Time To Presentation And Diagnosis In Patients With Esophageal Cancer At Kenyatta National Hospital

Abstract

Background: Cancer of esophagus (Ca-O) is the eighth most common cancer in the world and is ranked sixth amongst the leading causes of cancer death. Ca-O is a major health problem in Sub-Saharan Africa. A high incidence rate was reported amongst men in central and western Kenya region. The identification of modifiable patient and health care system factors accounting for delayed presentation and diagnosis is critical information with potential to improve outcomes. OBJECTIVE: To determine diagnostic time lines and factors associated with delayed health care service delivery among patients with established histological Ca-O at KNH. Methods: This was a retrospective diagnostic cohort study was conducted at Cardiothoracic, Endoscopy and Radiotherapy unit/clinics at Kenyatta national Hospital. Eighty-five (85) participants with established histological diagnosis Ca-O consented and enrolled into the study. Data was collected using a structured questionnaire to record time intervals to presentation, referral and diagnosis and the stage at Ca-O at diagnosis. Statistical analysis was done in SPSS version 21.0. Cancer delay variables were presented as percentages and associated with independent variables using chi square and t tests. Results: The mean age of the participants was 59.2 years (SD 14.5 years), 64.7% were males, 75.3% had attained some level of education, 47.1% were unemployed and 62.4% lived in the urban. Majority (89.4%) were diagnosed at stage III and IV. Delay to first presentation was 78.8%, referral delay was 76.5% and total diagnostic delay was 61.2%. Those who did not afford transport and consultation were more likely to delay first presentation (88.6%), OR 3.6 (95% CI 1.2-11.3), p=0.022. Referral delay was associated with residence with those living in the rural less likely to delay [OR 0.2 (95% CI 0.0-0.8), p=0.019]. Conclusion: There was a widespread delay among Ca-O patients throughout the cancer diagnostic process. More than three-quarters of the patients delayed in presenting for first consultation, referral to higher level facilities, endoscopy procedure and receiving histology results.