Prognosis and delay of diagnosis among Kaposi’s sarcoma patients in Uganda: a cross-sectional study

Abstract

BackgroundIn low- and middle-income countries, the association between delay to treatment and prognosis for Kaposi’s sarcoma (KS) patients is yet to be studied.MethodsThis is a prospective study of HIV-infected adults with histologically-confirmed KS treated at the Uganda Cancer Institute (UCI). Standardized interviews were conducted in English or Luganda. Medical records were abstracted for KS stage at admission to UCI. Multivariable logistic regression assessed relationships between diagnostic delay and stage at diagnosis.ResultsOf 161 patients (90% response rate), 69% were men, and the mean age was 34.0 years (SD 7.7). 26% had been seen in an HIV clinic within 3 months, 72% were on antiretroviral therapy, and 26% had visited a traditional healer prior to diagnosis. 45% delayed seeking care at UCI for ≥3 months from symptom onset. Among those who delayed, 36% waited 6 months, and 25% waited 12 months. Common reasons for delay were lack of pain (48%), no money (32%), and distance to UCI (8%). In adjusted analysis patients who experienced diagnostic delay were more likely than those who did not delay to have poor-risk KS stage (OR 3.41, p = 0.002, 95% CI: 1.46-7.45). In adjusted analyses visiting a traditional healer was the only variable associated with greater likelihood of delay (OR 2.69, p = 0.020, 95% CI: 1.17-6.17).ConclusionsDiagnostic delay was associated with poor-risk stage at diagnosis, and visiting a traditional healer was associated with higher odds of delay. The relationship between traditional and Western medicine presents a critical intervention point to improve KS-related outcomes in Uganda.

Use of traditional and complementary medicines by cancer patients at a national cancer referral facility in a low‐income country

“…Starting use of T&CM before seeking care at biomedical facilities potentially delays health seeking. Other studies have shown that patients with cancer who take recourse to T&CM often delay by several months to be diagnosed and are often in advanced stage disease at presentation (Broom et al, ; De Boer, Niyonzima, Orem, Bartlett, & Zafar, ; Kerdpon & Sriplung, ; Maghous et al, ). These findings have important implications for interventions to promote early detection of cancers by targeting the THPs who are visited earlier on in the disease trajectory.…”

Kaposi sarcoma

“…Indeed, a healthcare-facility-based randomized trial of an intervention to improve early detection of KS failed to improve outcomes in Zimbabwe 173 . The use of traditional healers by patients with KS in resource-limited settings may also delay early detection 174 . Thus, it is likely that the bene- fits of early KS detection will be realized only through community-based public education campaigns.…”

RNA-Seq of Kaposi’s sarcoma reveals alterations in glucose and lipid metabolism

“…Cutaneous lesions may also disfigure and lead to social stigma for KS patients [ 5 , 6 ]. The prognosis of KS patients in sub-Sahara Africa is generally poor, often due to delayed diagnosis and late initiation of treatment [ 7 ]. Even after receiving anti-retroviral drugs therapy (ART), the mortality of epidemic KS patient is often high due to advanced KS disease staging, simultaneous advanced HIV-1 diagnosis and both HIV-1 and KS-immune reconstitution inflammatory syndromes [ 8 ].…”