Perceived financial barriers and delayed hospital care for breast and cervical cancer in Nigeria: A qualitative study.

Abstract

e13522 Background: Breast and cervical cancers are leading causes of cancer-related morbidity and mortality in Nigeria, with disproportionately poor outcomes in rural communities due to delayed diagnosis and advanced-stage presentation. While financial barriers to hospital-based cancer care are frequently cited, the role of community perceptions and misinformation about hospital costs is less well understood. This qualitative study explored community perspectives on hospital utilization for breast and cervical cancer care in Nigeria. Methods: Qualitative in-depth semi structured interviews were conducted with consenting community leaders, religious leaders, women influencers, policy makers and traditional healers, five in each group and 4 focus group discussions with community women from July to September 2024 in 2 communities in Federal Capital Territory (FCT) Nigeria to explore healthcare-seeking behaviours, perceptions of hospital affordability, and barriers to accessing hospital-based services for breast and cervical cancer screening, diagnosis, and treatment. Data were analysed thematically using an inductive approach and coded using Dedoose software. Results: Participants reported that fear of high hospital costs discourages early hospital visits for breast lumps, abnormal vaginal bleeding, and other symptoms suggestive of breast or cervical cancer. Many residents assume hospitals are unaffordable and therefore delay care or first seek treatment from pharmacies or informal providers. Participants described hospital practices in which patients receive treatment and medications without immediate payment, with fees requested only for accommodation or after recovery; however, awareness of these practices was limited. Transportation challenges, long distances to hospitals, intimidating hospital environments, and fear of hidden charges further compounded delays. Participants emphasized that bringing services closer to rural communities and improving awareness of affordable care options would increase hospital utilization. Conclusions: In Nigeria, perceived financial barriers, compounded by transportation challenges and misinformation, significantly delay hospital-based care for breast and cervical cancer, contributing to late-stage presentation. Community-centred awareness strategies, clearer communication about payment policies, and decentralization of screening and diagnostic services are critical to improving early detection and cancer outcomes, especially in rural settings.