Delays in accessing childhood cancer care in western Kenya: A single-center, retrospective study

Larissa Klootwijk , Sandra Langat , Festus Njuguna , Sally Kimaiyo , Terry Vik , Gertjan Kaspers , Saskia Mostert
{"title":"Delays in accessing childhood cancer care in western Kenya: A single-center, retrospective study","authors":"Larissa Klootwijk ,&nbsp;Sandra Langat ,&nbsp;Festus Njuguna ,&nbsp;Sally Kimaiyo ,&nbsp;Terry Vik ,&nbsp;Gertjan Kaspers ,&nbsp;Saskia Mostert","doi":"10.1016/j.phoj.2024.04.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Approximately 80 % of children with cancer live in resource-limited settings where prompt access to diagnosis and treatment is challenging. Data regarding delays in diagnosis and treatment and outcomes of children with cancer in Kenya are lacking. This study aims to 1) compare the reported and expected number of children with cancer; 2) explore diagnosis, treatment, and total delays; 3) determine patient characteristics that influence delays; and 4) investigate treatment outcomes.</p></div><div><h3>Methods</h3><p>This study combined a retrospective medical records review with a case report. Data on delays and treatment outcomes of children from Bungoma County (Kenya) who were diagnosed with cancer at a large academic hospital between 2010 and 2016 were collected.</p></div><div><h3>Results</h3><p>Between 2010 and 2016, 92 children, an average of 13 per year, were referred from Bungoma. These 13 children constitute only 9 % of the expected 140 children developing cancer in this region. The most common diagnoses were non-Hodgkin lymphoma (17 %) and acute lymphoblastic leukemia (16 %). The median total delay was 108 (7–1731) days. The median diagnosis delay was 97 days, longer than the median treatment delay (3 days; P &lt; 0.001). A l</p><p>onger total delay was associated with referral from another facility (P = 0.008), longer symptom duration (P &lt; 0.001), solid tumors (P = 0.013), stage (P = 0.012), and tribe (P = 0.044). The event-free survival was 21 %. The reasons for treatment failure were abandonment (41 %), progressive/relapsed disease (25 %), or death (13 %). The case study highlights that health beliefs and fear of conventional medicine can delay healthcare seeking.</p></div><div><h3>Conclusion</h3><p>Underdiagnosis and delays in accessing childhood cancer care are considerable in Bungoma. Increasing awareness among the general public and personnel of primary-care facilities is essential to reducing delays in this county.</p></div>","PeriodicalId":101004,"journal":{"name":"Pediatric Hematology Oncology Journal","volume":"9 3","pages":"Pages 143-150"},"PeriodicalIF":0.0000,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468124524000378/pdfft?md5=d54da853f71c500405a31fef82b6de25&pid=1-s2.0-S2468124524000378-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Hematology Oncology Journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2468124524000378","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction

Approximately 80 % of children with cancer live in resource-limited settings where prompt access to diagnosis and treatment is challenging. Data regarding delays in diagnosis and treatment and outcomes of children with cancer in Kenya are lacking. This study aims to 1) compare the reported and expected number of children with cancer; 2) explore diagnosis, treatment, and total delays; 3) determine patient characteristics that influence delays; and 4) investigate treatment outcomes.

Methods

This study combined a retrospective medical records review with a case report. Data on delays and treatment outcomes of children from Bungoma County (Kenya) who were diagnosed with cancer at a large academic hospital between 2010 and 2016 were collected.

Results

Between 2010 and 2016, 92 children, an average of 13 per year, were referred from Bungoma. These 13 children constitute only 9 % of the expected 140 children developing cancer in this region. The most common diagnoses were non-Hodgkin lymphoma (17 %) and acute lymphoblastic leukemia (16 %). The median total delay was 108 (7–1731) days. The median diagnosis delay was 97 days, longer than the median treatment delay (3 days; P < 0.001). A l

onger total delay was associated with referral from another facility (P = 0.008), longer symptom duration (P < 0.001), solid tumors (P = 0.013), stage (P = 0.012), and tribe (P = 0.044). The event-free survival was 21 %. The reasons for treatment failure were abandonment (41 %), progressive/relapsed disease (25 %), or death (13 %). The case study highlights that health beliefs and fear of conventional medicine can delay healthcare seeking.

Conclusion

Underdiagnosis and delays in accessing childhood cancer care are considerable in Bungoma. Increasing awareness among the general public and personnel of primary-care facilities is essential to reducing delays in this county.

肯尼亚西部儿童癌症治疗的延误:单中心回顾性研究
导言约 80% 的癌症患儿生活在资源有限的环境中,很难及时获得诊断和治疗。肯尼亚缺乏有关癌症儿童诊断和治疗延误以及治疗效果的数据。本研究旨在:1)比较癌症儿童的报告人数和预期人数;2)探讨诊断、治疗和总延误时间;3)确定影响延误的患者特征;4)调查治疗结果。结果2010年至2016年间,邦戈马县(肯尼亚)有92名儿童被转诊至一家大型学术医院,平均每年13名。这13名儿童仅占该地区预计140名癌症患儿的9%。最常见的诊断结果是非霍奇金淋巴瘤(17%)和急性淋巴细胞白血病(16%)。总延误时间的中位数为 108(7-1731)天。诊断延误的中位数为 97 天,长于治疗延误的中位数(3 天;P < 0.001)。总延迟时间较长与其他机构转诊(P = 0.008)、症状持续时间较长(P < 0.001)、实体瘤(P = 0.013)、分期(P = 0.012)和部落(P = 0.044)有关。无事件生存率为 21%。治疗失败的原因是放弃治疗(41%)、疾病进展/复发(25%)或死亡(13%)。该案例研究强调,健康观念和对传统医学的恐惧会延误就医。在该县,提高公众和初级保健机构工作人员的认识对于减少延误至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
1.00
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信