Factors associated with cervical cancer stage at diagnosis among patients attending Kenyatta National Hospital, Kenya

Abstract

Background: The global burden of cervical cancer is considerable with nearly 527,600 new cancer cases and 265,700 cancer deaths resulting in cervical cancer being the second most frequently diagnosed cancer. In Kenya, cervical cancer is the second most common cancer among women, with almost half of all women with invasive cervical cancer having been diagnosed at a late stage. Lack of healthcare insurance and the user fees system for healthcare services can be an impediment to early diagnosis and treatment. Information regarding preventive care for cervical cancer is also wanting. Few women are aware of the symptoms and risk factors of cervical cancer and that its precursor lesions are detectable through screening procedures thereby causing most women to seek treatment when the cancer is at an advanced stage. Objective: To determine factors associated with cervical cancer stage at diagnosis among patients receiving treatment at Kenyatta National Hospital. Methods: The study was carried out at the cancer treatment centre and in the obstetrics and gynaecology department at Kenyatta National Hospital. A cross-sectional study method was adopted and 385 cervical cancer patients were recruited through convenience sampling. Histological information was obtained from patient files. Informed consent was sought and interviews were carried out by the researcher and by a research assistant using a semi-structured questionnaire. A pilot study was conducted in order to ensure reliability and validity of the instrument. Data collected was entered and analysed using SPPS 16. The outcome variable stage at diagnosis, was determined using the International Federation of Gynaecology and Obstetrics (FIGO) staging system. Chi-square, Fisher‟s exact and Wilcoxon ranksum tests were used to evaluate the association between stage at diagnosis of cervical cancer and factors that may bring about delays in diagnosis. Results: Stage at diagnosis was advanced, 72.6% and 27.4% for women with early stage cancer. Of the women with advanced stage cancer, 145 (55.6%) and 62 62.6%) with early stage cancer had heard of cervical cancer prior to their diagnosis. Only 22% of women with early stage cervical cancer and 23.7% women with advanced stage cervical cancer were aware of the sexually transmitted nature of cervical cancer. Majority of the women were not aware of the causative link between cervical cancer and human papillomavirus (HPV), 8 (13.1%) in women with early stage cancer and 5 (3.5%) in women with advanced stage cervical cancer (p=0.036). Conclusion: Most women presenting with advanced cervical cancer at Kenyatta National Hospital were not aware that cervical cancer is caused by HPV. They were also not aware that HPV can be sexually transmitted. Recommendations: There is need to increase awareness of basic cervical cancer symptoms in order to allow for early detection. Women should be informed about the HPV virus, on its role in the cervical cancer aetiology.