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Dr Nelson Muriu Kenya Field Epidemiology and Laboratory Training Program (KFELTP)

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) 18 th November 2013. Global Burden of Cancer.

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Dr Nelson Muriu Kenya Field Epidemiology and Laboratory Training Program (KFELTP)

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. Study Site • Nyeri hospice, Nyeri county, Central-Kenya • Started in 1995 • Caters for cancer patients • Offers pain relief and treatment of opportunistic infections

  7. 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

  8. 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

  9. 352(74%)-Deaths 100(21%)-Alive RESULTS 477 Records Included 598 Records Reviewed 25(5%) Drop outs Records Review Socio-Demographics • Females were 270(60%) • Married -260(63%) • Majority of the patients 335 (83%) resided within the county 21(54%) Metastasis at diagnosis

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

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

  12. Distribution of Cancer Cases by Age in Nyeri Hospice, 2011-2012 (n=448) Median age of the patients-62 (Range: 9-99)

  13. 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)

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

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

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

  17. 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

  18. Conclusion Recommendations • 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 • 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

  19. Acknowledgements • Nyeri Hospice CEO and staff • Kenya field epidemiology and laboratory Training program • Dr J. Kibachio-(Medical Epidemiologist-DNCD) • County Health Management Team • AFENET

  20. THANK YOU

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