| dc.description.abstract | Background
Breast cancer is the most common cancer affecting women in Kenya today and also in the western world. There are several factors that may influence the patient's'response to treatment. Treatment of breast cancer involves surgery, radiotherapy, chemotherapy and endocrine therapy. Endocrine therapy is a widely used and accepted modality and is primarily directed at reducing synthesis of estrogen or blocking estrogen at the receptor level in those tumors that are estrogen receptor positive. Tamoxifen is the drug of choice for adjuvant treatment of breast cancer in KNH.
Objective: To determine the factors that influences the treatment outcomes in breast cancer patients at Kenyatta National Hospital. Methodsr The study was designed as a hospital based retrospective descriptive study. patients diagnosed with breast cancer and who had their first visit at the KNH RTC in 2008 were identified using the new patients register. A total of 219 patient records were sampled using systematic sampling. Data were entered into a pre - designed data collection tool then entered into Microsoft Excel worksheets. Analysis was done using Microsoft excel and STATA software.
Results: The mean age of the 219 participants was 46.5 years (range 23 to 92 years), majority (36.1 %) of whom were aged between 41 to 50 years. Majority of the participants at time of diagnosis were from Kikuyu ethnic community 48.9%, had normal levels of white blood cell levels 59.8%, hemoglobin 44.3%, platelets 51.6%, body surface area 31.5% while 27.4% were overweight. Most of the participants had stage 2B (21.9%) cancer type and the histological grade 3 breast cancer was predominant type (50.2%). Majority (37%) of the participants started chemotherapy one year after diagnosis, 75.8% of which was Cyclophosphamide, doxorubicin and fluorouracil (CAF) first line chemotherapy regimen. About 13.7% of the patients were later put on second line therapy
with 19.4% being on docetaxel and zoledronic acid. About 62.6% of the participants were on hormonal therapy majority of which was tamoxifen 54.8%.
Of the 219 participants enrolled 101 (46.1 %) developed metastasis after treatment verses 118 (53.9%) had no evidence of metastasis disease. Majority 10.5% of the metastasis cases were on the bone and local recurrence.
In this study age and ethnicity were demographic factors that were not associated with the development of metastasis after treatment. In bivariate analyses; cancer stage 2A (OR 0.29, 95% CI 0.12 to 0.77) and stage 2B (OR 0.29, 95% CI 0.12 to 0.77), presence of estrogen receptors (OR 0.24, 95% CI 0.12 to 0.77), presence of progesterone receptor (OR 0.26, 95% CI 0.09 to 0.72), human epidermal growth factors (OR 0.05, 95% CI 0.003 to 0.84), those on hormonal treatment (OR 0.34,95% CI 0.19 to 0.62) and presence of treatment side effects (OR 0.34, 95% CI 0.12 to 0.91) were factors less likely to be
associated with development of metastasis after treatment. However, participants on second line chemotherapy (OR 2.53, 95% CI 1.64 to 3.91) and particularly the docetaxel and zoledronic acid (OR 2.62, 95% CI 1.14 to 6.03) were more likely to develop metastasis after treatment.
In multivariate analysis, HIV positive (OR 0.004, 95% ti 0.002 to 0.75), presence of estroaen (OR 0.23, 95% CI 0.08 to 0.64) and human epidermal growth factors (OR 2.53, 95% CI 1.64 to 3.91) receptors and obesity (OR 2.53,95% CI 1.64 to 3.91) were the only independent factors influencing development of metastasis after treatment
Conclusion: This study shows that we need to improve our follow up and monitoring strategies so as to give our patients quality care. Also, there needs to be enhanced screening for breast cancer and other cancers in general so as to diagnose them at earlier stages. The importance of ERIPR testing cannot be over emphasized. Younger patients are an important cohort in this population and more effort should be put treat these patients since they have poorer prognosis. | en_US |
