First Dialysis and Obstructive Release Delays in Patients With Cervical Cancer Stage Iiib With Obstructive Uropathy at Kenyatta National Hospital, 2013-2022

Abstract

Background. Cervical cancer accounts for 528,000 new cases annually worldwide and almost seventy percent of the burden is in the developing world. It is the leading cause of cancer-related mortalities among women in Kenya. About 50% of patients with cancer of cervix stage IIIB present with obstructive uropathy which requires urgent dialysis followed by obstruction release before initiation of chemoradiotherapy for the cervical cancer. Delay in management of obstructive uropathy increases the risks of acute or chronic kidney injury which also delays the initiation of chemoradiotherapy. Globally, studies have shown that Patients’ sociodemographic and clinicopathological characteristics can influence the turnaround time for the management of obstructive uropathy and cervical cancer. Objective: The broad objective of this study was to evaluate the causes of management delays of patients with cervical cancer stage IIIB with obstructive uropathy admitted at Kenyatta National Hospital (KNH), 2013-2022. Study site: This study was conducted at Kenyatta National Hospital. Study design: Retrospective descriptive cohort study Study population: File records of 153 Patients with cervical cancer stage IIIB with Obstructive Uropathy admitted for first dialysis and obstructive release at KNH from 1st January 2013 to 31st December 2022. Methodology: Data was transferred from data abstraction form to an Excel spreadsheet and then to SPSS version 24 software for cleaning, coding, and analysis. Continuous data was presented as mean, ranges, and standard deviations. Categorical data was presented as frequencies and percentages (tables). Delays were determined from the turnaround time. It was recorded as a delay if the first dialysis was done after three days and obstructive release was done after 14 days. The incidence of delay was then calculated. Causes predictive first dialysis and obstructive release delays were identified by bivariable analysis; the Chi-square test of independence was used. The odd ratios and the corresponding 95% Confidence Interval were obtained. P values of <0.05 were considered statistically significant. Those with statistical significance were subjected to multivariable analysis. The adjusted Odds ratios and the corresponding 95% confidence intervals were obtained. P values of <0.05 were considered statistically significant. Turnaround for first the dialysis and obstructive release were summarized and presented as mean, median, and range...