Factors Associated with Delayed Presentation of Ovarian Cancer at Teaching Hospitals in the South South Zone

Ovarian cancer is predominantly diagnosed at advanced stage in Nigeria, leading to poor treatment outcomes and high mortality, yet the specific patient-level, provider-level, and system-level factors driving diagnostic delay in the South South zone have not been empirically characterised. This study examines factors associated with delayed ovarian cancer presentation at teaching hospitals in Bayelsa, Rivers, and Akwa Ibom States. A case-control study recruited 90 histologically confirmed ovarian cancer cases and 90 age-matched controls presenting with benign gynaecological pathology at three South South tertiary hospitals. Delayed presentation was defined as first hospital contact occurring six or more months after symptom onset. Structured interviews assessed symptom-to-presentation interval, healthcare provider contact history, knowledge of ovarian cancer symptoms, and sociodemographic characteristics. Delayed presentation was documented in 72 percent of ovarian cancer cases. Significant determinants included absence of symptom knowledge (OR 5.1), initial primary care misdiagnosis (OR 4.3), financial barriers to tertiary care access (OR 3.7), and rural residence (OR 3.2). Symptom normalisation, attributing bloating and pelvic discomfort to dietary or spiritual causes, was identified in qualitative interview narratives. The study advocates for ovarian cancer symptom awareness campaigns targeting South South communities, primary care provider gynaecological oncology training, and referral pathway strengthening. Keywords: ovarian cancer, delayed presentation, South South Nigeria, symptom awareness, diagnostic delay