<strong>Background:</strong> In rural South Africa, most patients with oesophageal cancer have delayed presentations with debilitating symptoms and inoperable disease. This study was undertaken to quantify the delay between onset of symptoms and definitive treatment in a cohort of patients in rural South Africa, presenting to a state hospital in KwaZulu-Natal. The study also sought to establish reasons for delays in seeking medical attention and identify ways to encourage earlier presentation.<br /><strong>Methods:</strong> It was a two-armed study of patients with oesophageal cancer seen at Greys Hospital in Pietermaritzburg. One was a retrospective chart review establishing a timeline. The second part was a prospective study between June and November 2012 where data were collected by means of patient interviews.<br /><strong>Results:</strong> One hundred and thirteen charts were reviewed. The time from first symptoms to definitive management ranged from 2 to 14 months (average 7 months). Forty-six patients were interviewed. All experienced dysphagia but 83% were only prompted to seek help after weight loss. The duration of symptoms prior to first clinic or hospital attendance was 0–12 months (average 3 months). The reasons for the delay included the following: 41% of patients did not consider dysphagia a significant symptom, 24% had no money, 19% sought the help of traditional healers first and 15% said the hospital was too far away.<br /><strong>Conclusion:</strong> There are long delays in the management of oesophageal cancer in our setting. The delays are prehospital as well as within the health care system. Lack of knowledge about oesophageal cancer symptoms and limited access to health care contributed to delays in management. Targeted quality improvement interventions are necessary. Patient education and improved referral systems are vital in encouraging earlier presentation.

(1) Oesophageal squamous cell carcinoma is common in Africa and has a male preponderance. The gender-based differences in clinical presentation and risk factor exposure are poorly studied in the African context. Our aim was to compare males and females with this disease. We analyzed the differences in clinical features and risk factor exposure between males and females with oesophageal cancer. (2) Data from patients presenting to a tertiary hospital in South Africa with oesophageal squamous cell carcinoma were analyzed. Data collected included patient demographics, clinical presentation, pathology and risk factor exposure. (3) Three hundred and sixty three patients were included in the study. The male to female ratio was 1.4:1. The mean age was 66 years for females and 61 years for males (p < 0.0001). A significantly larger percentage of males were underweight compared to females (60% vs. 32%, p < 0.001). There were no differences between the genders with regards to performance status, dysphagia grade and duration and tumor length, location and degree of differentiation. There were significant differences between risk factor exposure between the two genders. Smoking and alcohol consumption was an association in more than 70% of males but in less than 10% of females There was no difference survival. (4) Female patients with oesophageal squamous cell carcinoma (OSCC) are older and have a higher body mass index (BMI) than their male counterparts. Traditionally purported risk factors of smoking and alcohol consumption are infrequent associations with OSCC in female patients and other environmental risk factors may be more relevant in this gender.

Background: There are limited prospective data sets on clinical characteristics, stage of presentation and treatment of patients with Oesophageal Squamous Cell Carcinoma (OSCC) in South Africa. This study aimed to assess the frequency and severity of clinical characteristics associated with late presentation of patients with OSCC presenting to a cancer referral centre in KwaZulu-Natal, South Africa. Methods: A prospective consecutive series of patients presenting with confirmed OSCC treated at Greys Hospital in 2016/2017 were enrolled. Data collected included: age, gender, home language, referral centre, clinical and laboratory characteristics: dysphagia score, Eastern Cooperative Oncology Group (ECOG) performance status, body mass index (BMI), serum albumin, tumour pathology and treatment administered. Results: One hundred patients were analysed. Ninety four percent spoke isiZulu. The mean age was 61 with a male to female ratio of 1.5:1 Ninety percent had palliative treatment as their overall assessment precluded curative treatment. Five patients underwent curative treatment. The age standardised incidence (ASR) was 25.2 per 100 000. The factors associated with late presentation and their frequency were: advanced dysphagia grade ( >/=2 in 68%), malnutrition (BMI <18.5kg/m2 in 49%), hypoalbuminaemia (serum albumin < 35 g/l in 70%), poor performance status (ECOG>/=2 in 50% ) and moderate to poor tumour differentiation in 95% of patients. Conclusions: OSCC in Kwazulu-Natal has double the ASR of South Africa and places a significant burden on the region's health care system. Factors associated with late presentation occur in the majority and alone or in combination preclude curative therapies. The frequency of these factors serve as a benchmark for comparison, and reduction in their frequency may indicate effectiveness of interventions designed to improve awareness and access to proper care.