Epidemiology of Cancer in Patients Seeking Palliative Care in Nyeri Hospice, Nyeri

County-Kenya, 2011-2012

Dr Nelson MuriuKenya Field Epidemiology and

Laboratory Training Program (KFELTP)18th November 2013

Global Burden of Cancer• A Leading cause of morbidity and mortality

worldwide –Annual incidence estimated at 10 million

• Accounted for 7.9 million deaths in 2009– > 70% of all cancer deaths occur in low and

middle-income countries

• By 2030, cases and deaths will increase by 69% and 72% respectively

Cancer in Kenya• Ranked 3rd leading cause of death • Causes 7% of total national mortality every year• Annual incidence ~28,000 cases • Annual mortality >22,000• Only two population-based registries exist

(regional)• National cancer control strategy (2011-2016)

developed–Strengthen cancer prevention and control in

various sectors– Investment in cancer awareness, human

resource, equipments, surveillance and research

Justification• Comprehensive data on the burden and

trends of cancer lacking in most sub Saharan Africa

• Data on cancer in Kenya are limited yet research is a key pillar in the national cancer control strategy

• No similar studies have been published in Central Kenya

Objectives

–To determine the various types of cancers in patients attending Nyeri Hospice in Central Kenya

–To characterize the cases in time, place and person

Study Site• Nyeri hospice, Nyeri

county, Central-Kenya • Started in 1995 • Caters for cancer

patients• Offers pain relief and

treatment of opportunistic infections

Study Design• Retrospective descriptive study

– We reviewed patients files and registers for a two year period

– New cancer cases registered between Jan 2011 and Dec 2012 were identified and extracted

• Study population: Cancer patients attending Nyeri hospice for palliative care

• Case definition: A reported diagnosis of cancer at any age admitted to Nyeri hospice between Jan 2011 and Dec 2012 for palliative care

Data Management• Data collection

– Socio-demographic and cancer data were abstracted from registers and files using a standardized form

• Data entry and cleaning

– Epi info version 3.5.4 software and Ms Excel 2007 used

• Data analysis

– Means ,medians, proportions and frequencies calculated for categorical and continuous variables

Records Review

•Females were 270(60%)

•Married -260(63%)

•Majority of the patients 335 (83%) resided within the county

598 Records Reviewed

25(5%) Drop outs352(74%)-

Deaths

477 Records Included

21(54%) Metastasis at diagnosis

100(21%)-Alive

Socio-Demographics

RESULTS

Leading Cancers as Registered by Nyeri Hospice, 2011-2012(N=452)

Type of cancer n(%) CasesBreast 56(21)Prostate 32(17)Cervix 46(17)Oesophagus 73(16)Stomach 41(9)Liver 39(9)Rectum 21(5)Pancreas 19(4) Ovary 13(3)Others 112(24)

Distribution of Leading Cancers in Nyeri Hospice by Sex, 2011-2012(N=452)

Distribution of Cancer Cases by Age in Nyeri Hospice, 2011-2012 (n=448)

Median age of the patients-62 (Range: 9-99)

Clinical Characteristics of Cancer Cases in Nyeri Hospice, 2011-2012

• Median duration from diagnosis to death-95 days(range:8-2615, IQR: 165)

• Median duration from admission to death -44 days(range:0-530 ,IQR: 76)

• Forty-nine percent(223) of the cancer cases had evidence of pathological diagnosis

• Median duration from first complaint to diagnosis-810 days(range:25-3463,IQR-482)

Referral Methods of Cancer Patients to Nyeri Hospice, 2011-2012(N=452)

Distribution of Cancer Cases by Outcome in Nyeri Hospice ,2011-2012

Annual Distribution of Cancer Deaths in Nyeri Hospice, 2011-2012(n=352)

Discussion• Cancer are an important public health

problem in this region–Breast and cervical cancer main cancers in

women• The study showed low levels of pathological

diagnosis(fifty-percent)– Inadequate diagnosing capacity

• Lung cancer was not among the top ten cancers–Potential deficiencies in diagnosis

Recommendations• Scaling up of cancer screening programs to enhance early

diagnosis• Improve on recording at the hospice to guarantee data quality• Public awareness on cancer prevention & control• Strengthened diagnosing capacity• Further epidemiological studies in cancer prevention and

control

• Oesophagus, stomach and prostate were the leading cancers in men.

• Commonest cancers among females were breast, cervix and oesophagus

• Short median duration from diagnosis to death (95 days) indicates late diagnosis

Conclusion

Acknowledgements• Nyeri Hospice CEO and staff• Kenya field epidemiology and laboratory

Training program• Dr J. Kibachio-(Medical Epidemiologist-

DNCD)• County Health Management Team • AFENET

THANK YOU