Cancer Reporting and the Perspective of Health Workers on Cancer Management in Delta State, Nigeria: Evidence from a Survey

Cancer Reporting and the Perspective of Health Workers on Cancer Management in Delta State, Nigeria: Evidence from a Survey | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cancer Reporting and the Perspective of Health Workers on Cancer Management in Delta State, Nigeria: Evidence from a Survey Kimoni Ikutegbe, Christiana Akpowowo, Abiodun Egwuenu, Isaac Joseph, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4765237/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Cancer remains a leading cause of mortality worldwide, with Africa experiencing a substantial burden due to inadequate healthcare infrastructure. In 2020, approximately 1.1 million new cancer cases and 711,000 deaths were reported in Africa. In Nigeria, a significant portion of the population is affected by rising cancer incidences, particularly in Delta State. This study aimed to evaluate cancer care quality and identify prevalent cancer types, risk factors, and demographic characteristics of patients in Delta State. Data were collected from four hospitals from 1,659 cancer patients and 138 health workers. The study employed a secondary data analysis design for patient data and purposive sampling for health workers' surveys. Frequencies and proportions were calculated using the R Package. Over the five years, the highest number of cases, 440 (26.5%), were reported in 2020. Females constituted 78.8% of the reported cases, with most patients over 40 years old. Results indicated a high prevalence of breast cancer, 908(54.7%), and cervical cancer, 107(6.4%), among females. Prostate cancer 94(5.7%) was the most common among males, and for both sexes, the most common cancers were colorectal 211(12.7%) and pancreatic cancer 72(4.3%). Health workers reported significant challenges in cancer management, including a lack of trained oncologists, limited treatment options, and inadequate facilities. Most patients presented at advanced stages due to late detection, exacerbating treatment difficulties. The study highlights the urgent need for improved cancer care infrastructure and early detection programs in Delta State. Recommendations include establishing comprehensive cancer management departments, increasing access to diagnostic and treatment facilities, and implementing robust public education campaigns to promote early detection. Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Cancer is the second-leading cause of death in the world, with over 10 million deaths in 2020 (1). According to GLOBOCAN, there were an estimated 19,292,789 cancer cases and 9,958,133 cancer deaths worldwide in 2020 (2). Recent updates from the International Agency for Research on Cancer (IARC) showed that about 1.1 million new cancer cases and 711,000 mortalities were reported in Africa in 2020 (3). There were approximately 801,392 new cases and 520,158 cancer-related deaths in sub-Saharan Africa (4), and these are projected to double by 2040 (3; 5). Cancer is a disease of dysregulated, dysfunctional cell growth that has the potential to spread to other body parts (6; 7). Cancer cells invade nonstop, and their growth happens anywhere in the human body. Cancerous cells can metastasise to distant locations in the body through the blood or lymph system, forming additional tumours and damaging healthy cells. Cancer is a non-communicable disease (8; 9), and the risk factors are associated with lifestyle-related choices and environmental and genetic factors (10). There are many types of cancer, and according to the National Cancer Institute (NCI), the common cancers with high incidence and prevalence rates are female breast cancer, lung and bronchial cancers, prostate cancer, colon and rectum cancers, melanoma of the skin, bladder cancer, non-Hodgkin lymphoma, kidney and renal pelvis cancers, endometrial cancer, leukaemia, pancreatic cancer, and liver cancer (1; 11). The prevalence of different types of cancer varies among countries, reflecting the influence of region-specific risk factors on cancer development. (12; 13) Quality healthcare encompasses a comprehensive assessment, precise diagnosis, prompt and suitable treatment, and appropriate referral for hospital care, including surgical interventions. It ensures diligent patient follow-up and treatment plan adjustment as necessary while adhering to scientific and professional standards (14). Different types of care are available for cancer patients, including curative, palliative, and hospice care. Curative care for cancer serves to cure or promote the recovery from cancer, whereas palliative care in cancer tends to bring comfort and relief from cancer severity and reduce disease progression, while hospice care in cancer serves as comfort and relief to cancer patients with little or no chance of recovery from the disease (15; 16; 17). There are unique challenges with cancer care in the developing world, which include struggles with financing the healthcare system, disparities in access and availability of quality care professionals, abandonment of treatment by patients due to financial constraints, the lack of availability of medical expertise, a lack of awareness and knowledge of cancer, and poverty (18). The effective cancer treatment options recommended by the WHO are often inaccessible to patients in low-resource areas due to several issues, including financial constraints and inadequate care infrastructure, which further worsen the burden of cancer in low- and middle-income countries. (18; 19) In two decades, cancer incidence in low- and middle-income countries (LMICs) is projected to be up to 70% of the global cancer cases if appropriate interventions, including appropriate treatment options, adequate quality care for patients and effective management policies are not promptly implemented (1; 2; 4). The cancer survival rate in developing and low-income countries, such as in Asia and Africa, is strikingly lower when compared to high-income settings (20). A major contributor to this disparity is that cancer research exhibits a notable bias towards high-income countries, resulting in a dearth of relevant studies conducted in LMICs addressing their specific challenges (21). For instance, only 8% of phase 3 trials investigating anti-cancer medications commenced and concluded in LMICs between 2014 and 2017 (20; 22). This discrepancy persists despite the increasing recognition that trial outcomes may not universally apply to diverse populations and national contexts (20). The striking disparity in generating and implementing cancer knowledge within global research is evident. Another factor for the disparity in cancer patient outcomes between high- and low-income nations is that high-income countries have stronger cancer care and palliative care systems than low-income nations, which have insufficient cancer patient care infrastructure (23). Several other challenges, such as superstitious beliefs and poor diagnostic approaches, amongst other issues, contribute to the increase in the number of reported cases at advanced stages- when the prognosis is worse and because of limited treatment options at such stages, the majority of the reported cases are fatal. The cancer problem is far from being solved, even though meaningful progress has been made in high-resource regions due to recent advanced innovations and discoveries in diagnostic and therapeutic procedures (24). Alleviating the burden of cancer patients can be achieved through early identification, accurate identification of biomarkers for targeted therapy, and effective management of disease-associated pain (25; 26). Nigeria, the most populated country in Africa, with approximately 20% of the continent’s population and slightly more than half of West Africa (27), contributes 15% of an estimated 100,000 new cases of cancer occurring every year. The rising incidence of cancer in Nigeria has been associated with population growth, the ageing population, and the adoption of behavioural and lifestyle factors such as tobacco use, alcohol intake, unhealthy diet, and physical inactivity (28). According to GLOBOCAN’s statistics, the top five common cancers in Nigeria are breast, prostate, cervix uteri, colorectal, and non-Hodgkin’s lymphoma (29; 30; 31). Significant advancements have been achieved in treating various cancers, resulting in a notable decline in mortality and morbidity rates among cancer patients in high-income countries (HICs) over the past five decades. Regrettably, the benefits of these advancements remain out of reach for individuals residing in (LMICs) like Nigeria due to resource constraints (1; 32; 33). There is a dearth of relevant studies conducted in LMICs addressing their specific cancer challenges (22). This study was conducted to determine the perspectives of patients and healthcare workers on cancer care in Delta State of Nigeria to determine the types of cancer that affect the people and perception of cancer patients and healthcare workers towards cancer. STATEMENT OF PROBLEM Cancer is a global health concern with profound implications, and it is imperative to assess the quality of care for cancer patients to ensure optimal outcomes. As it is in other parts of the world, certain types of cancer are predominant in some gender and age groups with specific demographic characteristics. The poor quality of care and glaring lack of epidemiological data in this part of the world contribute to why studies on cancer spread are not so effective. Delta State is located in the South-south region of Nigeria and is plagued by the rising incidence of cancer cases. Identifying the common types of cancer and their respective risk factors, as well as the demographic characteristics of the population primarily affected, is essential as it forms the foundation for tailored cancer care strategies. Studies have shown that late presentation at healthcare facilities for screening, lack of proper management options and workable prevention programs are the major factors hindering the progress of cancer care in Africa. In addition, adequate epidemiological data are crucial for understanding the true prevalence, incidence and pattern of cancer in this region. The absence of the above has hampered planning, resource allocation, and formulation of target intervention programs as there is no clear-cut manner to track the trends, evaluate their impact, and assess the effectiveness of cancer care services. This study seeks to give an in-depth analysis of the types of prevalent cancers, the demographic characteristics of those affected, and the perspectives of cancer patients and health workers in Delta State. The findings will inform evidence-based recommendations for improving cancer care in the State while emphasising the need for better data collection, increased awareness and development of more effective prevention and treatment strategies to address the issues relating to cancer in Delta State. SPECIFIC OBJECTIVES To determine the common types of cancers reported in four hospitals in Delta State. To describe the perception of health workers towards cancer management in Delta State. METHODS Study Area Delta State is located in the South-South geopolitical zone of Nigeria and has a population of 4,112,445, The Delta State Hospitals Management Board (HMB) comprises 62 hospitals spread across 25 Local Government Areas (LGAs). The Primary Health Centres are in rural and semi-urban environments, while General Hospitals are in the state capital, LGA headquarters, and a few other metropolitan cities (34). Data for this study were collected from four hospitals in Delta State that provide all three tiers of healthcare services. Lily Hospital Limited Warri is the only private hospital included in this study, and three government hospitals, namely, Central Hospital Warri, Delta State Teaching Hospital Oghara (DELSUTH), and Federal Medical Centre Asaba. Lily Hospital Limited Warri has a network of private healthcare institutions in Nigeria that provide clinical services, advanced medical care, and specialised support services. Central Hospital Warri, located in the Warri South local government area, offers primary care, emergency services, and specialised treatments. Federal Medical Centre Asaba, located at Oshimili South Local Government and Delta State Teaching Hospital Oghara in Ethiope West Local Government Area, are tertiary hospitals and serve as referral centres. The Teaching Hospital is a healthcare facility affiliated with a medical school that contributes to medical education, research, and advanced healthcare services in Delta State. Study Design and Population This study employed hospital-based, purposive sampling for health workers, including doctors, nurses, radiologists, and others, between July 2022 and August 2023. Secondary data analysis was also conducted for patient data retrieved from the medical records from 2018 to 2022 for all ages and sexes. Sampling Our study included hospitals and health workers aged 18 and above, who were purposively selected based on their availability at the hospital on the day of the survey. Participation in this survey was based solely on consent from health workers. Data for the years of interest on cancer cases reported to the four hospitals were collated. Data Management Primary data were obtained from health workers through self-administered questionnaires. Data was collected on the following variables: hospital’s level of care, hospital type(private or government), health worker’s profession, years of experience in clinical practice, availability of a department for cancer patients, available diagnostic tools for patients with cancer in the hospital, commonest stage of the cancer diagnosis, commonest cancer type, challenges with managing cancer patients and the treatment options available to cancer patients in the hospital. Health workers who were interested in participating were asked to read the consent form, sign it, complete the questionnaire, and return both documents to the research assistant. Each returned questionnaire was double-checked manually for completeness and entered into the Microsoft Excel 2016 Package. After entering data from all the questionnaires, the data were cleaned to detect, correct, or exclude outliers. Secondary data were obtained from each hospital's medical records and entered into the Microsoft Excel 2016 Package. Variables of interest were the hospital name - the level of care was deduced from the State’s healthcare registry, the patient’s sex, age, which was also recoded into age group, and cancer diagnosis. The cleaned primary and secondary data were analysed using the R Package, allowing for a comprehensive assessment of healthcare services, cancer diagnoses, treatment options, and associated challenges in the selected hospitals. This approach ensured the collected data were organised, reliable, and suitable for rigorous analysis. Ethical approval Ethical approval for this study was obtained from the Health Research Ethical Committee (HREC) Lily Hospitals Limited and the management of each hospital engaged in this study. Approval was given to use secondary data, i.e., medical records of patients who presented with cancer within the time frame. Informed consent was obtained from all health workers, who signed the form after the consent statement was read to them before interviews commenced. RESULTS Cancer patients From 2018 to 2022, 1,659 patients were diagnosed with cancer in the four hospitals in Delta State. Over the five years, the highest number of cases, 440 (26.5%), were reported in 2020, followed closely by 434 (26.2%) cases in 2021. The fewest cases, 112 (6.75%), were reported in 2018. Regarding the sociodemographic distribution of cases (Table 1), 464 (28.0%) were aged 60 years or older, followed by age groups 50 to 59 and 40 to 49 years. The majority, 1307 (78.8%), of the cancer cases presented at the hospitals were females, with Central Hospital Warri having an all-female-report case profile. Table 1 : Sociodemographic distribution of reported cancer cases in Delta State, 2018 – 2022 (n = 1659) Variable Female(n=1307) Freq(%) Male(n=352) Freq(%) Total(n=1659) Freq(%) Hospital level of care Tertiary 997(76.3) 352(100.0) 1349(81.3) Secondary 310(23.7) 0(0.0) 310(18.7) Sex Female 1,307(78.8) 0(0.0) 1307(78.8) Male 0(0.0) 352(21.2) 352(21.2) Age group (years) 0 - 4 2(0.2) 1(0.3) 3(0.2) 5 - 9 3(0.2) 1(0.3) 4(0.2) 10 - 14 4(0.3) 2(0.6) 6(0.4) 15 - 19 6(0.5) 3(0.9) 9(0.5) 20 - 29 64(4.9) 8(2.3) 72(4.3) 30 - 39 265(20.3) 26(7.4) 291(17.5) 40 - 49 355(27.2) 53(15.1) 408(24.6) 50 - 59 320(24.5) 82(23.3) 402(24.2) >=60 288(22.0) 176(50.0) 464(28.0) Mean age (± S.D.) years 48.6 ± 13.7 58.1 ± 15.9 50.6 ± 14.7 Mean age (± S.D.) years (children only, n = 13)* 7.9 ± 4.3 Cancer diagnosis (children only, n = 13)* Kidney cancer (Nephroblastoma) 3(23.1) Breast cancer 2(15.4) Cervical cancer 1(7.7) Rectal cancer 1(7.7) Colon cancer 1(7.7) Ovarian cancer 1(7.7) Gastric cancer 1(7.7) Skin cancer 1(7.7) Cancer unspecified 2(15.4) Overall, the mean age in years for reported female cancer cases across the years was 48.6 (±13.7) years compared with 58.1 (±15.9) years for males(Figure 2). The mean age for females was consistently lower than that for males, irrespective of hospital level of care and year, except in 2018, when the mean age of male cancer cases was lower than in the secondary hospital. For all sexes, the mean age reported for all cases was lower in secondary hospitals compared to tertiary hospitals. The five most common cancers reported were breast cancer 908(54.7%), colorectal cancer 211(12.7%), cervical cancer 107(6.4%), prostate cancer 94(5.7%) and pancreatic cancer 72(4.3%). Liver cancer and melanoma were the least reported carcinomas over the five-year period. Over the years, breast and cervical cancers were the most common cancers in females, with prostate cancer the most reported in males (Figure 3). Colorectal and bowel cancers were the most reported after breast, cervical, and prostate cancers. Anorectal cancer was reported more in males across the years except in 2018. The male-to-female ratio reporting for bowel cancers was 1:1 across the years. Health workers managing cancer patients Overall, 138 health workers responded to the survey – the majority, 84(60.9%), were from government-owned hospitals and 87(63.0%) from secondary hospitals. Forty-eight (34.1%) health workers had work experience of 5 years or less, and 118 (85.5%) stated that the hospitals did not have a specific department for managing cancer cases (Table 2). The most common cancers seen by health workers were breast, cervical and prostate cancers by 65(29.7%), 34(18.1%) and 28(9.4%), respectively, with 6 out of 10 respondents stating that the cases were often seen at late stages. Half of the health workers stated that cases are detected via history taking and physical examination. The most common challenge with managing cancer patients was the lack of capable hands, different treatment options and equipment, as reported by 50(36.2%) of the health workers. Table 2 : Access to treatment options and challenges faced by health workers managing cancer patients in Delta State, Nigeria (n = 138) Variable Frequency Percent Hospital type Government 84 60.9 Private 54 39.1 Hospital level Secondary 87 63.0 Tertiary 51 37.0 Profession Doctor 90 65.2 Nurse 37 26.8 Others 8 5.8 Radiologist 3 2.2 Years of experience 1-5years 47 34.1 6-10years 37 26.8 11-15years 27 19.6 16-20years 14 10.1 21years + 13 9.4 Institution has a department for cancer management No 118 85.5 Yes 20 14.5 Management of cancer History, physical examination 74 53.6 Diagnostic imaging (CT, MRI, X-ray) 20 14.5 Lab investigation 14 10.1 Pathology (Cytology, Histology) 13 9.4 No response 17 12.3 Treatment options for cancer patients Chemotherapy, surgery 73 52.9 Surgery 31 22.5 Chemotherapy 22 15.9 Chemotherapy, radiation therapy 3 2.2 Others (palliative care) 3 2.2 No report 6 4.4 Most prevalent cancer encountered Breast cancer 65 29.7 Cervical cancer 34 18.1 Prostrate cancer 28 9.4 Colon cancer 3 2.2 Other cancers 19 13.8 No report 13 9.4 Most prevalent cancer stage for presenting patients Late stage 90 65.2 Early stage 23 16.7 Both stages 20 14.5 No response 5 3.6 Challenges managing cancer patient Paucity of oncologists, different treatment options and equipment 50 36.2 Unavailability of treatment equipment 32 23.2 Limited number of health workers trained on cancer care 12 8.7 Lack of different treatment options 9 6.5 Patients’ financial constraint 9 6.5 Late presentation 8 5.8 Limited access to anticancer medications 7 5.1 Others 11 8.0 DISCUSSION Cancer significantly impacts health in Nigeria, presenting a major public health challenge with rising incidence rates and substantial strain on healthcare resources. The limited access to early detection and treatment services in the hospital results in high morbidity and mortality rates, affecting patients, families, and the nation's economy. Addressing this issue necessitates comprehensive strategies that include prevention, early diagnosis, effective treatment, and palliative care. There was a general decline in cancer incidence among people in the second decade and a subsequent rise in the sixth and seventh decades. Noticeably, over 75% of cancer occurred between the ages of 30 and 75 (35). This study's peak incidence corresponds with those observed across other locations in Nigeria, further expanding the relationship between oncogenesis and ageing. Data collected in our study showed that breast cancer was the most common type among females, followed by cervical cancer, while prostate cancer is the most prevalent among older males. Across the globe, breast cancer is the 2nd most commonly diagnosed malignant disease after lung cancer, accounting for 11.6% of all cases, even in Africa (4). This concurs with a 6-year (2014-2019) retrospective study conducted on all histologically diagnosed cancer cases in the State tertiary health care centres in the same (29; 36). Uchendu et al. also reported that more females presented with cancer than males, with a mean age of presentation of 48 years for females, 54 years for males and 50 years for both sexes combined (29; 36). Because the breast is an exposed organ of the body, diseases of the breast are easily noticeable, increasing reporting rates. However, variations across individuals and countries still exist due to differences in several risk factor exposures - lifestyle, genetic susceptibility, and population structure (4). In other Nigerian studies, prostate is the most common cancer reported in males and breast and cervical in females (37), similar to global patterns. As for the males in the survey, prostate cancer was predominant, and it was most common in men aged 61-75. The mean age of cancer diagnosis in males is about 5 years more than that of females. This was also observed in various studies across the country. In Akwa Ibom, it is a mean age of 59.63 male to 45.69 female; Sokoto had 45.77 male to 43.18 female ratio; 49.1 male to 45.4 female in Abuja and Ibadan with 51.1 in male as against 49.12 in female (37; 38; 39). Cervical cancer is another type of malignancy reported to be common among females in this study. Reports across the globe showed a decline in cervical cancer rate as compared to others, accounting for 3.2% of new cases in 2018. The decline has been noticeable in developed countries, leaving Africa with a high burden of the disease (4). The difference in this is due to the invention of preventive strategies like cervical screening in developed nations of the world and HPV vaccination, which is not available in most African nations. Prostate cancer was reported as the most common cancer among males. Worldwide, it is ranked second to lung cancer, with 1.3 million new cases recorded in 2018 (40). As in this study, it is also the most common cancer among males in the US, Europe, Australia and most other Sub-Saharan African countries (4). Colorectal cancer is another common cancer from this survey. About 1.8 million new cases were encountered worldwide in 2018, amounting to 6.1% and ranking 3rd among all cancers (4). The relatively high incidence of colorectal cancer in the survey region, especially at the initial part of the survey, may result from genetics and the rich starch content of the predominant native food. We found that chemotherapy and surgery were the most commonly offered treatment options, with very few sites offering radiation therapy. As of 2016, eight radiotherapy centres—one private and seven public centres—were mapped. At the time of the report, only two centres had functioning radiotherapy machines, and none in Delta State, which is extremely inadequate for managing cancer in Nigeria (41). Chemoradiotherapy is synergistic and allows for dose reduction of each modality, potentially mitigating the side effects of high-dose treatments. The toxicities for both treatments do not overlap, and this combination reduces the chances of cancer resistance (42; 4). This leads to better adherence to treatment regimens and reduces the chances of relapse, improving cancer patients' overall quality of life. Chemotherapy can increase the radiosensitivity of cancer cells, making them more vulnerable to radiation-induced damage, increasing the likelihood of eradicating the primary tumour, and reducing the risk of recurrence by targeting potential micro metastases that may not be addressed by localised radiation alone (43). This is particularly important in the treatment of cervical cancer, a common cancer found in our study, as the concurrent use of cisplatin-based chemotherapy with radiotherapy significantly reduces the risk of distant metastases, a common cause of treatment failure, compared to radiotherapy (44). Limited access to radiotherapy thus poses a key challenge to reducing recurrence rates and improving cancer survival rates in Delta and Nigeria. Even though health workers in these hospitals offered care to cancer patients, there was no cancer treatment centre and access to an oncologist was also limited. Access to quality and affordable care, including cancer screening centres, qualified medical professionals and palliative care services, remains limited in Nigeria CITATION Mao2022 \l 1033 (45) . Nigeria is experiencing an unprecedented shortage of skilled hands in the health sector (46). The ongoing brain drain worsens the health worker-patient gap, which has profound implications for cancer care (47). This shortage means fewer oncologists to diagnose and treat cancer, fewer radiologists to interpret diagnostic imaging, and fewer specialised nurses to provide the required care and support to cancer patients. The remaining healthcare professionals often face overwhelming workloads, leading to burnout and a potential decline in the quality of patient care (48). Additionally, the lack of expertise can hinder the application of new technologies and treatment protocols, such as targeted therapies, further impeding the progress of cancer care in the country, which is even more pronounced in rural and underserved regions. We therefore recommend that the State government intensify public education and awareness campaigns, which are essential for promoting early detection and reducing the late presentation of cancer patients. These campaigns should focus on educating the public about the importance of early cancer detection and recognising the signs and symptoms of common cancers such as breast, cervical, and prostate cancers. Regular screening programs should be established to facilitate early diagnosis, particularly in high-risk populations. Improving access to health insurance schemes for cancer patients and expanding treatment facilities to include diverse options such as chemotherapy, radiation therapy, and palliative care are vital. Additionally, there is a need to invest in advanced diagnostic equipment and implement standardised diagnostic protocols beyond patient history and physical examinations. To sustain improvements in cancer care, ongoing training and professional development opportunities for healthcare workers are necessary. This includes recruiting and training additional staff to address the shortage of capable healthcare workers in oncology. Comprehensive cancer care policies should be developed in collaboration with government bodies to prioritise funding, infrastructure, and research in oncology. Enhancing these diagnostic capabilities and supporting robust data management systems to track cancer cases will lead to more accurate and early detection, significantly improving patient outcomes. These multifaceted efforts are critical to overcoming current challenges and enhancing the overall management and outcomes of cancer patients in Nigeria. This study acknowledges several limitations that may have impacted the comprehensiveness and accuracy of the findings. First, the primary and secondary data collected may be inadequate due to the hospital's record-keeping mechanism. The quality and completeness of the hospital records vary, potentially leading to data gaps. Second, the purposive sampling of the health workers in this study may introduce bias and limit the generalizability of the findings. This approach can lead to an overrepresentation or underrepresentation of certain groups. Additionally, the reliance on self-reported data from health workers managing cancer patients introduces the possibility of response bias. Health workers may inadvertently misreport information due to several factors. Despite these limitations, the study provides valuable insights into the burden of cancers identified in key referral centres and current challenges with caring for patients with cancer and points to areas for improvement. Declarations Conflicts of interest None. Ethics approval and consent to participate Ethical approval for this study was obtained from the Health Research Ethical Committee (HREC) Lily Hospitals Limited and the management of each hospital engaged in this study. Consent for publication Not applicable. Availability of data and materials Data is provided within the manuscript, as datasets were generated and analysed during the current study. Competing interests The authors declare that they have no competing interests. Funding None. Authors' contributions KI, CA: Conceptualization, designing, validation, investigation, resources, data curation, writing—original draft. AE: formal analysis, validation, writing—review and editing. IJ, KO, EE, DU, DE, BE, TN: Validation, writing—review and editing. CE: Editing, supervision. The authors read and approved of this manuscript. References GLOBOCAN 2020 Report on Global Cancer Burden: Challenges and Opportunities for Surgical Oncologists. Deo, S. 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Jedy-Agba, Elima E., et al. 2015, Frontiers in Public Health, Vol. 3. ISSN: 2296-2565. Prostate Cancer Incidence and Mortality: Global Status and Temporal Trends in 89 Countries From 2000 to 2019. Wang, Le, et al. 2022, Frontiers in Public Health, Vol. 10. ISSN: 2296-2565. Barriers to radiotherapy access at the University College Hospital in Ibadan, Nigeria. Anakwenze, Chidinma P., et al. 2017, Clinical and Translational Radiation Oncology, Vol. 5, pp. 1-5. ISSN: 2405-6308. Chemoradiotherapy in Cancer Treatment: Rationale and Clinical Applications. Rallis, Katherine S, Lai Yau, Thomas H.O. and Sideris, Michail. s.l. : International Institute of Anticancer Research, 2021, Anticancer Research, Vol. 41, pp. 1–7. ISSN: 0250-7005. Molecular mechanisms of chemo- and radiotherapy resistance and the potential implications for cancer treatment. Liu, Ya-Ping, et al. 2021, MedComm, Vol. 2, pp. 315-340. Concurrent Cisplatin-Based Radiotherapy and Chemotherapy for Locally Advanced Cervical Cancer. Rose, Peter G., et al. 1999, New England Journal of Medicine, Vol. 340, pp. 1144-1153. Integrative oncology: Addressing the global challenges of cancer prevention and treatment. Mao, Jun J., et al. 2022, CA: A Cancer Journal for Clinicians, Vol. 72, pp. 144-164. High-level policy and governance stakeholder perspectives on health sector reform within a developing country context. Chukwu, Otuto Amarauche and Nnogo, Chinenye Chidinma. 2022, Health Policy and Technology, Vol. 11, p. 100690. ISSN: 2211-8837. An Investigation of Healthcare Professionals’ Motivation in Public and Mission Hospitals in Meru County, Kenya. Muthuri, Rose Nabi Deborah Karimi, Senkubuge, Flavia and Hongoro, Charles. 2020, Healthcare, Vol. 8. ISSN: 2227-9032. Stress Management in Healthcare Organizations: The Nigerian Context. Nwobodo, Ezinne Precious, et al. 2023, Healthcare, Vol. 11. ISSN: 2227-9032. Additional Declarations No competing interests reported. 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Africa","correspondingAuthor":false,"prefix":"","firstName":"Caleb","middleName":"","lastName":"Egwuenu","suffix":""}],"badges":[],"createdAt":"2024-07-18 22:55:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4765237/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4765237/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":64008433,"identity":"314c2d02-4a5c-424f-922e-4e16d4ab039c","added_by":"auto","created_at":"2024-09-04 22:57:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19748,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual trend in cancer cases presenting at four hospitals in Delta State, 2018 – 2022 (n = 1659)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4765237/v1/64a0db95947f69cfffbd860e.png"},{"id":64008435,"identity":"1946e1a7-3f13-4027-9616-f66295b0c705","added_by":"auto","created_at":"2024-09-04 22:57:26","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":76270,"visible":true,"origin":"","legend":"\u003cp\u003eBoxplot of mean ages of reported cancer cases, stratified by sex, hospital type and year of presentation, from 4 hospitals in Delta State, 2018 – 2022 (n = 1659)\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-4765237/v1/cbb0f43832a9af0aa6a4ac50.png"},{"id":64008432,"identity":"5dd95743-6403-4840-b4be-7827ab2e938c","added_by":"auto","created_at":"2024-09-04 22:57:25","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":104224,"visible":true,"origin":"","legend":"\u003cp\u003eCommonest types of reported cancers by sex and year in Delta State, 2018 – 2022 (n = 1659)\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-4765237/v1/cb7cb302a0014c463302c63a.png"},{"id":72171837,"identity":"bdc37911-9f8e-41b6-bd8c-a8b58ac6aa9b","added_by":"auto","created_at":"2024-12-23 11:08:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1096656,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4765237/v1/940ac4fe-dd25-49a2-8630-a19d33aec020.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cancer Reporting and the Perspective of Health Workers on Cancer Management in Delta State, Nigeria: Evidence from a Survey","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCancer is the second-leading cause of death in the world, with over 10\u0026nbsp;million deaths in 2020 (1). According to GLOBOCAN, there were an estimated 19,292,789 cancer cases and 9,958,133 cancer deaths worldwide in 2020 (2). Recent updates from the International Agency for Research on Cancer (IARC) showed that about 1.1\u0026nbsp;million new cancer cases and 711,000 mortalities were reported in Africa in 2020 (3). There were approximately 801,392 new cases and 520,158 cancer-related deaths in sub-Saharan Africa (4), and these are projected to double by 2040 (3; 5).\u003c/p\u003e \u003cp\u003eCancer is a disease of dysregulated, dysfunctional cell growth that has the potential to spread to other body parts (6; 7). Cancer cells invade nonstop, and their growth happens anywhere in the human body. Cancerous cells can metastasise to distant locations in the body through the blood or lymph system, forming additional tumours and damaging healthy cells. Cancer is a non-communicable disease (8; 9), and the risk factors are associated with lifestyle-related choices and environmental and genetic factors (10).\u003c/p\u003e \u003cp\u003eThere are many types of cancer, and according to the National Cancer Institute (NCI), the common cancers with high incidence and prevalence rates are female breast cancer, lung and bronchial cancers, prostate cancer, colon and rectum cancers, melanoma of the skin, bladder cancer, non-Hodgkin lymphoma, kidney and renal pelvis cancers, endometrial cancer, leukaemia, pancreatic cancer, and liver cancer (1; 11). The prevalence of different types of cancer varies among countries, reflecting the influence of region-specific risk factors on cancer development. (12; 13)\u003c/p\u003e \u003cp\u003eQuality healthcare encompasses a comprehensive assessment, precise diagnosis, prompt and suitable treatment, and appropriate referral for hospital care, including surgical interventions. It ensures diligent patient follow-up and treatment plan adjustment as necessary while adhering to scientific and professional standards (14).\u003c/p\u003e \u003cp\u003eDifferent types of care are available for cancer patients, including curative, palliative, and hospice care. Curative care for cancer serves to cure or promote the recovery from cancer, whereas palliative care in cancer tends to bring comfort and relief from cancer severity and reduce disease progression, while hospice care in cancer serves as comfort and relief to cancer patients with little or no chance of recovery from the disease (15; 16; 17).\u003c/p\u003e \u003cp\u003eThere are unique challenges with cancer care in the developing world, which include struggles with financing the healthcare system, disparities in access and availability of quality care professionals, abandonment of treatment by patients due to financial constraints, the lack of availability of medical expertise, a lack of awareness and knowledge of cancer, and poverty (18). The effective cancer treatment options recommended by the WHO are often inaccessible to patients in low-resource areas due to several issues, including financial constraints and inadequate care infrastructure, which further worsen the burden of cancer in low- and middle-income countries. (18; 19)\u003c/p\u003e \u003cp\u003eIn two decades, cancer incidence in low- and middle-income countries (LMICs) is projected to be up to 70% of the global cancer cases if appropriate interventions, including appropriate treatment options, adequate quality care for patients and effective management policies are not promptly implemented (1; 2; 4). The cancer survival rate in developing and low-income countries, such as in Asia and Africa, is strikingly lower when compared to high-income settings (20). A major contributor to this disparity is that cancer research exhibits a notable bias towards high-income countries, resulting in a dearth of relevant studies conducted in LMICs addressing their specific challenges (21). For instance, only 8% of phase 3 trials investigating anti-cancer medications commenced and concluded in LMICs between 2014 and 2017 (20; 22). This discrepancy persists despite the increasing recognition that trial outcomes may not universally apply to diverse populations and national contexts (20). The striking disparity in generating and implementing cancer knowledge within global research is evident. Another factor for the disparity in cancer patient outcomes between high- and low-income nations is that high-income countries have stronger cancer care and palliative care systems than low-income nations, which have insufficient cancer patient care infrastructure (23).\u003c/p\u003e \u003cp\u003eSeveral other challenges, such as superstitious beliefs and poor diagnostic approaches, amongst other issues, contribute to the increase in the number of reported cases at advanced stages- when the prognosis is worse and because of limited treatment options at such stages, the majority of the reported cases are fatal. The cancer problem is far from being solved, even though meaningful progress has been made in high-resource regions due to recent advanced innovations and discoveries in diagnostic and therapeutic procedures (24).\u003c/p\u003e \u003cp\u003eAlleviating the burden of cancer patients can be achieved through early identification, accurate identification of biomarkers for targeted therapy, and effective management of disease-associated pain (25; 26).\u003c/p\u003e \u003cp\u003eNigeria, the most populated country in Africa, with approximately 20% of the continent\u0026rsquo;s population and slightly more than half of West Africa (27), contributes 15% of an estimated 100,000 new cases of cancer occurring every year. The rising incidence of cancer in Nigeria has been associated with population growth, the ageing population, and the adoption of behavioural and lifestyle factors such as tobacco use, alcohol intake, unhealthy diet, and physical inactivity (28). According to GLOBOCAN\u0026rsquo;s statistics, the top five common cancers in Nigeria are breast, prostate, cervix uteri, colorectal, and non-Hodgkin\u0026rsquo;s lymphoma (29; 30; 31).\u003c/p\u003e \u003cp\u003eSignificant advancements have been achieved in treating various cancers, resulting in a notable decline in mortality and morbidity rates among cancer patients in high-income countries (HICs) over the past five decades. Regrettably, the benefits of these advancements remain out of reach for individuals residing in (LMICs) like Nigeria due to resource constraints (1; 32; 33). There is a dearth of relevant studies conducted in LMICs addressing their specific cancer challenges (22). This study was conducted to determine the perspectives of patients and healthcare workers on cancer care in Delta State of Nigeria to determine the types of cancer that affect the people and perception of cancer patients and healthcare workers towards cancer.\u003c/p\u003e\n\u003ch3\u003eSTATEMENT OF PROBLEM\u003c/h3\u003e\n\u003cp\u003eCancer is a global health concern with profound implications, and it is imperative to assess the quality of care for cancer patients to ensure optimal outcomes. As it is in other parts of the world, certain types of cancer are predominant in some gender and age groups with specific demographic characteristics. The poor quality of care and glaring lack of epidemiological data in this part of the world contribute to why studies on cancer spread are not so effective. Delta State is located in the South-south region of Nigeria and is plagued by the rising incidence of cancer cases. Identifying the common types of cancer and their respective risk factors, as well as the demographic characteristics of the population primarily affected, is essential as it forms the foundation for tailored cancer care strategies. Studies have shown that late presentation at healthcare facilities for screening, lack of proper management options and workable prevention programs are the major factors hindering the progress of cancer care in Africa. In addition, adequate epidemiological data are crucial for understanding the true prevalence, incidence and pattern of cancer in this region. The absence of the above has hampered planning, resource allocation, and formulation of target intervention programs as there is no clear-cut manner to track the trends, evaluate their impact, and assess the effectiveness of cancer care services. This study seeks to give an in-depth analysis of the types of prevalent cancers, the demographic characteristics of those affected, and the perspectives of cancer patients and health workers in Delta State. The findings will inform evidence-based recommendations for improving cancer care in the State while emphasising the need for better data collection, increased awareness and development of more effective prevention and treatment strategies to address the issues relating to cancer in Delta State.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSPECIFIC OBJECTIVES\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo determine the common types of cancers reported in four hospitals in Delta State.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo describe the perception of health workers towards cancer management in Delta State.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy Area\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDelta State is located in the South-South geopolitical zone of Nigeria and has a\u0026nbsp;population of 4,112,445, The Delta State Hospitals Management Board (HMB) comprises 62 hospitals spread across 25 Local Government Areas (LGAs). \u0026nbsp;The Primary Health Centres are in rural and semi-urban environments, while General Hospitals are in the state capital, LGA headquarters, and a few other metropolitan cities\u0026nbsp;(34).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData for this study were collected from four hospitals in Delta State that provide all three tiers of healthcare services.\u0026nbsp;Lily Hospital Limited Warri is the only private hospital included in this study, and three government hospitals, namely, Central Hospital Warri, Delta State Teaching Hospital Oghara (DELSUTH), and Federal Medical Centre Asaba.\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLily Hospital Limited Warri has a network of private healthcare institutions in Nigeria that provide clinical services, advanced medical care, and specialised support services. Central Hospital Warri, located in the Warri South local government area, offers primary care, emergency services, and specialised treatments. Federal Medical Centre Asaba, located at Oshimili South Local Government and Delta State Teaching Hospital Oghara in Ethiope West Local Government Area, are tertiary hospitals and serve as referral centres. The Teaching Hospital is a healthcare facility affiliated with a medical school that contributes to medical education, research, and advanced healthcare services in Delta State.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed hospital-based, purposive sampling for health workers, including doctors, nurses, radiologists, and others, between July 2022 and August 2023. Secondary data analysis was also conducted for patient data retrieved from the medical records from 2018 to 2022 for all ages and sexes. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur study included hospitals and health workers aged 18 and above, who were purposively selected based on their availability at the hospital on the day of the survey. Participation in this survey was based solely on consent from health workers. Data for the years of interest on cancer cases reported to the four hospitals were collated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary data were obtained from health workers through self-administered questionnaires. Data was collected on the following variables: hospital\u0026rsquo;s level of care, hospital type(private or government), health worker\u0026rsquo;s profession, years of experience in clinical practice, availability of a department for cancer patients, available diagnostic tools for patients with cancer in the hospital, commonest stage of the cancer diagnosis, commonest cancer type, challenges with managing cancer patients and the treatment options available to cancer patients in the hospital.\u003c/p\u003e\n\u003cp\u003eHealth workers who were interested in participating were asked to read the consent form, sign it, complete the questionnaire, and return both documents to the research assistant. Each returned questionnaire was double-checked manually for completeness and entered into the Microsoft Excel 2016 Package. After entering data from all the questionnaires, the data were cleaned to detect, correct, or exclude outliers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSecondary data were obtained from each hospital\u0026apos;s medical records and entered into the Microsoft Excel 2016 Package. Variables of interest were the hospital name - the level of care was deduced from the State\u0026rsquo;s healthcare registry, the patient\u0026rsquo;s sex, age, which was also recoded into age group, and cancer diagnosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe cleaned primary and secondary data were analysed using the R Package, allowing for a comprehensive assessment of healthcare services, cancer diagnoses, treatment options, and associated challenges in the selected hospitals. This approach ensured the collected data were organised, reliable, and suitable for rigorous analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Health Research Ethical Committee (HREC) Lily Hospitals Limited and the management of each hospital engaged in this study. Approval was given to use secondary data, i.e., medical records of patients who presented with cancer within the time frame. Informed consent was obtained from all health workers, who signed the form after the consent statement was read to them before interviews commenced.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eCancer patients\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom 2018 to 2022, 1,659 patients were diagnosed with cancer in the four hospitals in Delta State. Over the five years, the highest number of cases, 440 (26.5%), were reported in 2020, followed closely by 434 (26.2%) cases in 2021. The fewest cases, 112 (6.75%), were reported in 2018.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding the sociodemographic distribution of cases (Table 1), 464 (28.0%) were aged 60 years or older, followed by age groups 50 to 59 and 40 to 49 years. The majority, 1307 (78.8%), of the cancer cases presented at the hospitals were females, with Central Hospital Warri having an all-female-report case profile. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSociodemographic distribution of reported cancer cases in Delta State, 2018 \u0026ndash; 2022 (n = 1659)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale(n=1307)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFreq(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale(n=352)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFreq(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal(n=1659)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eFreq(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital level of care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e997(76.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e352(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e1349(81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e310(23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e310(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e1,307(78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e1307(78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e352(21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e352(21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e0 - 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e2(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e1(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e3(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e5 - 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e3(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e1(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e4(0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e10 - 14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e4(0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e2(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e6(0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e15 - 19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e6(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e3(0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e9(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e20 - 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e64(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e8(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e72(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e30 - 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e265(20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e26(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e291(17.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e40 - 49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e355(27.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e53(15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e408(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e50 - 59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e320(24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e82(23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e402(24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;=60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e288(22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e176(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e464(28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age\u003c/strong\u003e(\u0026plusmn;\u0026nbsp;S.D.) years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e48.6\u0026nbsp;\u0026plusmn;\u0026nbsp;13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e58.1\u0026nbsp;\u0026plusmn;\u0026nbsp;15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e50.6\u0026nbsp;\u0026plusmn;\u0026nbsp;14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean age\u003c/strong\u003e(\u0026plusmn; S.D.) years (children only,\u0026nbsp;\u003c/p\u003e\n \u003cp\u003en = 13)*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e7.9\u0026nbsp;\u0026plusmn;\u0026nbsp;4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCancer diagnosis (children only, n = 13)*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eKidney cancer (Nephroblastoma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e3(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eBreast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e2(15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eCervical cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eRectal cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eColon cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eOvarian cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eGastric cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eSkin cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.366515837104075%\" valign=\"top\"\u003e\n \u003cp\u003eCancer unspecified\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.529411764705884%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.099547511312217%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.004524886877828%\" valign=\"top\"\u003e\n \u003cp\u003e2(15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eOverall, the mean age in years for reported female cancer cases across the years was 48.6 \u0026nbsp;(\u0026plusmn;13.7) years compared with 58.1 (\u0026plusmn;15.9) years for males(Figure 2). The mean age for females was consistently lower than that for males, irrespective of hospital level of care and year, except in 2018, when the mean age of male cancer cases was lower than in the secondary hospital. For all sexes, the mean age reported for all cases was lower in secondary hospitals compared to tertiary hospitals. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe five most common cancers reported were breast cancer 908(54.7%), colorectal cancer 211(12.7%), cervical cancer 107(6.4%), prostate cancer 94(5.7%) and pancreatic cancer \u0026nbsp;72(4.3%). Liver cancer and melanoma were the least reported carcinomas over the five-year period.\u003c/p\u003e\n\u003cp\u003eOver the years, breast and cervical cancers were the most common cancers in females, with prostate cancer the most reported in males (Figure 3). Colorectal and bowel cancers were the most reported after breast, cervical, and prostate cancers. Anorectal cancer was reported more in males across the years except in 2018. The male-to-female ratio reporting for bowel cancers was 1:1 across the years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth workers managing cancer patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 138 health workers responded to the survey \u0026ndash; the majority, 84(60.9%), were from government-owned hospitals and 87(63.0%) from secondary hospitals. Forty-eight (34.1%) health workers had work experience of 5 years or less, and 118 (85.5%) stated that the hospitals did not\u0026nbsp;have a specific department for managing cancer cases (Table 2).\u003c/p\u003e\n\u003cp\u003eThe most common cancers seen by health workers were breast, cervical and prostate cancers by 65(29.7%), 34(18.1%) and 28(9.4%), respectively, with 6 out of 10 respondents stating that the cases were often seen at late stages. Half of the health workers stated that cases are detected via history taking and physical examination. The most common challenge with managing cancer patients was the lack of capable hands, different treatment options and equipment, as reported by 50(36.2%) of the health workers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Access to treatment options and challenges faced by health workers managing cancer patients in Delta State, Nigeria (n = 138)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"629\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eGovernment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e60.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e39.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospital level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e63.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e37.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfession\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eRadiologist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of experience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e1-5years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e34.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e6-10years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e11-15years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e16-20years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e21years +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eInstitution has a department for cancer management\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e85.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eManagement of cancer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eHistory, physical examination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e53.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eDiagnostic imaging (CT, MRI, X-ray)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eLab investigation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003ePathology (Cytology, Histology)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eNo response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment options for cancer patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eChemotherapy, surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e52.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eChemotherapy, radiation therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eOthers (palliative care)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eNo report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost prevalent cancer encountered\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eBreast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eCervical cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eProstrate cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eColon cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eOther cancers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e13.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eNo report\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost prevalent cancer stage for presenting patients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eLate stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eEarly stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eBoth stages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eNo response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eChallenges managing cancer patient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003ePaucity of oncologists, different treatment options and equipment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e36.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eUnavailability of treatment equipment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eLimited number of health workers trained on cancer care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eLack of different treatment options\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003ePatients\u0026rsquo; financial constraint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eLate presentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eLimited access to anticancer medications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"65.65977742448331%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.170111287758345%\" valign=\"top\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eCancer significantly impacts health in Nigeria, presenting a major public health challenge with rising incidence rates and substantial strain on healthcare resources. The limited access to early detection and treatment services in the hospital results in high morbidity and mortality rates, affecting patients, families, and the nation\u0026apos;s economy. Addressing this issue necessitates comprehensive strategies that include prevention, early diagnosis, effective treatment, and palliative care. There was a general decline in cancer incidence among people in the second decade and a subsequent rise in the sixth and seventh decades. Noticeably, over 75% of cancer occurred between the ages of 30 and 75 \u0026nbsp;(35). This study\u0026apos;s peak incidence corresponds with those observed across other locations in Nigeria, further expanding the relationship between oncogenesis and ageing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData collected in our study showed that breast cancer was the most common type among females, followed by cervical cancer, while prostate cancer is the most prevalent among older males. Across the globe, breast cancer is the 2nd most commonly diagnosed malignant disease after lung cancer, accounting for 11.6% of all cases, even in Africa\u0026nbsp;(4). \u0026nbsp;This concurs with a 6-year (2014-2019) retrospective study conducted on all histologically diagnosed cancer cases in the State tertiary health care centres in the same\u0026nbsp;(29; 36). Uchendu et al. also reported that more females presented with cancer than males, with a mean age of presentation of 48 years for females, 54 years for males and 50 years for both sexes combined\u0026nbsp;(29; 36). \u0026nbsp;Because the breast is an exposed organ of the body, diseases of the breast are easily noticeable, increasing reporting rates. However, variations across individuals and countries still exist due to differences in several risk factor exposures - lifestyle, genetic susceptibility, and population structure\u0026nbsp;(4).\u003c/p\u003e\n\u003cp\u003eIn other Nigerian studies, prostate is the most common cancer reported in males and breast and cervical in females\u0026nbsp;(37), similar to global patterns. As for the males in the survey,\u0026nbsp;prostate cancer was predominant, and it was most common in men aged 61-75.\u0026nbsp;The mean age of cancer diagnosis in males is about 5 years more than that of females. This was also observed in various studies across the country. In Akwa Ibom, it is a mean age of 59.63 male to 45.69 female; Sokoto had 45.77 male to 43.18 female ratio; 49.1 male to 45.4 female in Abuja and Ibadan with 51.1 in male as against 49.12 in female (37; 38; 39).\u003c/p\u003e\n\u003cp\u003eCervical cancer is another type of malignancy reported to be common among females in this study. Reports across the globe showed a decline in cervical cancer rate as compared to others, accounting for 3.2% of new cases in 2018. The decline has been noticeable in developed countries, leaving Africa with a high burden of the disease\u0026nbsp;(4). The difference in this is due to the invention of preventive strategies like cervical screening in developed nations of the world and HPV vaccination, which is not available in most African nations.\u003c/p\u003e\n\u003cp\u003eProstate cancer was reported as the most common cancer among males. Worldwide, it is ranked second to lung cancer, with 1.3 million new cases recorded in 2018\u0026nbsp;(40). As in this study, it is also the most common cancer among males in the US, Europe, Australia and most other Sub-Saharan African countries (4). \u0026nbsp;Colorectal cancer is another common cancer from this survey. About 1.8 \u0026nbsp;million new cases were encountered worldwide in 2018, amounting to 6.1% and ranking 3rd among all cancers\u0026nbsp;(4). \u0026nbsp;The relatively high incidence of colorectal cancer in the survey region, especially at the initial part of the survey, may result from genetics and the rich starch content of the predominant native food.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe found that chemotherapy and surgery were the most commonly offered treatment options, with very few sites offering radiation therapy. As of 2016, eight radiotherapy centres\u0026mdash;one private and seven public centres\u0026mdash;were mapped. At the time of the report, only two centres had functioning radiotherapy machines, and none in Delta State, which is extremely inadequate for managing cancer in Nigeria\u0026nbsp;(41).\u0026nbsp;Chemoradiotherapy is synergistic and allows for dose reduction of each modality, potentially mitigating the side effects of high-dose treatments. The toxicities for both treatments do not overlap, and this combination reduces the chances of cancer resistance (42; 4). This leads to better adherence to treatment regimens and reduces the chances of relapse, improving cancer patients\u0026apos; overall quality of life. Chemotherapy can increase the radiosensitivity of cancer cells, making them more vulnerable to radiation-induced damage, increasing the likelihood of eradicating the primary tumour, and reducing the risk of recurrence by targeting potential micro metastases that may not be addressed by localised radiation alone\u0026nbsp;(43).\u0026nbsp;This is particularly important\u0026nbsp;in the treatment of cervical cancer, a common cancer found in our study, as the concurrent use of cisplatin-based chemotherapy with radiotherapy significantly reduces the risk of distant metastases, a common cause of treatment failure, compared to radiotherapy\u003cstrong\u003e\u0026nbsp;(44).\u0026nbsp;\u003c/strong\u003eLimited access to radiotherapy thus poses a key challenge to reducing recurrence rates and improving cancer survival rates in Delta and Nigeria.\u003c/p\u003e\n\u003cp\u003eEven though health workers in these hospitals offered care to cancer patients, there was no cancer treatment centre and access to an oncologist was also limited. Access to quality and affordable care, including cancer screening centres, qualified medical professionals and palliative care services, remains limited in Nigeria\n \u003c!--[if supportFields]\u003e\u003cspan style='mso-element: field-begin'\u003e\u003c/span\u003e\u003cspan lang=EN-US style='mso-ansi-language:EN-US'\u003e CITATION Mao2022 \\l 1033 \u003c/span\u003e\u003cspan style='mso-element:field-separator'\u003e\u003c/span\u003e\u003c![endif]--\u003e\u003cspan lang=\"EN-US\"\u003e\u0026nbsp;(45)\u003c/span\u003e\n \u003c!--[if supportFields]\u003e\u003cspan style='mso-element:field-end'\u003e\u003c/span\u003e\u003c![endif]--\u003e.\u0026nbsp;Nigeria is experiencing an unprecedented shortage of skilled hands in the health sector\u0026nbsp;(46). The ongoing brain drain worsens the health worker-patient gap, which has profound implications for cancer care (47). This shortage means fewer oncologists to diagnose and treat cancer, fewer radiologists to interpret diagnostic imaging, and fewer specialised nurses to provide the required care and support to cancer patients. The remaining healthcare professionals often face overwhelming workloads, leading to burnout and a potential decline in the quality of patient care\u0026nbsp;(48). Additionally, the lack of expertise can hinder the application of new technologies and treatment protocols, such as targeted therapies, further impeding the progress of cancer care in the country, which is even more pronounced in rural and underserved regions.\u003c/p\u003e\n\u003cp\u003eWe therefore recommend that the State government intensify public education and awareness campaigns, which are essential for promoting early detection and reducing the late presentation of cancer patients. These campaigns should focus on educating the public about the importance of early cancer detection and recognising the signs and symptoms of common cancers such as breast, cervical, and prostate cancers. Regular screening programs should be established to facilitate early diagnosis, particularly in high-risk populations. Improving access to health insurance schemes for cancer patients and expanding treatment facilities to include diverse options such as chemotherapy, radiation therapy, and palliative care are vital. Additionally, there is a need to invest in advanced diagnostic equipment and implement standardised diagnostic protocols beyond patient history and physical examinations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo sustain improvements in cancer care, ongoing training and professional development opportunities for healthcare workers are necessary. This includes recruiting and training additional staff to address the shortage of capable healthcare workers in oncology. Comprehensive cancer care policies should be developed in collaboration with government bodies to prioritise funding, infrastructure, and research in oncology. Enhancing these diagnostic capabilities and supporting robust data management systems to track cancer cases will lead to more accurate and early detection, significantly improving patient outcomes. These multifaceted efforts are critical to overcoming current challenges and enhancing the overall management and outcomes of cancer patients in Nigeria.\u003c/p\u003e\n\u003cp\u003eThis study acknowledges several limitations that may have impacted the comprehensiveness and accuracy of the findings. First, the primary and secondary data collected may be inadequate due to the hospital\u0026apos;s record-keeping mechanism. The quality and completeness of the hospital records vary, potentially leading to data gaps. Second, the purposive sampling of the health workers in this study may introduce bias and limit the generalizability of the findings. This approach can lead to an overrepresentation or underrepresentation of certain groups. Additionally, the reliance on self-reported data from health workers managing cancer patients introduces the possibility of response bias. Health workers may inadvertently misreport information due to several factors. Despite these limitations, the study provides valuable insights into the burden of cancers identified in key referral centres and current challenges with caring for patients with cancer and points to areas for improvement.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eConflicts of interest\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Health Research Ethical Committee (HREC) Lily Hospitals Limited and the management of each hospital engaged in this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript, as datasets were generated and analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eKI, CA: Conceptualization, designing, validation, investigation, resources, data curation, writing\u0026mdash;original draft. AE: formal analysis, validation, writing\u0026mdash;review and editing. \u0026nbsp;IJ, KO, EE, DU, DE, BE, TN: Validation, writing\u0026mdash;review and editing. CE: Editing, supervision. The authors read and approved of this manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cem\u003eGLOBOCAN 2020 Report on Global Cancer Burden: Challenges and Opportunities for Surgical Oncologists. \u003c/em\u003e\u003cstrong\u003eDeo, S. V. S., Sharma, Jyoti and Kumar, Sunil.\u003c/strong\u003e 2022, Annals of Surgical Oncology, Vol. 29, pp. 6497\u0026ndash;6500. 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ISSN: 2227-9032.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4765237/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4765237/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCancer remains a leading cause of mortality worldwide, with Africa experiencing a substantial burden due to inadequate healthcare infrastructure. In 2020, approximately 1.1\u0026nbsp;million new cancer cases and 711,000 deaths were reported in Africa. In Nigeria, a significant portion of the population is affected by rising cancer incidences, particularly in Delta State. This study aimed to evaluate cancer care quality and identify prevalent cancer types, risk factors, and demographic characteristics of patients in Delta State. Data were collected from four hospitals from 1,659 cancer patients and 138 health workers. The study employed a secondary data analysis design for patient data and purposive sampling for health workers' surveys. Frequencies and proportions were calculated using the R Package.\u003c/p\u003e \u003cp\u003eOver the five years, the highest number of cases, 440 (26.5%), were reported in 2020. Females constituted 78.8% of the reported cases, with most patients over 40 years old. Results indicated a high prevalence of breast cancer, 908(54.7%), and cervical cancer, 107(6.4%), among females. Prostate cancer 94(5.7%) was the most common among males, and for both sexes, the most common cancers were colorectal 211(12.7%) and pancreatic cancer 72(4.3%). Health workers reported significant challenges in cancer management, including a lack of trained oncologists, limited treatment options, and inadequate facilities. Most patients presented at advanced stages due to late detection, exacerbating treatment difficulties.\u003c/p\u003e \u003cp\u003e The study highlights the urgent need for improved cancer care infrastructure and early detection programs in Delta State. Recommendations include establishing comprehensive cancer management departments, increasing access to diagnostic and treatment facilities, and implementing robust public education campaigns to promote early detection.\u003c/p\u003e","manuscriptTitle":"Cancer Reporting and the Perspective of Health Workers on Cancer Management in Delta State, Nigeria: Evidence from a Survey","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-04 22:57:21","doi":"10.21203/rs.3.rs-4765237/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"271ec99d-c50f-4a75-b06f-3e57f8356b15","owner":[],"postedDate":"September 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T11:08:36+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-04 22:57:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4765237","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4765237","identity":"rs-4765237","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}