An assessment of the patients’ perception of colorectal Cancer management cancer at Kenyatta National Hospital

Abstract

Background: Colorectal cancer (CRC) is one of the most common malignancies worldwide causing 9% of the total cancer mortality. The incidence of CRC has been decreasing in Western countries because of earlier diagnosis and improved treatment modalities; however the mortality is increasing in low and middle income countries and the trend is characterized by late presentation and poor outcome. Objective: This study sought to establish the patients’ perception of colorectal cancer management at KNH. Methodology: The study utilized a descriptive cross-sectional design and was conducted at surgical and oncology wards and clinics at KNH. Data was collected using a semi-structured, interviewer administered questionnaire, information from the patients’ medical records and key informants’ guide. Quantitative data was analyzed by Statistical Package for Social Sciences (SPSS) version 20.0 while qualitative data was coded through content analysis according to the themes. Statistical inference was made between variables to draw associations. The results were presented in graphs, charts, tables and in narrative form and statistical inference has been made between variables to draw associations. Ethical principles were upheld during the study. Results: A total of 68 respondents were enrolled in the study, with majority 55.9% (n=38) being females. The age of the respondents ranged from 16 to 78 years with a mean of 53.5 years and a modal age of 40-59years. Majority 94.1% (n=64) of the respondents had undergone formal education. Most 69.4% (n=47) of the respondents were earning less than Ksh 10,000 per month. Monthly income of the patient was a statistically significant (p=0.001) determinant of patients’ perception of CRC management at KNH with those respondents earning less than Kshs 10,000 being 10.22 times likely to say the management was effective compared to those who had no income and this relationship was statistically significant (p=0.042). The cost of CRC diagnosis and treatment was high with majority of the respondents having spent more than Kshs 100,000 so far. Majority 97% (n=67) of the patients were diagnosed with CRC when they presented with symptoms of which the most common were rectal bleeding 69.1% (n=47), change in bowel habits 45.6% (n=31) and abdominal pain51.5% (=35). 60.3% of the patients were diagnosed with CRC more than six (6) months after they presented with symptoms and this had a statistically significant association with their perception on CRC management (p=0.016). The participants whose diagnostic period was longer than 6 months were 66.3% less likely to perceive the management of CRC at KNH as being effective. There was a statistical significance diagnostic period was longer than 6 months were 66.3% less likely to perceive the management of CRC at KNH as being effective. There was a statistical significance (P=<0.001) between the treatment modality and the perception of the patient on colorectal cancer management at KNH with those patients who had undergone all the three modalities (surgery, radiation and chemotherapy) being 91% less likely to perceive that CRC management was effective as compared to those who had chemotherapy only [OR=0.09; 95% CI=0.009 – 0.964; P=0.047] Majority of the respondents felt that the oncology doctors and nurses had adequate training and knowledge (93.7% and 95.3% respectively). Most of the respondents also felt oncology doctors and nurses had a positive attitude (93.9% and 82.1% respectively.) Other health care system factors that influenced the management of CRC included inadequate chemotherapy drugs reported by 70% of respondents, inadequate radiotherapy machines reported by 76.9% of respondents and inadequate bed capacity cited by 58.6% of respondents. Majority of the respondents however felt that the numbers of doctors and nurses was adequate (63.9% and 77.4% respectively.) The key informants however felt the number of specialized health workers was inadequate. Overall, a majority (57.3%) of the respondents felt that the management of CRC at KNH was effective. Conclusions: The main factors influencing the patient’s perception of CRC management at KNH were income, duration of diagnostic period, treatment modality and availability or lack of human and physical resources. The government should increase health funding and allocation for colorectal cancer so that KNH and other health facilities can step up their diagnostic and treatment services. KNH should plan for primary prevention services namely health education and awareness creation so as to increase screening and early diagnosis of colorectal cancer.