EPIDEMIOLOGY OF CANCER IN PATIENTS SEEKING PALLIATIVE CARE AT NAIROBI HOSPICE – NAIROBI, KENYA.
DR. L. W. CUSHNY,
SCHOOL OF MEDICINE,
UNIVERSITY OF NAIROBI.
INTRODUCTION:• Cancer is among the leading causes of
morbidity and mortality worldwide.• GLOBOCAN estimates from 2008 showed 12.7
million cases and 7.6 million deaths from cancer (13% of the worlds deaths)
• Of these, 56% of the cases and 64% of the deaths are from the economically developing world.
Cont..• The overall burden of cancer in the world is
projected to continue rising, particularly in developing countries.
• It is projected that by 2030, the number of new cancer cases and deaths will increase by 69% and 72% to 21.4 million and 13.2 million respectively
• The estimated Incidence and mortality rates for Eastern Africa are 123 and 100 per 100,000 respectively.
JUSTIFICATION• Comprehensive data on the burden and
trends of cancer in most of Sub-Saharan Africa is scarce.
• In Kenya, cancer ranks third as a cause of death after infectious and cardiovascular diseases but data on the same is scarce and inconsistent with the magnitude of the problem.
• There are few population based cancer registries and no cancer surveillance system.
• No similar studies have been published.
MATERIALS AND METHODS 1/2• Study site: Nairobi Hospice located at KNH. • It was the first Hospice facility in Kenya
established in 1990.• It is an outpatient site that provides pain and
relief treatment to cancer patients along with social and psychological support.
• Study Design: This was a retrospective descriptive study – I reviewed 290 records from the patient files and
registers of the patients enrolled by the hospice between 1st Nov 2012 and 30th Oct 2013.
MATERIALS AND METHODS 2/2• Study Period: 4th Nov 2013 – 8th Nov 2013• Study population: Cancer patients attending
hospice for palliative care• Case definition: A cancer patient of any age
presenting to Nairobi hospice for palliative care between Nov 2012 and Oct 2013.
• Specific objectives– To determine the various types of cancers in
patients attending Nairobi hospice.– To characterize the cases in time place and
person.
DATA COLLECTION AND MANAGEMENT• Socio-demographic and cancer data on cancer
cases and deaths was abstracted using a standardized form.
• Data from Nov 2012 to Oct 2013 was abstracted.
• Data entry
– SPSS 17.0 software and Ms Excel 2007 used
• Data analysis
– Means , proportions and frequencies were calculated for categorical and continuous variables
Results…• Median age of the patients: 54 (range:18-
93)years• Mortality rate during the twelve month period
in those attending the hospice for care - 21.5% (62)
• Median duration from diagnosis to first visit to the hospice – 7 months (range =0-231 months)
• Median duration from diagnosis to death-7 months (range= 0- 85 months)
• 60.4 % of the patients had NHIF
Distribution of Forms of Treatment received:
YES NO
RADIOTHERAPY 32.9% (95) 66.4 % (192)
CHEMOTHERAPY 37.0 % (107) 62.3% (180)
SURGERY 37.4% (108) 61.9% (179)
DISCUSSION:• In Kenya there is an estimated 28,000 new cases
each year and 22,000 deaths due to cancer. • The most common cancers among women are
breast, cervical and Oesophagus while the most common in men are Prostrate, Head and Neck and Hepatocellular carcinoma.
• This is somewhat similar to the KEMRI estimates.• According to this study, 80% of cancers occur in
those aged between 30 and 70. This is a reflection of the KEMRI estimate that in the Kenyan population over 60% of those affected are under the age of 70.
• The median survival time is 7 months which is an indication of late diagnosis.
CONCLUSION AND RECCOMENDATIONS:• There is need for setup of cancer care facilities
countrywide in order to increase the rates of early diagnosis and subsequent treatment.
• A majority of the population remains unaware of the disease and IEC materials should be tailored to address the masses in a clear and concise way.
• There is also a need to support research in the field of cancer.