Determinants for late presentation of head and neck cancer at Kenyatta National Hospital

Abstract

Head and Neck Cancer patients frequently present late and occupy about 50% of inpatients bed space in the Ear, Nose, Throat, Head and Neck surgery Department of the Kenyatta National Hospital. This study aimed to describe the determinants of late presentation of Head and neck cancer at Kenyatta National Hospital. It was descriptive cross sectional hospital based study carried out at the Kenyatta National Hospital Ear, Nose and Throat/Head and Neck Surgery Department, Radiotherapy Department and other departments managing Head and Neck Cancer. Patients presenting for the first time at Kenyatta National Hospital Ear, Nose and Throat Head and Neck department and other departments managing head and neck cancer and meeting the prescribed inclusion criteria were interviewed, examined and their records scrutinized for specified demographic and clinical data, which were extracted and entered into a questionnaire. The results were analyzed using SPSS and presented in graphic tables. One hundred and seventy four patients being managed for Head and Neck Cancer (HNC) at Kenyatta National hospital were inducted. The primary sites were larynx (LC) 64 (36.8%), Nasopharynx (NPC) 45 (25.9%), Hypopharynx (HyPC) 10(5.7%), oropharynx (OPhC) 15 (8.6%), oral cavity (OcC) 9 (5.2%) sinonasal (SNC) 14(8%), Salivary glands (SGC) 11(6.3%) and others 6 (3.4 %). The later group included a small number with rhabdomyosarcoma, malignant melanoma, Kaposi sarcoma and occult primary. Over 87% of the patients had squamous cell carcinoma. Overall 152 (87.3%) patients had stage ill & IV disease and 22 (12.6%) had stage I and II. The mean duration of symptoms for all primary sites at diagnosis was 57.23 weeks (Range 4 - 521). Patient delay accounted for 35.29 weeks, presentation at PHF to referral for specialized management 13.76 weeks and professional diagnostic delay at KNH 7.97 weeks.

The majority of the patients came from Central and Eastern provinces of Kenya 39.9% and 25.4% respectively accounting for 65.3% of total. Majority of our patients are poor or living below poverty line (80.6%). The level of education for majority was also low with 73.4% having only up to primary level. The control group in this study (patients will stage 1 & Il diseased) was quite small and also most of the patients in the sample had almost similar parameters being tested as determinants of late presentation. The results of this study unfortunately suggest that the potential for increasing the proportion of patients being diagnosed with early disease is very limited as no statistical relationship was established between duration of symptoms, socioeconomic status, education level, distance and cost to health facilities and stage at diagnosis.