Barriers to Timely Surgical Management of Oral and Oropharyngeal Cancers in Northern Nigeria: A Mixed Methods Study

Oral and oropharyngeal cancers carry high mortality in northern Nigeria due to overwhelmingly late-stage presentation and protracted delays from symptom onset to surgical intervention. These delays arise from a complex interplay of patient, provider, and health system factors that have not been comprehensively investigated. This dissertation employs a mixed-methods design to examine barriers to timely surgical management of oral and oropharyngeal cancers in the North West and North East geopolitical zones. A quantitative component analyzed referral and treatment timelines for 200 confirmed cases across four tertiary hospitals from 2019 to 2023, while a qualitative component involved 35 in-depth interviews with patients, family members, traditional healers, and health professionals. The patient interval (symptom onset to first consultation) averaged 14 months. Provider interval (first consultation to surgical referral) averaged 4.8 months. Systemic barriers included absence of endoscopy and biopsy facilities at primary and secondary care levels. Patient-level barriers included reliance on traditional remedies, fear of cancer diagnosis, and financial incapacity. The qualitative data revealed deeply embedded fatalistic beliefs and social stigma surrounding cancer diagnoses in northern communities. An integrated multilevel barrier model is proposed as an original theoretical contribution. The study recommends a Northern Nigeria Oral Cancer Early Detection Initiative with community health worker integration and inter-facility telemedicine pathways. Keywords: oral cancer, barriers to care, oropharyngeal cancer, northern Nigeria, mixed methods