A qualitative exploratory study of delay in the presentation of gastrointestinal cancer

Introduction: Patients with gastrointestinal (GI) cancers often present late in the advanced stages, due to various reasons and may experience delays in treatment. Hence, we have attempted to find the factors leading to this delay. Methods: This was an exploratory qualitative study, in a tertiary care hospital, including 20 patients with advanced GI cancers. They were interviewed to assess the reasons for delays in presentation, diagnosis and treatment, and the factors were analysed based on the interval of delay and the cause. Results: This study found that there was an interval of delay of 8 months from the onset of symptoms till primary treatment, more than half of which occurred in the pre-hospital phase (56.4%). We classified the causes for the delay into different intervals such as the appraisal interval, health-seeking interval, diagnostic interval and the pre-treatment interval. Lapses at the individual, societal and institutional level lead to the delay. The major causes included ignorance, substance abuse, poverty, social stigma, vague symptoms and missed diagnosis, miscommunication, resource constrain, very poor doctor-patient ratio and delay in investigation and treatment. Conclusion: This study noted a significant delay in the treatment of patients with advanced gastrointestinal cancers. Reasons for delay have been noted at various levels. Further action based on this study, at the community and hospital level could potentially reduce the delay and result in better survival and improved quality of life.