Kesho Conference 2014

1. EPIDEMIOLOGY OF CANCER IN
PATIENTS SEEKING PALLIATIVE CARE
AT NAIROBI HOSPICE – NAIROBI,
KENYA.
DR. L. W. CUSHNY,
SCHOOL OF MEDICINE,
UNIVERSITY OF NAIROBI.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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

8. RESULTS:
Distribution by Sex:
FEMALE 64.7% (188)
MALE 35.3% (102)
TOTAL 100% (290)

9. 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

10. Top ten cancers as registered by the
hospice:

13. PREVALENCE OF CO-MORBIDITIES:
DISEASE HYPERTENSION HIV DIABETES
FREQUENCY 9% 7.6% 6.2%

15. Distribution by Area of Residence

16. 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)

17. Distribution by Level of Education:

18. Distribution by Source of Referral

19. 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.

20. 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.