RESUMEN
BACKGROUND: The most important prognostic factor in head and neck cancer is the stage of the disease at presentation. Early cancer has an excellent prognosis following treatment. Unfortunately most patients present with late disease that requires radical treatment with considerable morbidity and mortality. Clinical experience at Kenyatta National Hospital (KNH) shows that most patients present with late disease. OBJECTIVE: To determine the causes of late presentation of head and neck cancer. DESIGN: A prospective descriptive study. SETTING: Kenyatta National Hospital, Nairobi. RESULTS: Forty four cases were seen among whom 34 were males and 10 were females. The age range was 20 to 90 years with a peak incidence between 50 and 60 years. Most of the patients had little or no education and the majority lived in the rural areas. Seventy one percent of the patients came from the Central and Eastern provinces. Tobacco and alcohol use were the most common risk habits. The larynx was the most common site affected followed by the tongue. In 61% of the cases the size of the tumours at presentation was unknown. In 14% the size was 1-2cm, in 7% of the cases it was 2-4 cm while in 5% of the cases it was 4-6 cm. In 14% of the cases the tumour size was over 6 cm. The most common presenting symptom was hoarseness followed by swelling. The majority of the patients attended a public health facility nearest them. For most patients the facility lay within 5 km and could be accessed by walking. However, most of the patients went through multiple referrals to get to KNH. By the time the patients reached KNH, 35 patients (77%) had been treated with unspecified medications, two (4%) had had tooth extraction, and seven (16%) had had biopsies done. The time-lapse between the first symptom and consultation ranged from zero and eight months. Forty five percent of the patients presented to a medical facility within one month of their symptom and 45% presented after three months. The time lapse between referral and attendance at KNH ranged from zero and thirteen weeks and 45% of the patients presented to KNH within two weeks of referral. The overall duration of symptoms by the time of diagnosis ranged from zero months to unspecified years. Thirty two percent of the cases had experienced symptoms for six months or less by the time of diagnosis. However, a number of patients had had their symptoms for a number of years by the time of diagnosis. The distribution of the tumours by stage at the time of final diagnosis were as follows: stage I were 2%, stage II 6%, stage III 14% and stage IV 56%. CONCLUSION: This study showed that the referral system was the main cause of delayed presentation of head and neck cancer to Kenyatta National Hospital.
Asunto(s)
Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/terapia , Estadificación de Neoplasias , Derivación y Consulta , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales , Hospitales de Enseñanza , Humanos , Kenia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Derivación y Consulta/organización & administración , Factores de TiempoRESUMEN
BACKGROUND: Currently there is a dearth of data on the pattern of occurrence of head and neck cancers in Kenya. OBJECTIVE: To provide a comprehensive analysis of the pattern of occurrence of head and neck cancers in a Kenyan population. DESIGN: Retrospective hospital-based descriptive study. SETTING: Kenyatta National Hospital, Nairobi. RESULT: A total of 793 cases were recorded consisting of 507 male and 286 female (M: F = 2:1). Most of the lesions arose from the upper aerodigestive pathway. The larynx was the most common site for aerodigestive malignancies. This was followed in order of frequency, by the tongue, the mouth, and the nasopharynx. Outside the aerodigestive pathway the eye was the most commonly affected site followed by the thyroid. Squamous cell carcinoma was the most common malignancy. Sarcomas were typically rare. Gender and age distribution showed an overall male preponderance and a wide age range. However, specific tumour sites and tumour types showed varying patterns of gender and age distribution. CONCLUSION: This study confirms the relative prominence of laryngeal, oral and nasopharyngeal cancers in the African population. It is, however, at variance with other African studies regarding the relative frequency of nasal and paranasal cancers.
Asunto(s)
Neoplasias del Ojo/epidemiología , Neoplasias de Cabeza y Cuello/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Depression is an important predictor of post therapy quality of life (QOL) in head and neck (H&N) cancer patients. In addition, depression rates may vary among cultures. OBJECTIVE: As part of a larger cross cultural study on post therapy QOL differences in H&N cancer patients, the goal of this project was to translate a well-validated English language depression scale into Swahili, and then validate this scale in Kenyan H&N cancer patients. METHODS, SETTINGS AND SUBJECTS: In Part 1 of the study, we translated the Patient Health Questionnaire-9 (PHQ-9) into Swahili, adhering to established International Quality of Life Association (IQOLA) guidelines. In Part 2, we psychometrically validated the newly translated scale using a prospective study of 48 patients at the Kenyatta National Hospital ENT clinic in Nairobi, Kenya. RESULTS: The Swahili PHQ-9 had good test retest reliability (Intraclass correlation coefficient, 0.71) and internal consistency (Cronbach's alpha = 0.80). It also had good construct validity, as scores correlated strongly with TNM stage (Chi square = 123, p < 0.05), and with the compositeand global scores of an H&N cancer specific QOL scale (UW-QOL, r = -0.87, p < 0.05). CONCLUSION: The Swahili version of the PHQ-9 is a reliable scale in Kenyan H&N cancer patients, and is a valuable tool in screening for and monitoring of depression as a function of QOL in this population.
Asunto(s)
Trastorno Depresivo/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Psicometría/métodos , Calidad de Vida , Encuestas y Cuestionarios , Adulto , Anciano , Comparación Transcultural , Demografía , Trastorno Depresivo/epidemiología , Femenino , Neoplasias de Cabeza y Cuello/epidemiología , Neoplasias de Cabeza y Cuello/patología , Humanos , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , TraduccionesAsunto(s)
Adenoidectomía , Tonsilectomía , Tonsila Faríngea/patología , Niño , Humanos , Hipertrofia , Tonsila Palatina/patologíaRESUMEN
OBJECTIVE: To determine the bacteriology and antibiotic sensitivity of the bacterial isolates in chronic maxillary sinusitis patients seen at the Kenyatta National Hospital. DESIGN: Cross-sectional study. SETTING: Kenyatta National Hospital, ENT department. SUBJECTS AND METHODS: Seventy-three patients had bilateral sntral washout done and the lavage submitted for culture and anti-microbial sensitivity between January and June 1996. RESULTS: Antral lavage yielded secretions in 63% of patients but bacteria were cultured in only 28.8% of the specimens. The isolates included Streptococcus pneumonia (22.2%), Staphylocococus albus (18.5%), Staphylocococus aureus (11.1%) and Enterobactericiae (11.1%). Anaerobic bacteria were cultured in 22.2% of the specimens. Of the commonly used antibiotics, there was high sensitivity to erythromycin, cefadroxyl, chloramphenicol and amoxicillin and poor sensitivity to ampicillin, cotrimoxazole and perfloxacin. CONCLUSION: The bacteriology of chronic maxillary sinusitis at Kenyatta National Hospital is generally similar to that found elsewhere. The bacteria are susceptible to relatively affordable antibiotics like amoxicillin, erythromycin and cefadroxyl.