Factors Associated With Time Taken From Histologic Diagnosis to Initiation of Radiotherapy in Women With Cervical Cancer at the Kenyatta National Hospital;Cross-sectional Study

Abstract

Background: Cervical cancer is the second most diagnosed cancers of women after breastcancer. Time taken from histological diagnosis to initiation of radiotherapy is considered as a measure of the quality of care. However, the wait time for initiation of radiotherapy after a histological diagnosis of cervical cancer has not been studied sufficiently in KNH. Broad Objective: To determine factors associated with time taken between histologicaldiagnosis and initiation of radiotherapy in women with cervical cancer at the Kenyatta National Hospital. Methodology: A cross-sectional study was conducted on 246 patients, presenting at KNH between September 2019 andNovember 2019. Face to face structured questionnaire was administered to capture patient characteristics i.e. age, education level,county of residence etc. and information on treatment pathway duration. Patient wait time from histological diagnosis to initiation of radiotherapy was collected from patient records as a continuous variable. Dates on histology diagnosis and the first time patient received radiotherapy session were collected. Knowledge of patients on radiotherapy was also evaluated. Data was extracted from questionnaire, fed into worksheet, and analyzed using version 23 of the Statistical Package for Social Scientists software. The demographics characteristics of participants were computed and presented on tables. Mean and median waiting time by the demographic characteristics of patients and hospital factors were computed using the Kruskall Wallis test. Analysis of Covariance (ANOVA) was used to control for confounding. Results: The mean age of participants was 53.16, range of 18 to 84 years. A majority of participants were age group 51-60 years (32.2%). Married (65.5%),unemployed (54.3%), and those with stage IIB cervical cancer at diagnosis (60.8%). The Median wait time from

histological diagnosis to initiation of radiotherapy was 84 days, higher among 31-40 year old women (102), widows (93), employed women (111), and those using NHIF insurance cards (86). Patient factors and institution factors evaluated did not affect wait times. However, the distance to hospital explained 2.3% of the variation in wait times for radiotherapy that we reported. Conclusion: Median wait time from cervical cancer histological diagnosis to initiation of radiotherapy was unacceptably higher at KNH than the recommended average of 30 days in UK. Health system should be strengthened by increasing more radiotherapy machines at KNH and decentralization of radiotherapy treatment centers to counties to improve health seeking behavior, shorten wait time, and improve prognosis.