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:Distribution by Sex:

FEMALE 64.7% (188)

MALE 35.3% (102)

TOTAL 100% (290)

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

Top ten cancers as registered by the hospice:

PREVALENCE OF CO-MORBIDITIES:DISEASE HYPERTENSION HIV DIABETES

FREQUENCY 9% 7.6% 6.2%

Distribution by Area of Residence

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)

Distribution by Level of Education:

Distribution by Source of Referral

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.