Palliative care needs in breast cancer patients entering inpatient hospice in Western Kenya

Abstract

Context: Breast cancer in Kenya is associated with a high mortality due to late stage disease at presentation and limited access to specialty care.Objectives: To understand the symptom burden in breast cancer patients entering hospice in Western Kenya and utilize the data to meet the growing need for palliative care and hospice services. Methods: We conducted a quality improvement exercise to assess the needs of Kenyan women admitted to inpatient hospice with the diagnosis of breast cancer. A retrospective chart review was undertaken to collect and collate demographic, physical and symptom data from a standardized admission form and the medical record. Results: Between 2011-2019, 62 women with breast cancer were admitted for care. The median age was 50.0 years (range 23-86) and the median time from diagnosis to admission one year (range 0-4). Only 20% had received surgical treatment for breast cancer. Pain was the predominant symptom on admission (98%) and breast wounds were the most common physical finding. Approximately 50% voiced worry, depression, and stress with <10% voicing spiritual distress. The mean length of stay was 42.6 days (median 10, range 1-1185). While over 70% died in hospice, 27% were discharged home.Conclusions: The low rate of surgical intervention leads to painful breast wounds that were a major factor for many women seeking hospice admission. The findings challenge our team to maintain expertise in pain and wound management but to also include breast cancer awareness in our rural outreach services.