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) 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 Among women the most common areas affected are breast, lung, stomach, colorectal and cervix. According to the WHO, cancer accounted for 7.9 million deaths(13%) in 2009. The most frequent types of cancer among men affect the lung, stomach, liver, colorectal, oesophagus and prostate. Among women the most common areas affected are breast, lung, stomach, colorectal and cervix. According to the WHO, cancer accounted for 7.9 million deaths in 2009 It is projected that by 2030, the number of new cancer 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 Ranked 3rd cause of death after infectious diseases and cardiovascular diseases No national registry. Multi-sectoral approach for the na Aims to build strong cancer prevention and control capacities both in various sectors Achievable through 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

21(54%) Metastasis at diagnosis RESULTS Records Review Socio-Demographics 598 Records Reviewed 25(5%) Drop outs 352(74%)-Deaths 477 Records Included 21(54%) Metastasis at diagnosis 100(21%)-Alive Females were 270(60%) Married -260(63%) Majority of the patients 335 (83%) resided within the county 39 had evidence of diagnosis Majority of the patients 335 (83%) resided within the county, 70 (17%) from outside the county

Leading Cancers as Registered by Nyeri Hospice, 2011-2012(N=452) Type of cancer n(%) Cases Breast 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) CA PHARYX ,CA TONGUE ,MM RENAL CELL CA ,ADENOCA ,AML CA BRAIN ,CA HYPOPHARYNX ,CA MAXILLA ,CA MOUTH CA OVARY CA PNS COLORECTAL CA GLIOBLASTOMA GLIOMA LEUKEMIA MALIGNANT MELANOMA METASTATIC HISTIOCYTOMA NHL CA BREAST CA CERVIX CA ENDOMETRIUM CA EYE CA GALL BLADDER CA LARYX CA PALATE CA RENAL CA THYROID CA VULVA FACIAL CA HEPATIC MENINGIOMA LIPOSARCOMA MALIGNANT MENINGIOMA MENINGIOMA PNS CA

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 A similar pattern to that reported by the Nairobi cancer registry 2002 with breast cancer being the most frequent cancer among females, followed by cancer of the cervix uteri(Cancer Incidence Report Nairobi 2000 – 2002) Cancers of the breast and cervix uteri comprise a large proportion (43.3%) of all reported cases (Cancer Incidence Report Nairobi 2000 – 2002). Based on 2002 data from the Nairobi Cancer Registry, of all the cancers ,breast cancer accounted for 23.3%, cervical cancer for 20% and prostate cancer for 9.4%. In Cameroon, Mbakop and coll in 1997 found that breast and cervical cancers, with the prevalence of 21.5% each, were the top two cancers in Cameroonian women. The study showed low levels of lab diagnosis, consistent to a study done in Malawi that revealed only 18% of the cancer cases had laboratory verified diagnosis. In our study lung cancer was not among the top ten cancers Lung cancer, the world’s most frequent cancer in males, is generally reported to be less common in sub-Saharan Africa although tobacco smoking is common with prevalence of at least 25% in men

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 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 Establishment of a county cancer registry-regional-mention this

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

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