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Epidemiology of Cancer in Patients Seeking Palliative Care in Nyeri Hospice, Nyeri County-Kenya, 2011-2012 Dr Nelson Muriu Kenya 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 RESULTS Records Review 598 Records Reviewed Socio-Demographics •Females were 270(60%) •Married -260(63%) 477 Records Included 25(5%) Drop outs 352(74%)Deaths 100(21%)-Alive 21(54%) Metastasis at diagnosis •Majority of the patients 335 (83%) resided within the county Leading Cancers as Registered by Nyeri Hospice, 2011-2012(N=452) Type of cancer Breast Prostate Cervix Oesophagus Stomach Liver Rectum Pancreas Ovary Others n(%) Cases 56(21) 32(17) 46(17) 73(16) 41(9) 39(9) 21(5) 19(4) 13(3) 112(24) Distribution of Leading Cancers in Nyeri Hospice by Sex, 2011-2012(N=452) Male 25 Female % Cases 20 15 18 17 14 12 10 6 5 0 Type of Cancer 5 Distribution of Cancer Cases by Age in Nyeri Hospice, 2011-2012 (n=448) 60 50 % Cancer Cases 40 30 20 10 0 9-24. 25-35 36-65 Age in Years Median age of the patients-62 (Range: 9-99) 66-74 >75 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) 100 90 80 Percent 70 60 50 40 40 37 30 20 10 12 8 3 0 Faith based organisation Government Facility Hospice Private health facility Referral Method Self Distribution of Cancer Cases by Outcome in Nyeri Hospice ,2011-2012 25 Percent 20 15 10 13 14 10 11 2 Dead Alive 8 5 9 4 1 0 Type of Cancer 5 1 1 Annual Distribution of Cancer Deaths in Nyeri Hospice, 2011-2012(n=352) 35 30 No. of Deaths 25 20 2011 15 2012 10 5 0 Jan Feb Mar Apr May Jun Jul Aug Month of Death Sep Oct Nov Dec 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 Conclusion • 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 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 Acknowledgements • Nyeri Hospice CEO and staff • Kenya field epidemiology and laboratory Training program • Dr J. Kibachio-(Medical EpidemiologistDNCD) • County Health Management Team • AFENET THANK YOU