Time to presentation and diagnosis of esophageal cancer in patients seen at the Kenyatta National Hospital

Abstract

Background: Esophageal Cancer (EC) is one of the leading causes of cancer death in Kenya. Majority of the patients with esophageal cancer at Kenyatta National Hospital (KNH) present at an advanced stage limiting their treatment options.

Objective: To determine diagnostic time lines and factors associated with delayed health care service delivery among patients with established histological diagnosis of EC at KNH.

Design and Setting: A retrospective diagnostic cohort study was carried out at the Cardiothoracic, endoscopy and radiotherapy units at KNH.

Results: Eighty-five participants with established histological diagnosis of EC consented and were enrolled into the study. Majority (89.4%) were diagnosed in stage III and IV of the disease. The median time to  histological diagnosis of EC was 90 days. The time to first presentation was more than 30 days among 78.8% of subjects. The median time from first consultation to referral to a diagnostic-capable facility was 30 days, with 76.5% of the participants taking more than 30 days to reach KNH. Those who could not afford transport and consultation were more likely to report delay to first presentation (OR 3.6 95% CI 1.2-11.3, p=0.022). Referral delay was associated with residence, with those living in the rural areas less likely to delay (OR 0.2, 95% CI 0.0-0.8, p=0.019).

Conclusion: Overall this study found that there was significant delay in the diagnostic process of EC patients. Over 75% of the patients delayed in presenting for the first consultation, being referred to higher level facilities, getting an endoscopy done and receiving histological diagnosis.  Consequently, about 90% of the patients were diagnosed at an advanced stage of the disease.