Symptom attributions by cervical cancer patients attending specialized care at the Uganda cancer institute: a cross-sectional study
Most women in the low- and middle-income countries who develop cervical cancer are diagnosed at advanced stages following symptomatic presentations to healthcare professionals. This study sought to describe the symptoms experienced, symptoms' attributions, and factors associated with the perceived causes of the symptoms among a cohort of cervical cancer patients. This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form for clinical variables in the patients' case notes and analyzed using STATA version 15.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical characteristics associated with perceived causes of symptoms. We report prevalence ratios with accompanying 95% confidence intervals. Prevalence ratios were considered statistically significant when the two-sided p values < 0.05. We collected data from 449 participants, with a median age of 49.0 (IQR = 42-58). More than half of the participants, 59.2% (n = 266) were diagnosed with early-stage (stages 1/2) cancer. Most participants recognized risk factors for cervical cancer as using hormonal family planning 91.3% (n = 410) and having many sexual partners 89.1% (n = 400). Initial symptoms experienced by the patients included vaginal discharge 78.6% (n = 353) and vaginal bleeding in between monthly periods, 48.3% (n = 217). More than half of the patients, 57.2% (n = 257) thought the symptoms experienced were due to sexually transmitted infections (STI), while only 5.6% (n = 25) of patients thought the initial symptoms were due to cancer. The socio-demographic factors significantly associated with the perceptions that symptoms were due to STIs included having formal education, i.e., secondary and tertiary levels of education with adjusted prevalence ratios (aPR) = 1.84(95% CI: 1.38-2.47) and aPR = 1.71(95% CI: 1.20-2.42), respectively, and being formally employed aPR = 1.19 (95% CI: 1.00-1.40). Women ought to be aware that cervical cancer may present as vaginal discharge or vaginal bleeding in between menstrual periods and should therefore seek care promptly when they develop such symptoms. Primary healthcare physicians need to avoid empirical treatment of every woman with vaginal discharge but rather conduct careful evaluations to properly assess the cervix for diagnoses.