{
  "abstract": "Introduction Shorter time to diagnosis may lead to better cancer outcomes in Southern Africa. This study measured the time from symptoms to first healthcare visit (patient interval; PI) and diagnosis (diagnostic interval; DI) and associated factors for breast, cervical and colorectal cancer in Zimbabwe and South Africa (SA).Methods A cross-sectional survey collected data on socio-demographics, cancer awareness, barriers to seeking care, symptoms, healthcare visits and diagnosis after recent cancer diagnosis. Cox regression was used to determine factors associated with PI and DI.Results This study included 1021 participants (Zimbabwe 396, SA 625). Symptom and risk factor recall was low. Median PIs were shorter than DIs across cancers and regions. For breast cancer, those reporting more health-seeking barriers had longer PIs (Zimbabwe HR 0.801, 95% CI 0.703 to 0.913; SA HR 0.885, 95% CI 0.817 to 0.958), while greater emotional response to symptoms was associated with a shorter PI (Zimbabwe HR 1.194, 95% CI 1.101 to 1.295; SA HR 1.145, 95% CI 1.079 to 1.216). Interpreting a cervical symptom as serious (Zimbabwe) was associated with a shorter PI. DIs were longer in less-resourced regions and increased with number of healthcare visits before diagnosis. Significantly shorter DIs occurred when the first provider was a clinic doctor or specialist compared with a clinic nurse.Conclusions Efforts to improve timely cancer diagnosis in Zimbabwe and SA should focus on supporting primary healthcare providers in managing and referring symptomatic patients, enhancing cancer symptom awareness and interpretation, and addressing barriers to care.",
  "authors": [
    {
      "affiliations": [
        "School of Public Health, University of Cape Town, Rondebosch, South Africa"
      ],
      "name": "Jennifer Moodley"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University, London, UK"
      ],
      "name": "Suzanne E Scott"
    },
    {
      "affiliations": [
        "School of Public Health, University of Cape Town, Rondebosch, South Africa"
      ],
      "name": "Sarah Day"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe"
      ],
      "name": "Bothwell T Guzha"
    },
    {
      "affiliations": [
        "Bixby Centre for Global Reproductive Health, University of California San Francisco, San Francisco, California, USA"
      ],
      "name": "Zvavahera M Chirenje"
    },
    {
      "affiliations": [
        "Health Economics Unit, University of Cape Town, Rondebosch, South Africa",
        "Health Economics Laboratory, University of Manitoba, Winnipeg, Manitoba, Canada"
      ],
      "name": "John E Ataguba"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University, London, UK"
      ],
      "name": "Dharmishta Parmar"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University, London, UK"
      ],
      "name": "Ekaterina Pazukhina"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University, London, UK"
      ],
      "name": "Jonathan Myles"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University, London, UK"
      ],
      "name": "Valerie A Sills"
    },
    {
      "affiliations": [
        "School of Public Health, University of Cape Town, Rondebosch, South Africa"
      ],
      "name": "Sudarshan Govender"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University, London, UK"
      ],
      "name": "Fiona M Walter"
    },
    {
      "affiliations": [],
      "name": "on behalf of the AWACAN-ED collaborator team"
    }
  ],
  "title": "Time to diagnosis for breast, cervical and colorectal cancer in Zimbabwe and South Africa: a cross-sectional study",
  "uid": "201e8944-b82f-5c2f-9680-0625d816cd4b"
}