1. A RETROSPECTIVE STUDY OF THE PRESCRIBING PATTERN OF ANTICANCER DRUGS AT THE KENYATTA NATIONAL HOSPITAL DURING THE PERIOD JANUARY 2014 TO JULY 2014 By Nyamai Beatrice Kalekye U29/35598/2010 Supervisor: Dr. P. M. Njogu

2. Introduction Cancer is an abnormal mass of tissue with growth that exceeds and is uncoordinated with that of surrounding tissues. Prevalence: 7.4 million deaths ≈ 13% of all deaths in 2004 worldwide. In Kenya: ≈ 7% deaths annually. Treatment includes a number of interventions such as psychological support, surgery, radiotherapy, hormonal therapy and chemotherapy. Chemotherapy is the mainstay of cancer treatment.

3. Justification Cancer is a growing problem in Kenya with over 82 000 new cases reported annually in Kenya. Given that anticancer drugs are expensive, rational use of anticancer agents is important. Hence, the need of the study. Patients travel many kilometers to the Kenyatta National Hospital (KNH), a public hospital that hosts most of the oncology expertise and technology in Kenya.

4. Study Objectives Specific objectives To document the most common cancers encountered in KNH. To determine the cancer prevalence among the different genders and age groups. To determine the drugs commonly used in the treatment of cancer. Main objective To evaluate the prescription patterns of anticancer drugs used in the treatment of cancer out-patients at Kenyatta National Hospital.

5. Methodology A retrospective study was done at the Kenyatta National Hospital to determine the common anticancer drugs prescribed to out-patients at the oncology pharmacy for the time period of January 2014-July 2014. Using the sample formula proposed by Cochran, a sample size of 219 patient prescription sheets were analyzed.

6. Only patients over the age of 18 attending the Radio- chemotherapy clinic who had undergone chemotherapy of at least one chemo-cycle were included. It was the prescribing pattern in the first chemo-plan treatment that were studied. Permission to carry out the research was sought from the Kenyatta National Hospital/ University of Nairobi Ethics and Research Committee before the study was carried out. Information acquired treated with utmost confidentiality.

7. Results and Discussion The study captured a total of 219 patients.

9. Prevalence of cancer in KNH out-patient clinic A total of 44 cancers were observed in the study. Eighty nine percent of the cases had specified cancers while only 11% had their cancers unspecified. CancerPercentage Breast cancer32.9% Cervical cancer11.9% Squamous cell carcinoma5.9% Nasopharyngeal carcinoma5.5% Prostate cancer4.6%

14. Conclusion The commonly prescribed anticancer drugs in KNH were alkylating agents and natural products. There was a strong correlation between the type of cancer and the sex (p=0.00). The most common cancers in females were breast and cervical cancers, while in males, prostate and nasopharyngeal cancers were predominant. The management of cancer in Kenyatta National Hospital is commendable.

15. Recommendations There should be great emphasis on prevention through modifiable risk factors. Public education about cancer and its prevention. Research using a larger sample size including other hospitals. Research on use of oral anticancer agents to improve cancer management in the country may be beneficial as it is already on-going in developed countries.