By Mark Mudenyo - Principal Investigator Ms Mercy Mugo - Co Investigator
KNH HBCR The hospital attends to an average of 550,000 out- patients and over 80,000 in-patients annually Currently between 2,000-2,500 new patients are seen per year. 130 - 150 patients receives radiotherapy daily
KNH – Hospital based cancer registry The registry was started by group of professionals with skills in operational research, cancer care, training and curriculum development, information and technology, resource mobilization and public health. The group aims to Offer technical support to MoH in cancer care and control.
Broad Objective The main objective was to establish a quality KNH Hospital Based Cancer Registry in order to comply with the National Cancer Prevention and Control Strategy and provide quality cancer data for improved care, teaching and research.
Specific objectives To establish a HBCR at the KNH by capturing, and integrating existing cancer information from all departments within the hospital To estimate cancer trends at KNH To create a quality system and database for continuing cancer data documentation at KNH To link with the National Cancer registry and avail data for research in Kenya
Methodology The KNH cancer registry is based in the Health Information Department and managed by KNH staff together with the University of Nairobi and other affiliated institutions. KNH registry work in collaboration with National Cancer Registry at KEMRI, in data collection analysis and report writing.
Methodology cont… Cancer data is collected by trained registrars using the standard CANREG5(1) data entry software system. Cancer diagnosis is based on histology/cytology, imaging and clinical guidelines.
Source of data • Records of all patients diagnosed with cancer are abstracted and documented including co-morbidities • Sources of data: patient files, laboratory reports, autopsy records, radio-oncology, palliative care centre, Nairobi Hospice, Cancer Care Centre, KNH CCC, University of Nairobi Clinical departments and Pediatrics Oncology unit among others.
AGE DISTRIBUTION OF CANCER CASES Age group Males % Females % Total 0-14 411 10 293 5 704 15-29 329 8 390 6 719 30-49 954 24 2503 40 3457 50-69 1621 40 2368 38 3989 70+ 741 18 725 12 1466 Total 4056 100 6279 100 10335
TOP 10 FEMALE CANCER CASE 2000 1800 1600 1400 No of cases 1200 1000 800 600 400 200 0
TOP 10 MALE CANCER CASES 500 450 400 350 No of cases 300 250 200 150 100 50 0
CHILDHOOD CANCER ICCC-Classification AGE GROUP 0-4 5-9 10-14 ALL Leukemia, Myelopro/Myelodys.dis. 41 59 57 157 Lymphomas, Reticuloendothelial 14 47 36 97 CNS, Intracranial/Spinal 12 31 16 59 Neuroblastoma, Per.nerv.cell 3 3 0 6 Retinoblastoma 119 6 0 125 Wilms Tumor 75 26 2 103 Hepatic Tumor 5 1 1 7 Malignant bone Tumor 2 7 15 24 Soft tissue, Extraoss.Sarcoma 19 10 9 38 Germ cell, Trophoblast,Gonad 3 4 5 12 Malig.Epithelial/Melanoma 2 7 23 32 TOTAL 295 201 164 660
CANCER CASES PER COUNTY SEEN AT KNH COUNTY FREQUENCY PERCENTAGE NAIROBI 2272 22 KIAMBU 1183 11 MURANGA 838 8 MERU 601 6 MACHAKOS 591 6 NYERI 579 6 KIRINYAGA 424 4 NAKURU 369 4 KITUI 331 3 MAKUENI 304 3
HIV AND CANCER CASES Age group Males HIV Positive Females HIV Positive 0-14 411 14 293 4 15-29 329 13 390 42 30-49 954 134 2503 435 50-69 1621 69 2368 202 70+ 741 8 725 4 Total 4056 238 6279 687
LEADING CAUSES OF LEADING CAUSES OF Disease DiseaseCod HOSPITALIZATION 2016 Year Code ALIVE DEAD HOSPITALIZATION 2015 Year e ALIVE DEAD CANCERS 4325 1111 CANCERS 4241 1315 2016C* 2015C* Pneumonia, 1950 491 2015J18.9 Human immunodeficiency virus [HIV] Complications 1638 609 2016B24 Bacterial sepsis of newborn, 1910 764 2015P36.9 Pneumonia, 1479 432 Human immunodeficiency 2016J18.9 virus [HIV] Complications 1723 733 2015B24 2016P36.9 Bacterial sepsis of newborn, 1392 567 DIARRHOEA 1103 252 2015A09 injury of head 1033 240 2016S09.9 injury of head 922 254 2015S09.9 Essential (primary) Neonatal jaundice, 891 204 2015P59.9 hypertension 944 236 2016I10 Essential (primary) hypertension 835 271 2015I10 DIARRHOEA 720 175 2016A09 Other preterm infants 644 736 2015P07.3 2016P59.9 Neonatal jaundice, 671 151 Meningitis, 628 250 2015G03.9 Diabetes 522 200 2015E14.9 2016P07.3 Other preterm infants 655 670 Hypertrophy of tonsils with 2016G03.9 Meningitis, 554 249 hypertrophy of adenoids 493 4 2015J35.3 Cancer was the leading cause of hospitalization in both 2015 and 2016 . In 2016 this represents a 6% of the total diseases reported in the period while 2015, it constitutes a 5% of the total diseases reported in the hospital.
LEADING CAUSES OF DEATHS Year CODE LEADING CAUSES OF DEATHS 2016 DEAD PMR % Year Code 2015 DEAD PMR % 2016 C* CANCERS 1111 14 2015 C* CANCERS 1315 15 2016 P07.3 Other preterm infants 670 8.3 2015 P36.9 Bacterial sepsis of newborn, 764 9.2 2015 P07.3 Other preterm infants 736 8.8 Human immunodeficiency virus Human immunodeficiency 2016 B24 [HIV] Complications 609 7.6 2015 B24 virus [HIV] Complications 733 8.8 2016 P36.9 Bacterial sepsis of newborn, 567 7.0 Respiratory distress Respiratory distress syndrome of 2015 P22.0 syndrome of newborn 616 7.4 2016 P22.0 newborn 472 5.9 2015 J18.9 Pneumonia, 491 5.9 2016 J18.9 Pneumonia, 432 5.4 2015 P07.1 Other low birth weight 470 5.6 2016 P07.1 Other low birth weight 417 5.2 2015 N17.9 Acute renal failure, 415 5.0 2016 N17.9 Acute renal failure, 339 4.2 2015 A41.9 Sepsis, 330 4.0 2016 A41.9 Sepsis, 329 4.1 2016 P21.9 Birth asphyxia, 258 3.2 Essential (primary) 2015 I10 hypertension 271 3.2 2016 G03.9 Meningitis, 249 3.1 In 2016 the cancer deaths represent 14% proportionate deaths rate (8055) occurring in the hospital while in 2015 the deaths represent a 15% proportionate deaths rate (8346)
Limitations Certified cancer registrars: KNH has only two Data is for 2014 to 2016 No backup of data Counties data not represented
Recommendations: Intensify clinical audit for cancers cases. Prevention of HIV to reduce HIV/Cancer related infection. Increase cancer screening awareness e.g. mammogram Increase of cancer registrars at KNH. Proper backup of data. Expand the registry to cover county data
Acknowledgement Prof. Lucy Muchiri Prof. C. Kigondo Prof. P. Wainganjo Dr. J. Rajab Dr. W. Konya Dr. M. Michieka Ms. E. Mwiti
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