Factors related to the late presentation of women with vulvar cancer
Thesis (MMed)--Stellenbosch University, 2018.
Background Vulva cancer is increasing in incidence and becoming more prevalent amongst younger women. Over 50% of patients present with advanced stage disease at Tygerberg Hospital. The prognosis for late stage vulvar cancer is poor and the treatment has a high morbidity. The reasons for delayed presentation of cancer include a lack of knowledge about the disease, financial constraints, psychosocial factors, transport and access to health care. Objective To determine the reasons behind the late presentation of patients with vulva cancer at Tygerberg Hospital and to propose strategies to reduce avoidable factors, both patient-related and within the health care system, leading to the delay in diagnosis. Methods This prospective cohort study included all women presenting to the Tygerberg Oncology unit with a new diagnosis of histologically confirmed vulvar carcinoma between November 2015 and December 2016. An interview was conducted and a questionnaire completed. Data obtained included demographic, social, health seeking behavior, disease and transport related factors. Descriptive statistics were reported and comparisons between early and late stage disease were calculated using Microsoft Excel version 14 and Social Science Statistics Calculators. Results Fifteen of the 30 patients interviewed presented with early vulva cancer (FIGO stage 1 or 2), and 15 patients presented with late stage disease (FIGO stage 3 or 4). The youngest patient was 28 years old and the oldest patient in the study was 72 years. There were no significant differences noted between the early and late stage disease with regards demographic, social or transport factors. There was no correlation between the size of the vulva lesion and delay in presentation. Nineteen patients (63.3%) used alternative modalities before seeking help from a health care worker. Although 21 (70%) women had a gynecological examination at the primary health facility, many were treated with antibiotics or creams before a definitive diagnosis was made. Nineteen patients (63.3%) made 4 or more visits to the primary health care facility before being referred to Tygerberg Hospital for management. Conclusion A delay of diagnosis of vulva cancer can be attributed to patient delay in the lack of recognition and interpretation of seriousness of the symptoms of vulvar cancer. Similar to the available literature, a system delay was also noted on the part of the primary health care practitioner. Educating women about this once rare disease and raising suspicion in health care workers regarding the presentation of vulva cancer might aid in earlier health seeking behavior, a prompter biopsy and prevent delayed diagnosis.
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