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

Abstract

IntroductionApproximately 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. MethodsThis 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. ResultsBetween 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 longer 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. ConclusionUnderdiagnosis 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.