This document summarizes a study on the epidemiology of cancer in patients seeking palliative care at Nairobi Hospice in Kenya. The study found that the most common cancers seen were breast, prostate, cervical, esophageal and Kaposi's sarcoma. A majority of patients were female (64.7%) and the median age was 54 years. The top five cancers accounted for over 60% of cases. Late diagnosis was also indicated by a median survival time of only 7 months from diagnosis. The study concludes there is a need for increased cancer care facilities, education and research to address the growing burden of cancer in Kenya.

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.