Cancerous tumor
Patients diagnosed with throat and other digestive tract
cancers at Kenyatta National Hospital wait about two months before starting
treatment, a new study has found.
The wait is far too long for diseases that could potentially
be cured if diagnosed and treated promptly, experts say.
The delay remained largely unchanged even after the introduction
of a Patient Navigation Programme (PNP), a support system designed to help
patients navigate the complex cancer treatment process.
The study, published in the JCO Global Oncology journal,
found that patients started treatment a median of 55 days after diagnosis
before the programme was introduced, compared with 62 days after its
introduction.
The researchers include oncologist Dr Catherine Nyongesa,
who currently serves as the Director of Medical Services at KNH.
They explained; "At KNH, high patient volumes and
limited surgical and radiotherapy capacity persisted. Although navigation may
have mitigated extreme delays for some patients, overall delay patterns were
unchanged, underscoring that navigation can complement but cannot replace
health system strengthening to improve timeliness."
Dr Nyongesa's team evaluated 360 adults with
gastrointestinal cancers treated at KNH between 2010 and 2025.
Although the research focused on digestive tract cancers
such as oesophageal, stomach, colorectal, liver and pancreatic cancers, the
findings also highlight challenges faced by many cancer patients in Kenya.
The Patient Navigation Programme was introduced at KNH in
2017 in partnership with the American Cancer Society.
A patient navigator is a trained health worker who helps
patients understand their diagnosis, keep appointments, overcome financial and
transport challenges and remain connected to care.
At KNH, the programme uses oncology nurses, social workers
and trained lay navigators.
"The programme integrates oncology nurses, social
workers and trained lay navigators to support patients through care
coordination, appointment reminders, patient education, psychosocial support,
and assistance with logistical and financial barriers," the researchers said.
Their paper is titled, Evaluating the Impact of a Patient
Navigation Program on Treatment Timeliness, Continuity, and Follow-Up Outcomes
for Patients With Digestive Tract Cancer at Kenyatta Hospital.
The team found that while navigators did not shorten waiting
times or significantly improve treatment completion, they greatly improved
follow-up and survival.
"The most pronounced effect of the PNP was a
substantial reduction in loss to follow-up,” the researchers said.
“At one year, 20 per cent of pre-navigation patients were
lost to follow-up compared with 6.7 per cent in the navigation era,
representing an approximately 66 per cent relative reduction and an additional
approximately 13 per cent of patients retained in care."
Loss to follow-up occurs when patients stop attending
appointments and health workers can no longer determine what happened to them.
Cancer experts say this is a major problem in many African
countries because patients may abandon treatment due to costs, long travel
distances, side effects or confusion about the health system.
The study found that treatment completion remained low
regardless of whether patients received navigation support.
Only 41.1 per cent of patients completed their planned
first-line treatment before the programme was introduced, compared with 46.1
per cent after its introduction.
The researchers said; "Among non-completers,
health-related factors predominated, followed by financial barriers and health
system constraints, with overlapping causes being common. Although navigation
did not increase completion rates, it supported ongoing engagement in care,
including transitions to palliative or supportive management, contributing to
improved follow-up and survival."
The researchers also found that oesophageal cancer was the
most common digestive tract cancer among patients treated at KNH, accounting
for nearly 35 per cent of all cases.
Most patients presented with advanced disease, making
successful treatment more difficult.
Hospital-based studies have consistently shown that the
majority of Kenyans are diagnosed at advanced stages, sharply limiting curative
treatment options.
Despite these challenges, the Patient Navigation Programme
was associated with improved survival.
The researchers reported that one-year survival increased
from about 70 per cent to about 80 per cent among patients whose outcomes could
be tracked.
"In this retrospective cohort study at Kenya's largest
cancer centre, implementation of a PNP was associated with substantial
improvements in patient retention and short-term survival among patients with
GI cancer," the researchers wrote.
These benefits were seen among both wealthy and low-income
patients, as well as among people living in rural and urban areas.
Improvements in follow-up and survival were observed among
both rural and urban patients and among uninsured and insured patients.
Notably, rural and uninsured patients experienced gains comparable with those
of more advantaged groups, narrowing pre-existing disparities.
The researchers said patient navigation can help save lives
even in resource-constrained settings but warned that it is not enough on its
own.
"Patient navigation was feasible and effective in a
resource-constrained tertiary hospital, improving continuity of care and
survival without additional clinical infrastructure," they said.
"However, sustained gains will require integration with
health system strengthening, including expanded treatment capacity,
decentralisation and improved financial protection."
