Cultural, social, and healthcare access factors associated with delays in gastric cancer presentation, diagnosis, and treatment: A cross-sectional study.

BACKGROUND: The aim of this study was to identify the time intervals between the demand for health services and the initiation of cancer treatment, and to explore the associated factors, in gastric cancer patients being treated in an oncology hospital in northern Brazil. METHODS: This cross-sectional study. Gastric cancer patients receiving treatment in a northern Brazil reference hospital were interviewed. A Mann-Whitney test was used to verify associations between the time intervals of access to treatment and socioeconomic factors, clinical variables, and patient difficulties, adopting a 0.05 significance level. RESULTS: The average time intervals were 471.3 days between symptom onset and primary health service request and 180.9 days between diagnosis and treatment. The average time between the onset of symptoms and the treatment of gastric cancer was 747.8 days. Patients using herbal home remedies showed the longest times before seeking primary health care (p = 0.04). Delays between diagnosis and treatment were associated with unemployment (p = 0.03). High average times until oncologist appointments were related to the absence of comorbidities (p = 0.004). Personal difficulties and a lack of hospital beds were associated with long time intervals to specialist appointments and between diagnosis and treatment. Personal difficulties were associated with long time intervals between the onset of symptoms and the treatment of gastric cancer. CONCLUSION: Gastric cancer patients faced delays and healthcare access barriers in a region with high mortality for this disease. Appropriate interventions are necessary to reduce delays and better control the disease. POLICY SUMMARY: In this paper we have explored the barriers to access to diagnosis and treatment for patients with gastric cancer in a major cancer centre in Northern Brazil. The results will inform strategies for improving timely access to critical cancer services.

Helicobacter Pylori cagA+ Genotype is Associated With Consumption of Untreated Drinking Water in North-Eastern Brazil.

INTRODUCTION: This study aimed to identify the Helicobacter pylori cagA+ genotype prevalent in a region of north-eastern Brazil and find possible associations between this genotype and socioeconomic variables. METHODS: This cross-sectional study included 751 patients with dyspepsia from a public endoscopy clinic. Genotyping was carried out on 98 samples from gastric tissue with positive urease test for H. pylori using polymerase chain reaction (PCR). Socioeconomic variables were collected via forms. Pearson's χ2 test was used to analyze associations between variables and odds ratios were obtained to compare effects. Statistical significance was defined as p < 0.05 for univariate and multivariate analyses. RESULTS: H. pylori infection was present in 52.7% of the patients and associated with low income and consumption of untreated drinking water. The prevalence of the cagA+ genotype was 25.5%. Low income was inversely related to the presence of cagA+ genotype, even after adjustment. Untreated drinking water consumption was associated with the presence of the cagA+ genotype in both the univariate (p = 0.03; OR = 2.55; 95% CI: 1.008-6.48) and multivariate (p = 0.03; OR = 2.89; 95% CI: 1.08-7.67) analyses. CONCLUSION: The findings of this study suggest that water can be an important vehicle for the transmission of pathogenic H. pylori strains and may be a public health challenge, especially in less developed regions with precarious water and sanitary conditions.