In this study, we identified two major themes that delineate the journey of women with advanced cervical cancer from the manifestation of initial symptoms to the initiation of treatment at a tertiary healthcare facility: "Personal Attitude: from symptom recognition to seeking healthcare", which encompasses symptom recognition and healthcare-seeking behaviors, and "Weaknesses of the health system: from access to referral", covering issues related to access and referral processes. A deeper understanding of these issues has the potential to guide improvements in the healthcare system, aiming to provide enhanced support for these women and alleviate the impact of this devastating disease.
The participants in this study represent a profile commonly observed among cervical cancer patients. In Brasil, cervical cancer predominantly afflicts women aged between 49 and 59 years who have received incomplete primary education [13]. Numerous studies provide further evidence of the link between cervical cancer and factors such as early initiation of sexual activity, having multiple sexual partners, and experiencing multiple pregnancies [14–16]. Both active and passive smoking have been identified as cofactors that promote cervical oncogenesis [17]. Additionally, women with HIV are at an increased risk of being diagnosed with invasive carcinoma at an advanced stage [18].
The theme "Personal Attitude: from symptom recognition to seeking healthcare" unraveled the complex emotions and perceptions of women as they recognized and responded to their symptoms. Some women described a profound sense of abnormality. For them, these symptoms were alarming, leading to prompt healthcare-seeking behaviors. Others, however, normalized their symptoms, attributing them to routine occurrences like menstrual cramps or hormonal fluctuations. This normalization often led to delayed medical attention. The perception of symptoms as abnormal was also evident in the experiences of cervical cancer survivors in North Carolina, the United States. Upon the onset of symptoms, they had an intuitive sense that something was amiss with their bodies and promptly sought healthcare services [19]. Similarly, studies conducted in Uganda and South Africa revealed that when symptoms appeared, women often turned to their spouses and trusted family members for lay opinions and advice as their first course of action [20, 21]. Findings from studies conducted in Uganda and Ethiopia indicated that some women struggled to connect their symptoms to a potentially serious condition due to their lack of awareness about cervical cancer. Instead, they attributed their symptoms to sexually transmitted diseases like syphilis and gonorrhea, which they believed were acquired from their partners. Additionally, some women associated vaginal bleeding with the natural physiological changes of menopause or hormonal fluctuations resulting from prolonged use of oral and injectable contraceptives [21, 22].
The theme "Weaknesses of the health system: from access to referral" highlighted the challenges women face in accessing timely and appropriate healthcare services. Excessive bureaucratic hurdles, long waiting times, and restricted access to primary healthcare facilities were common obstacles encountered by participants. Numerous studies consistently underscore that women often resort to healthcare services when their symptoms worsen, typically when cervical cancer has already advanced to a critical and intolerable stage, posing a significant threat to their health. This pattern of behavior is prevalent and reflects the widespread belief that healthcare is primarily sought when the disease becomes manifest [16, 21–23]. The healthcare journeys of women dealing with cervical cancer are characterized by substantial challenges in accessing medical services. Many women who turn to primary healthcare facilities encounter excessive bureaucratic hurdles. Medical appointments are typically available by appointment only, and the waiting times are often extensive [24]. The COVID-19 pandemic has had adverse effects on healthcare delivery for various diseases, with notable implications for malignant genital neoplasms. In particular, there has been a significant delay in the diagnosis and treatment of these cancers. Consequently, we anticipate a surge in cases presenting at more advanced stages of the disease, potentially leading to compromised survival rates [25].
Furthermore, participants reported difficulties in their interactions with healthcare professionals. The absence of empathy among healthcare professionals is a prevalent cause of patient dissatisfaction and frustration. Attitudes characterized by indifference have been linked to subpar healthcare quality. Diminished interpersonal skills compromise the delivery of care, hindering the identification of patients' needs. The delayed diagnosis of cervical cancer is often attributed to insufficient knowledge and unpreparedness among healthcare professionals in recognizing the disease's symptoms [26]. Frequently, patients receive initial diagnoses of benign conditions or sexually transmitted infections. With no improvement in their health, women frequently return to healthcare services in pursuit of an accurate diagnosis and effective treatments.
In conclusion, women diagnosed with advanced cervical tumors encounter numerous challenges in their pursuit of comprehensive healthcare. Their diagnostic journey is marked by distress and suffering. Several contributing factors have been identified as key elements in the delayed initiation of treatment. These factors include the normalization of symptoms, obstacles in accessing primary health care, difficulties in establishing effective relationships with healthcare professionals, diagnostic complexities, and issues related to referrals. Addressing these factors is of paramount importance to expedite the diagnosis and treatment of cervical cancer. To proactively tackle the delay in diagnosis, a multifaceted approach is necessary. This should encompass efforts to enhance women's awareness of the signs and symptoms associated with cervical cancer, improve interpersonal dynamics in healthcare interactions, enhance the training and professional qualifications of healthcare providers, and streamline the bureaucratic processes hindering access to tertiary care units. By addressing these critical factors, we can work toward reducing the suffering experienced by women and improve the prospects for early diagnosis and timely intervention in cervical cancer cases.