Assessment of Total Delays and Their Associated Factors among Breast, Cervical, and Head and Neck Cancers in Northwestern India: A Cross-Sectional Study
- 1Department of Community Medicine, Government Medical Collage, Amritsar (BFUHS), India.
Abstract
Background:: Timely diagnosis and treatment are critical for improving cancer survival; however, significant delays persist across the cancer care continuum, particularly in resource-constrained settings like India. This study aimed to analyze the extent and patterns of delays among patients with breast, cervical, and head and neck cancers in northwestern India.
Methods:: This exploratory cross-sectional study included all histopathologically confirmed cases of the three cancer types who initiated radiotherapy at the Radiotherapy Department of Government Medical College, Amritsar, during December 1, 2023, to November 30, 2024. Data on sociodemographic profiles, clinical details, and treatment timelines were collected through interviews and medical records. Delays were categorized as appraisal, help-seeking, diagnostic, pre-treatment, system, and total delays. Analysis was conducted at the descriptive, bivariate, and multivariable levels. Median delays and interquartile ranges were calculated for each cancer type. Differences in delay intervals between cancer groups were assessed using the Kruskal–Wallis H test, and differences between two-category variables were assessed using the Mann–Whitney U test. Associations between categorical variables and the presence of prolonged total delay (≥120 days) were examined using the chi-square test or Fisher’s exact test, as appropriate. Correlation between total delay and number of medical contacts was evaluated using Spearman’s rank correlation coefficient. Finally, multivariable binary logistic regression was performed to identify independent predictors of prolonged total delay, and adjusted odds ratios with 95% confidence intervals were reported. A p-value of <0.05 was considered statistically significant.
Results:: Among the 119 patients included in the study (45 breast, 28 cervical, and 46 head and neck cancers), breast cancer patients experienced the longest total delay (median: 282 days), followed by cervical (median: 199 days) and head and neck cancers (median: 190 days). System delay was the primary contributor across all three cancer types, driven largely by diagnostic delays. Appraisal delay was longest for breast cancer (median 155.5 days), help-seeking delay was longest for head and neck cancer (median 65 days), and pre-treatment delay was also longest for breast cancer (median 51.5 days). Variations in delays were observed across sociodemographic factors, but none reached statistical significance.
Conclusion:: This study highlights the need for a targeted, cancer-specific approach to address delays, with a focus on strengthening diagnostic services and improving system efficiency within the healthcare infrastructure. Implementing multi-pronged strategies for early detection, timely care, and prevention is crucial in reducing the cancer burden in this high-risk region.
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BibTeX
@article{abraham2026assessment,
title = {{Assessment of Total Delays and Their Associated Factors among Breast, Cervical, and Head and Neck Cancers in Northwestern India: A Cross-Sectional Study}},
author = {Alain Abraham and Sanjeev Mahajan and Preeti Padda and Jasleen Kaur and Sukhmanpreet Kaur Sandhu and Ishaan Khanna},
journal = {Asian Pacific Journal of Cancer Prevention : APJCP},
year = {2026},
month = jun,
doi = {10.31557/apjcp.2026.27.6.2097},
url = {https://doi.org/10.31557/apjcp.2026.27.6.2097},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Assessment of Total Delays and Their Associated Factors among Breast, Cervical, and Head and Neck Cancers in Northwestern India: A Cross-Sectional Study
AU - Alain Abraham
AU - Sanjeev Mahajan
AU - Preeti Padda
AU - Jasleen Kaur
AU - Sukhmanpreet Kaur Sandhu
AU - Ishaan Khanna
PY - 2026
DA - 2026/06/19
JO - Asian Pacific Journal of Cancer Prevention : APJCP
DO - 10.31557/apjcp.2026.27.6.2097
UR - https://doi.org/10.31557/apjcp.2026.27.6.2097
AB - Background:: Timely diagnosis and treatment are critical for improving cancer survival; however, significant delays persist across the cancer care continuum, particularly in resource-constrained settings like India. This study aimed to analyze the extent and patterns of delays among patients with breast, cervical, and head and neck cancers in northwestern India. Methods:: This exploratory cross-sectional study included all histopathologically confirmed cases of the three cancer types who initiated radiotherapy at the Radiotherapy Department of Government Medical College, Amritsar, during December 1, 2023, to November 30, 2024. Data on sociodemographic profiles, clinical details, and treatment timelines were collected through interviews and medical records. Delays were categorized as appraisal, help-seeking, diagnostic, pre-treatment, system, and total delays. Analysis was conducted at the descriptive, bivariate, and multivariable levels. Median delays and interquartile ranges were calculated for each cancer type. Differences in delay intervals between cancer groups were assessed using the Kruskal–Wallis H test, and differences between two-category variables were assessed using the Mann–Whitney U test. Associations between categorical variables and the presence of prolonged total delay (≥120 days) were examined using the chi-square test or Fisher’s exact test, as appropriate. Correlation between total delay and number of medical contacts was evaluated using Spearman’s rank correlation coefficient. Finally, multivariable binary logistic regression was performed to identify independent predictors of prolonged total delay, and adjusted odds ratios with 95% confidence intervals were reported. A p-value of <0.05 was considered statistically significant. Results:: Among the 119 patients included in the study (45 breast, 28 cervical, and 46 head and neck cancers), breast cancer patients experienced the longest total delay (median: 282 days), followed by cervical (median: 199 days) and head and neck cancers (median: 190 days). System delay was the primary contributor across all three cancer types, driven largely by diagnostic delays. Appraisal delay was longest for breast cancer (median 155.5 days), help-seeking delay was longest for head and neck cancer (median 65 days), and pre-treatment delay was also longest for breast cancer (median 51.5 days). Variations in delays were observed across sociodemographic factors, but none reached statistical significance. Conclusion:: This study highlights the need for a targeted, cancer-specific approach to address delays, with a focus on strengthening diagnostic services and improving system efficiency within the healthcare infrastructure. Implementing multi-pronged strategies for early detection, timely care, and prevention is crucial in reducing the cancer burden in this high-risk region.
SN - 1513-7368
SN - 2476-762X
ER -