondents, 401(93%) of them had some education while 37(7.4%) of respondents have not had any formal education. Logistic regression of socio-demographic factors and late presentation of cancer indicated that there was a significant association between Age range 36-45 years OR 2.7, (P=0.0005), Male sex OR 2.5, (P=0.002), Farming occupation OR 1.7, (P=0.0005) and Primary education OR 2.0, (P=0.0005) status of respondents. Religious affiliation was not a significant factor. Kaposi sarcoma 173(31.63%) was the commonest occurring cancer among the respondents. Majority of respondents 349(69%) presented more than six months after onset of symptom. There Initial reaction to health issues was mainly theuse of Alternative remedies 234(46.5) CI 42.1-51.0. The most frequent symptoms among respondents was pain 462(45.70%) followed by swelling 237(23.44%) and skin changes 210(20.77). Waiting time to obtain histological diagnosis from time of presentation to health facility was mainly 3-6months 274(54.47%). Laboratory related issues 199(39.56%) and Long booking time 163(32.40%) were the most common reasons for delay in initiating treatment. Delay occurred at three phases in the study, First was the interval between the patient first noticing a symptom and first consulting a doctor, Second, between first consultation and obtaining histological diagnosis and Third between diagnosis and referral or initiating treatment. In addition to outlining the various points during which factors have influenced time to presentation and referral, considering delay in these phases has enabled identification of areas where interventions can be designed to reduce delay. Key words: Late Presentation, Cancer, HIV/AIDS, Factors.