Cascade of care for people with positive symptoms of common cancers in selected primary health centres of Puducherry - An explanatory mixed-method study

Sep 21, 2026

Uploaded by Theodora

Cancer is a leading cause of death globally, and delays in diagnosis and treatment can worsen survival, recovery, and treatment costs. This explanatory mixed-method study estimated the proportion seeking timely care among people with early warning signals for oral, breast, and cervical cancers, and examined facilitators and barriers to early detection. Data from 241 participants used medical records and in-depth interviews; findings highlighted screening and referral adherence patterns and identified neglect and family responsibilities as key barriers.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Background & objectives

Methods

Results

Interpretation & conclusions

Indian J Med Res 160, November 2024, pp 457-465 DOI: 10.25259/ijmr_34_24 Original Article Cascade of care for people with positive symptoms of common cancers in selected primary health centres of Puducherry: An explanatory mixed-method study Srijeeta Mitra1, Swaroop Kumar Sahu 1, Subitha Lakshminarayanan1, Kalaiarasi Raja2 & Sunitha V.C.3 Departments of 1Preventive and Social Medicine, 2ENT, & 3Radiodiagnosis, Jawaharlal Institute of Postgraduation Medical Education and Research, Puducherry, India Received January 8, 2024; Accepted October 14, 2024; Ahead of print December, 2024; Published December 23, 2024 Background & objectives: Cancer is a leading cause of death worldwide and constitutes a public health priority. Delays in diagnosis and treatment of cancer can adversely impact survival, recovery, and cost of treatment. The objective of this study was to estimate the proportion seeking timely care among those having early warning signals for oral, breast or cervical cancer and to explore the facilitators and barriers to early detection. Methods: The study was conducted among 241 participants, including those having early signals for selected cancers and women who underwent opportunistic cervical cancer screening in the selected health facilities. Information regarding symptom appearance, presentation to any registered medical practitioner, confirmatory diagnosis, and treatment initiation were obtained from medical records. In depth Interviews (IDIs) were conducted among six participants to explore facilitators and barriers to cancer detection. Results: Among 7300 people screened using the Community Based Assessment Checklist (CBAC), 128 (1.7%) had warning signals for any one of the cancers. The percentage of people who sought medical care for oral, breast and cervical cancer symptoms were 80 per cent, 82 per cent and 57 per cent, respectively. Among those who underwent opportunistic cervical cancer screening in health centres (113), the screen positivity rate was 11 per cent, and adherence to referral for confirmation was 80 per cent. The median pre-diagnostic and diagnostic delays for the three cancers were 79 [Interquartile range (IQR): 44-126] and 27 (IQR: 13-73) days. One individual was diagnosed with oral cancer, and the treatment delay was 27 days. Facilitators identified for early seeking of care were encouragement by family and low-cost treatment at public facilities. Major barriers identified were neglect of symptoms by participants and their responsibilities towards family. Interpretation & conclusions: Although very few people were identified to have early warning symptoms using CBAC, a substantial proportion of them sought medical care and underwent confirmatory diagnosis. Screen positivity rate and treatment-seeking behaviour were better among women undergoing opportunistic cervical cancer screening in the health centres. Measures need to be taken to improve health literacy among people to reduce diagnostic delay for cancers. Key words Cascade of care-common cancer-delay-early detection-India-screening © 2024 Indian Journal of Medical Research, published by Scientific Scholar for Director-General, Indian Council of Medical Research This open access publication is protected under CC-BY-NC-SA 4.0 458 INDIAN J MED RES, NOVEMBER 2024 Cancer is a leading cause of death globally, with approximately 10 million deaths reported in 20201. In India, the age-standardized incidence rate of cancer in 2022 was 98.5 per 100,000 population, with one in every ten individuals expected to develop the disease in their lifetime2. The three most prevalent cancers in India are of breast, lip/oral cavity and uterine cervix2. Together, they account for ~32 per cent of new cancer cases and highlight a significant public health priority2. A study assessing cancer distribution in southern India revealed that the most prevalent cancer among females was breast cancer whi

FAQs

What was the study aiming to assess among people with early warning signals?

It estimated the proportion seeking timely care for early warning signals of oral, breast, and cervical cancers, and explored facilitators and barriers to early detection.

How were data and qualitative insights collected?

Medical records provided information on symptom appearance, presentation, diagnosis confirmation, and treatment initiation. In-depth interviews were conducted with six participants to explore facilitators and barriers.

What were the main barriers and facilitators identified for early care seeking?

Facilitators included family encouragement and low-cost treatment at public facilities. Major barriers were participants’ neglect of symptoms and responsibilities toward their families.

Sep 21, 2026

Uploaded by Theodora