Evaluating compliance to Kenya national cancer guidelines on diagnosis and staging of breast cancer at Kenyatta national hospital

Abstract

Background : In Kenya, breast cancer is one of the most prevalent diseases among women. Early diagnosis and stage-directed treatment are vital in reducing morbidity and mortality associated with it. The Kenya National Cancer Guidelines (KNCG) was developed in 2013. Utility of the guidelines is expected to improve early detection, timely diagnosis, harmonize and standardize treatment of cancer. This study sought to assess whether health care providers at Kenyatta National Hospital are utilizing the guidelines in diagnosis and staging of breast cancer. Study objective : To evaluate adherence to KNCG on diagnosis and staging of breast cancer. Study design : Retrospective descriptive study was conducted within five months. Study subjects : Two hundred and fifty (250) patients’ records with diagnosis of breast cancer between September 2013 and September 2015. Results : Most patients were female 95.6 % with mean age of 47.5±15.5 years. Duration from referral point to index breast clinic review was 10.9±11.1 days. Duration from index breast clinic review to surgery was 64.0 ±114.4 days. Documentation on findings from clinical assessment varied between 24.8 to 86.4%. Documentation on radiological assessment of the breast varied between 3.6 to 35.2% whereas for metastatic assessment varied between 3.6 to 64.0 %. Laboratory investigations documentation varied between 8.4 to 94.8% whereas pathologic diagnosis and tumour biology documentation varied between 3.6-62.4%. American joint cancer committee- tumour, node and metastasis (AJCC-TNM) staging was documented in 16 % of the records reviewed. Conclusion : From this study, triple assessment for breast cancer was incomplete and inconsistent which could result in negatively impacting management of these patients. Every effort should be put in place to track as well as prioritize patients with breast cancer in terms of investigations and surgical interventions in a timely manner. Clinical, radiologic and pathologic assessment must adhere to KNCG and be accurately documented. Clinician should undergo knowledge, attitude and practice (KAP) survey on KNCG so as to identify possible gaps and institute measures aimed at compliance which ultimately could improve care of patients with breast cancer at KNH.