Abstract 55: Insurance Status and Surgical Cancer Patient Characteristics and Outcomes at Muhimbili National Hospital in Dar Es Salaam Tanzania

Abstract

Abstract Purpose: Cancer is a leading cause of death among adults in Tanzania. Surgery plays a vital role in the diagnosis, treatment, and palliation of malignancies. Laparotomy is a common surgical approach for abdominal cancer pathologies in Tanzania where access to minimally invasive surgery is limited. We aimed to understand the characteristics and laparotomy outcomes of patients with abdominal organ cancer at Muhimbili National Hospital (MNH), the National Referral Hospital in Dar es Salaam Tanzania. Methods: We conducted a prospective observational cohort study of all patients over the age of 18 undergoing laparotomy at MNH from August 1st 2022-December 22nd 2022. Patients were consented and followed during their index and, if applicable, re-admission hospitalization(s), and were contacted 30-days post discharge by telephone. Cancer diagnosis was made via the operative report by the operative surgeon. Staging and final pathology was not routinely collected. Results: Overall, 246 patients underwent laparotomy during the study period. Of those patients, 109 (44%) were diagnosed with cancer. Of the patients with cancer, 54 (50%) were male and the median age was 59 (IQR 45, 65). Insurance status was known in 101 patients and 64 (63%) were insured. Of those with insurance, 57 (89%) were covered by the National Health Insurance Fund. Uninsured patients were significantly more likely to present for an emergency operation versus insured patients (24% vs. 8%, p=0.02). In addition, insurance status was an independent risk factor for death within 30 days post-operatively after controlling for age, sex, evidence of pre-operative sepsis, American Society of Anesthesiologists physical status classification, and emergency versus scheduled surgery (OR 5.5, CI 1.4-22). Conclusion: Access to medical and surgical services is vital for a country’s national cancer control strategy. At the National Referral Hospital in Tanzania, uninsured cancer patients are more likely to present for emergency surgery, suggesting limited access to care for these vulnerable patients. In addition, being uninsured is independently associated with increased 30-day perioperative mortality, highlighting the need to expand insurance coverage to ensure all cancer patients in Tanzania have equal access to care throughout their treatment course to achieve equitable outcomes. Citation Format: Nathan Brand, Obedi Emanual, Marissa Boeck, Larry Akoko. Insurance Status and Surgical Cancer Patient Characteristics and Outcomes at Muhimbili National Hospital in Dar Es Salaam Tanzania [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 55.