Treatment Delay in Kaposi Sarcoma Patients in Uganda

Abstract

Background

Significant delay occurs in initiating cancer treatment worldwide. In Uganda, there has been an increase in HIV/AIDS related malignancies due to the large number of people with HIV/AIDS. One particular cancer that has had a very large increase in prevalence is Kaposi Sarcoma. Despite the availability of chemotherapy for Kaposi Sarcoma at the Uganda Cancer Institute, many patients will present with advanced disease. Most studies on delay in cancer have been done in developed countries and very few have been done in Africa. Even fewer studies have been done in the context of HIV/AIDS and KS where patients are under continuous care. This study sought to establish the causes of treatment delay and describe the pathway to care in KS patients in Uganda.

Methods

The study was a cross sectional study carried out at the Uganda Cancer Institute. The study enrolled adult consenting patients that presented to the Uganda Cancer Institute with histologically diagnosed Kaposi Sarcoma. The study used an interviewer-administered survey that comprised questions on demography, socio-economic status as well as different aspects of HIV/AIDS and KS care. The study lasted from July to August 2011.

Findings

180 patients were enrolled in the study, and 27% experienced delays in treatment initiation lasting more than 3 months. 44% of the study participants used traditional healers and of these, 33% experienced delays greater than 3 months (P value=0.05) compared to 23% in those that did not use traditional healers. The odds of delay in those who visited traditional healers was 2 times the odds of delay in those who did not use traditional healers (P Value= 0.07). Other factors that were correlated with delay were education status, attendance of HIV care clinics, use of HAART and marriage.

Discussion

Treatment delay still remains a significant problem in cancer patients in Uganda despite the increasing knowledge about cancer, and in HIV/AIDS related malignancies, despite the availability of evaluation in HIV care clinics. Some of the factors responsible for treatment delay use of traditional healers, and knowledge of cancer and the potential care, which is available. It is important that we address the lack of knowledge about cancer symptoms in the patients if we are to address treatment delay sufficiently. It is also imperative that we address the challenges in the health care systems that contribute to delay in order to ensure access to diagnostic and treatment services.