PATIENT REPORTED BARRIERS TO DIAGNOSTIC AND TREATMENT DELAYS IN NASOPHARYNGEAL CARCINOMA (NPC) IN MULTIETHNIC MALAYSIA
DOI:
https://doi.org/10.37268/mjphm/vol.26/no.2/art.3900Keywords:
Cancer, Social determinants of health, Health system access, Low- and middle-income countries (LMICs), Health risks, Health equity, Nasopharyngeal CarcinomaAbstract
In Malaysia, nasopharyngeal carcinoma (NPC) is frequently diagnosed at advanced stages, but the underlying patient experiences driving diagnostic and treatment delays remain poorly understood. This qualitative descriptive-interpretive study explored the pathway to treatment among 21 NPC survivors recruited at a tertiary cancer center in Northern Malaysia. Semi-structured interview data were analyzed using thematic analysis guided deductively by the Model of Pathways to Treatment (MPT), while allowing inductive insights to emerge. Four major themes spanned the MPT intervals: symptom misinterpretation; work and geographic barriers to help-seeking; provider-level clinical misjudgment and system-level referral fragmentation; and financial toxicity. In the appraisal interval, limited NPC awareness, non-specific symptoms, and culturally familiar explanations reduced the perceived urgency of seeking care. Work obligations, limited labor protections, and distance from specialist services constrained help-seeking; diagnostic progress was further slowed by provider misjudgment and fragmented referrals. After diagnosis, financial toxicity among informal and low-income workers impeded timely treatment initiation. The findings extend the MPT by showing that delay can be recursive, nonlinear, and structurally embedded in multiethnic and low- and middle-income country settings. For Malaysian public health practice, the findings support culturally tailored NPC symptom education, targeted primary-care training and escalation protocols, coordinated referral navigation, and employment and financial support matched to the barriers identified.
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