Morbidity and quality of life among head and neck cancer patients treated with radical radiotherapy.

OBJECTIVES: To determine the relative frequency of acute radiation morbidity and their perceived effect on quality of life among head and neck cancer patients treated with radical radiotherapy. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: Thirty eight patients comprising 28 males and 10 females with ages ranging between 21 and 69 years were evaluated. RESULTS: Most of the tumours occurred in the nasopharynx (38.6%). The rest of the tumours were equally divided between the oral cavity and larynx (31.6%). All tumours except two were carcinomas. The two exceptions were a glomus tumour and a malignant melanoma. The patients had received doses of radiotherapy ranging between 58.5 Grey and 75.5 Grey. Of the 38 patients, 22 (53%) completed their treatment in the prescribed time while 16 (47%) had treatment interruption on account of radiation morbidity. The cumulative radiation done at the time of interruption ranged between 20 and 46 Grey. The most frequent symptom was dryness of the mouth while the most troublesome symptom was difficulty in tasting foods. The quality of life (QOL) did not vary by age, gender or tumour site. Patients who had treatment interruption had a better QOL than those who did not. CONCLUSION: This study provides information that should aid in communicating with the head and neck cancer patients scheduled for radiotherapy and in the design of preventive and interventional strategies aimed at enhancing patient support and rehabilitation.

Hodgkin's lymphoma in the 1990s: a Kenyatta National Hospital experience.

OBJECTIVE: To re-evaluate clinico-pathologic categorisation of patients with Hodgkin's lymphoma, treatments offered and their appropriateness, and outcome of this disease at Kenyatta National Hospital in the 1990s. DESIGN: Retrospective survey of Hodgkin's lymphoma patients aged 13 years and above at the Kenyatta National Hospital. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: Patients aged 13 years and above, with diagnosis of Hodgkin's lymphoma. RESULTS: There were 75 males and 36 females. One case had no clear gender details. 14.2% of the cases were of lymphocyte predominant histologic subtype, 23.6% nodular sclerosis, 26.4% mixed cellularity and 17% Lymphocyte depletion (Rye Modification of Lukes and Butler Classification). Disease stages IIIB, IVA and IVB (Ann Arbor) were found in 24.5% of the cases. The majority of the patients (60.3%) were treated with the COPP protocol and 17% with ABVD. Complete remission was realised in 56% of the cases and most cases were lost to follow-up, making it difficult to correlate survival with known prognostic parameters, apart from early stage disease and attainment of complete remission which correlated with prolonged durations of follow-up. CONCLUSION: The patients had earlier stage diseases than in earlier studies locally, the histologic classification is still wanting, and the COPP protocol appeared still popular instead of being abandoned. Response rates were lower than expected and losses to follow-up made it difficult to properly evaluate prognostic parameters. Early disease stage and attainment of complete remission appeared to correlate with longer follow-up duration.

Non-Hodgkin's lymphomas at Kenyatta the National Hospital Nairobi in the 1990's.

OBJECTIVES: To determine the clinico-pathologic and prognostic factors, treatment and outcome of non-Hodgkin's lymphomas as seen at the Kenyatta National Hospital in the 1990s. DESIGN: Retrospective study of patients with non-Hodgkin's Iymphoma. SETTING: Kenyatta National Hospital, Nairobi, Kenya, between January 1990 and January 2000 inclusive. SUBJECTS: Patients aged 13 years and above, with non-Hodgkin's Iymphomas. RESULTS: Case records were available for 207 patients, 146 males and 60 females, with one having had gender not clarified. Fifty two per cent of the patients were aged less than 40 years and 18.4% over 60 years. Forty one per cent were not properly classified histologically, seventy patients out of 190 evaluable (36.8%) had stages IVA and IVB disease at diagnosis. Twenty five out of 77(32.5%) tested positive for HIV infection, none of them being of the indolent variety. Up to 57.1% of cases of Burkitt's lymphoma tested positive for HIV infection. Cyclophosphamide, doxorubicin, vincristine and prednisone, (CHOP) chemotherapy was given to 68.7% of the patients with complete remission rates of 55.6% for those who got a minimum of six courses of chemotherapy. Only 15.3% of 105 patients evaluable were followed up for 36 months and above, the majority of patients having been lost to follow-up. Poor performance status at diagnosis correlated with shorter follow-up durations (p<0.05). CONCLUSION: A good percentage of the patients were not comprehensively characterized pathologically. Standard treatment was offered to the majority of patients, and those who could afford to purchase the medicines stood good chance of achieving complete remission. Poor performance status at diagnosis correlated with shorter follow-up durations and early stage disease correlated with longer follow-up durations. Overall, the outlook for NHLs treated at KNH in the 1990s appears to have improved tremendously.

Knowledge and practice about cervical cancer and Pap smear testing among patients at Kenyatta National Hospital, Nairobi, Kenya.

Invasive cervical cancer (ICC) is the leading cause of cancer-related death among women in developing countries. Population-based cytologic screening and early treatment does reduce morbidity and mortality associated with cervical cancer. Some of the factors related to the success of such a program include awareness about cervical cancer and its screening. The objective of this study was to assess knowledge and practice about cervical cancer and Pap smear testing among cervical cancer and noncancer patients using a structured questionnaire to obtain information. Fifty-one percent of the respondents were aware of cervical cancer while 32% knew about Pap smear testing. There were no significant differences in knowledge between cervical cancer and noncancer patients. Health care providers were the principal source of information about Pap testing (82%). Only 22% of all patients had had a Pap smear test in the past. Patients aware of cervical cancer were more likely to have had a Pap smear test in the past. The level of knowledge is low among ICC and noncancer patients. There is need to increase the level of knowledge and awareness about ICC and screening among Kenyan women to increase uptake of the currently available hospital screening facilities.