Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

Abstract

ABSTRACT. Early diagnosis and start of treatment are fundamental goals in cancer care. This study determines the time lag and the factors that influence the time to diagnosis and start of treatment.Study participants were parents of childhood cancer patients diagnosed between August 2013and July 2014 in a hospital in Kenya. Patient, physician, diagnosis, treatment, health care system, and total delay were explored using a questionnaire. Demographic and medical data were collected from the patients' medical records. Parents of 99 childhood cancer patients were interviewed (response rate: 80%). Median total delay was 102 (9-1021) days. Median patient delay (4 days) was significantly shorter than health care system delay (median 87 days;P < .001).Diagnosis delay (median 94 days) was significantly longer than treatment delay (median 6 days; P < .001). days. Lack of health insurance at diagnosis and use of alternative medicine before attending conventional health services were associated with a significantly longer patient delay (P = .041 and P = .017, respectively). The type of cancer had a significant effect on treatment delay (P = .020). The type of health facility attended affected only patient delay (P = .03). Gender, age at diagnosis, stage of disease, parents' education level or income, and distance from hospital did not have a significant effect on the length of any type of delay. Training on childhood cancer should be included in the curricula for medical training institutes. In-service workshops should be held for the health workers already working. Families must be obligated to get health insurance. Families should be encourage to attend conventional health facilities and informed on symptoms of cancer through mass media

Health‐care providers’ perspectives on health‐insurance access, waiving procedures, and hospital detention practices in Kenya

“…In another study, we found that 40% of parents, who were aware of HDP, delayed coming to MTRH because they feared that their child would be detained . We concluded that HDP are highly distressing for families and contribute to delays in health‐seeking behavior and treatment abandonment …”

Lessons for Patient Engagement in Research in Low- and Middle-Income Countries

“…It is well known that several barriers exist to accessing healthcare services in LMICs, such as distance to nearest health facility, lack of resources, and complex bureaucratic referral systems [22]. These barriers are linked to poor health outcomes [22][23][24]. Therefore, if access to healthcare services for basic treatment is limited, and health outcomes remain poor as a result, the common notion is that it is unlikely and even unwise to focus efforts towards less ''urgent'' initiatives, like patient involvement in research.…”

“…If an individual's financial situation can be a determinant of their health-seeking behavior, then it follows that it can also affect their engagement in research [23,29,30]. Patients often incur out-of-pocket medical costs for diagnosis, travel to healthcare facilities, and treatment [31], which places a high burden on patients of low socioeconomic status.…”

“…In many settings, the diagnosis of an illness can lead to unpleasant effects on community life, such as social isolation and stigmatization [24,25,32]. Patients with cancer report experiencing social stigma, with consequences such as termination of employment, familial shame, and social rejection [23,31,33]. In some regions, beliefs persist that cancer is caused by witchcraft and, therefore, patients prefer to keep their disease private [19].…”

<p>Factors Associated with the Detection of Childhood and Adolescent Cancer in Primary Health Care: A Prospective Cross-Sectional Study</p>

“…10 Studies show that the first contact of patients diagnosed with childhood cancer occurred in primary care. [11][12][13][14] During this first contact, the patients were assisted by a physician (68%) or a nurse (32%). 11 However, another study verified that diagnostic errors seem more common in primary care when compared to the diagnosis performed in departments of other levels of the health system.…”