1. Kenya Field Epidemiology and Laboratory Training Program (KFELTP)
Epidemiology of Cancer in Patients Seeking Palliative Care in Nyeri Hospice, Nyeri County-Kenya,
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
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

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 ( ) 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

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 software and Ms Excel used
Data analysis
Means ,medians, proportions and frequencies calculated for categorical and continuous variables

9. 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

10. 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

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: ,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
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

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
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

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