Correlates of the Stage of Esophageal Cancer at Diagnosis Among Patients: A Mixed-Methods Cross-Sectional Study

Francisca Nagujja,1 Imelda Kyamwanga Tamwesigire,2 Germanus Natuhwera3,4 1Clinical Department, Mobile Hospice Mbarara, Hospice Africa Uganda, Kampala, Uganda; 2Department of Community Health, Mbarara University of Science and Technology, Kampala, Uganda; 3Administration and Clinical Departments, Little Hospice Hoima, Hospice Africa Uganda, Kampala, Uganda; 4Education department, Institute of Hospice and Palliative Care in Africa, Kampala, UgandaCorrespondence: Francisca Nagujja, Email [email protected]; [email protected]: Late-stage presentation is common in patients with esophageal cancer (EC). Sadly, it is a predictor of poor health and survival outcomes in these patients.Aim: To examine the stage of esophageal cancer at diagnosis and associated factors.Setting and Design: A mixed-method cross-sectional study was conducted at a Hospice and Cancer Treatment Center in South western Uganda.Participants: Health workers, caregivers and patients were purposively sampled during their clinic appointments. Patients’ records were consecutively sampled.Methods: Quantitatively, 150 patients’ records were reviewed and analyzed using percentages, chi-square and poison multivariate regression. Qualitatively, 13 key informant interviews were conducted and data were analyzed using thematic analysis.Results: Late stage was found in 79% patients. Tribes and patients who smoked were associated with late-stage [p = 0.011] and [p = 0.017], respectively. Significant correlates of late-stage diagnosis included age ranges 40– 49 (95% CI 0.28– 0.95, p = 0.032), 50– 59 (95% CI 0.39– 0.91, p = 0.016), and 70– 79 (95% CI 0.39– 0.92 p = 0.02), ethnicity (95% CI 4.44– 5.4 p = 0.0001), time between symptom onset and diagnosis of chest pain of 7– 12 months and 13– 18 months (95% CI 1.030– 2.13 p = 0.034; 95% CI, 1.05– 1.92; p = 0.02), time between symptom onset and diagnosis of dysphagia of 13 months and above (95% CI 2.08– 3.5, p = 0.0001). Three major themes emerged: knowledge gaps about esophageal cancer, health system-related barriers and challenges, and the demographic factors of patients.Conclusion: Seventy-nine percent of esophageal cancer patients present in late-stage at diagnosis, more associated with patient’s age, ethnicity, and the time spent with symptoms of chest pain and dysphagia before staging. Furthermore, knowledge about esophageal cancer and health system factors plays a large role in late presentation of patients.Plain Language Summary: Late-stage esophageal cancer is common. Age, ethnicity, and the time spent with symptoms from onset to diagnosis contributed to this presentation. This is also attributed to the challenges in referral networks and knowledge gaps regarding esophageal cancer. This study directs all stakeholders to areas of focus to improve the prevention, early screening, and diagnosis of esophageal cancer.Keywords: correlates, esophageal cancer, factors, late-stage