A poor woman with breast cancer takes nine months from noticing symptoms to the time she gets the initial intervention, according to an analysis of patient records at the Kenyatta National Hospital.
Some three months are lost in cheap clinics that often misdiagnose symptoms. But most of the time is wasted when the woman arrives at KNH. Here she finds a long queue of cancer patients and must look for more money to take multiple diagnostic tests.
The information comes from a study that involved interviews and analyses of medical records of poor women with breast cancer at KNH.
Unfortunately, by the time most of these women start treatment at KNH, the cancer usually has spread to other parts of the body and is no longer curable.
“Patients experience long healthcare system delays before diagnosis and treatment. Educating communities and providers about breast cancer and expediting referrals may minimise such delays and subsequently breast cancer mortality rates in Kenya,” said the researchers.
They published their study, “Delayed breast cancer presentation, diagnosis, and treatment in Kenya”, in the Breast Cancer Research Treatment journal last month.
Their study involved 378 female breast cancer patients with an average age of 50.
All of them were poor, with nearly half having no education beyond primary level, over half being jobless, and the vast majority earning less than Sh5,000 per month.
The analysis revealed troubling statistics. The women took an average of three months (13 weeks) from the time they noticed breast cancer symptoms to their arrival at KNH.
After reaching KNH, they found a large queue and the majority had no money for biopsy and other tests.
They therefore lost four months (17.5 weeks) at KNH before getting a diagnosis.
Although the National Health Insurance Fund (NHIF) covers the treatment of cancer, it has limited diagnostic coverage and patients often have to pay out of pocket.
After the diagnosis, most women waited another one-half months (six weeks) before the receipt of initial interventions. That is a total of nine months before treatment.
The researchers said patients who were unmarried, less educated, less affluent, users of hormonal contraception, and had more than three children were more likely to experience diagnosis and treatment delays.
“Data showed that financial constraints, lack of patient breast cancer awareness, and healthcare practitioner misdiagnosis and/or strikes delayed patient diagnosis and treatment,” they said.
Breast cancer is highly treatable, especially with effective treatment in the early stages.
However, the Ministry of Health complains that most of the 6,799 annual breast cancer cases in Kenya are diagnosed too late and most of the women never survive beyond five years.
The country reports about 3,100 breast cancer deaths every year.
In July, the ministry also revealed although many poor women go for mammography and ultrasound tests in public health facilities, the majority with abnormalities are never referred further for diagnosis.
Most abnormal findings usually show a benign (not cancer) breast condition and only a small fraction turn out to be breast cancer.
However, immediate referral has been shown to substantially reduce mortality in women with breast cancer.
The ministry surveyed 439 facilities to identify gaps in breast cancer management.
Dr Mary Nyangasi, head of the National Cancer Control Programme at the ministry, said cancer diagnosis is also a problem.
Dr Nyangasi said most hospitals have no capacity to diagnose cancer.
“Very few facilities in the country, we would say about 10 county referral facilities, are able to offer some form of cancer diagnosis,” she said.
Nairobi has the highest number of residents with breast cancer in the country according to the current Status of Cancer Report from the National Cancer Registry.
It is followed by Nakuru, Nyeri, Machakos, Kiambu, Kakamega, Murang’a, Makueni, Kitui, Meru and Embu.
NHIF pays a maximum Sh600,000 for the treatment of cancer in a year.
Currently, the package entails up to 10 chemotherapy sessions, oral and injectable anti-cancer drugs, inpatient and outpatient oncology services, 20 sessions for radiotherapy and up to two sessions for brachytherapy for advanced cancer, per year.
NHIF covers six sessions for the first-line treatment for up to Sh25,000 per session, four sessions for second- and third-line treatment for up to Sh150,000 per session and 20 sessions of radiotherapy at Sh3,600 per session.
At the diagnosis level, the cover includes a biopsy under the surgical package in addition to radiology, including MRIs, ultrasounds, or CT and PET scans.