Factors Associated With Delayed Initiation of First Chemotherapy Treatment of Patients Diagnosed With Gestational Trophoblastic Neoplasia at Kenyatta National Hospital Between Years 2013 to 2022

Abstract

Introduction: Gestational Trophoblastic Neoplasia (GTN) contributes to significant morbidity and mortality all over the world including Africa and Kenya in particular. It contributes approximately 2% of all gynaecological malignancies in Kenya. The problem is huge in third world countries (resource poor) where specialized GTN treatment centers do not exist, coupled with delayed and poor referral systems together as well as lack of well-trained health workers to handle suspected cases. Kenyatta National Hospital, other than Moi Teachig and Referral Hospital in Eldoret, is by default the GTN center in Kenya but there exists a delay in initiation of chemotherapy among these patients. It is therefore useful to establish these institutional and patient delay factors to inform establishment of local or national standard operating procedures for these patients. Broad Objective: To determine the factors associated with delayed initiation of first chemotherapy treatment in GTN patients seen at KNH between 2013 and 2022. Study design: Retrospective cross-sectional study design. Study location: Kenyatta National Hospital Study population: GTN patients full or partially managed at KNH in the period 2013 to 2022. Sample size: 115 patients of GTN who met the eligibility criteria. Data collection: Descriptive variables, management of GTN variables, and date of diagnosis, admission and ward investigations were captured. Electronic data capture was done by REDcap software. Variables: Independent variables included demographics such as age, marital status, availability of NHIF, clinical factors such as type of GTN, disease stage. Dependent variables included the duration of initiation of first treatment for GTN whether timely or delayed. Results: 63% of the GTN patients were referrals and the mean age was about 33.4 ± 9.8 years. It was noted that 57% of the participants in the current study had comorbidities with the majority having anemia and hypertension. Nulliparous women accounted for 22% of the patients and use of family planning methods were noted in about 50%. 70% of the GTN patients were categorized as high risk. The patients took a median of 17 days from diagnosis of GTN to initiation of chemotherapy...