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Hillary Kibet
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EP1.09 - Pathology (ID 199)
- Event: WCLC 2019
- Type: E-Poster Viewing in the Exhibit Hall
- Track: Pathology
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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EP1.09-12 - Lung Cancer in Kenya: Quantification of the Problem (Now Available) (ID 879)
08:00 - 18:00 | Author(s): Hillary Kibet
- Abstract
Background
Objective As part of MLCCP to establish a baseline of lung cancers in Kenya.
Method
Methods Setting I: A Retrospective review of lung cancer diagnosis at Eldoret Cancer registry 1995-2017; 310 analyzed. Setting II: All those with lung masses at radiology unit from 2014- 2018 ;78 lung masses noted. Setting III: Data from a large private laboratory group- 514 cases that were biopsied, 279 malignant vs 235 others.
Result
Results Setting I: 310 lung malignancies. Primary lung 102 (32.9%) . M: F was 1:1. Mean age, and range in years was 60.3±1.2 and 29-98. NSCLC 81.4% and SCLC 18.6%. Adenoca 62.7%, SCC 21.7%, large cell carcinoma 6.0%. Staging on 18 patients, 14 had stage IV disease. Age 55-74 accounted for 61.7% Setting II: From Rad unit Biopsies done mainly by CT-guidance (31/73), Ultrasound guidance (20/73), bronchoscopy (19/73) and Thoracotomy (3/73). Of 78 cases, 50 (64.1%) were malignancies. Lung cancer had 34 of the 50. Mean age 57.1 range 32-84 yrs with median 61. Males were 21 (67.8%) and females were 13 (38.2 %) NSCLC was 83.4% and SCLC was 17.6%. Adenoca accounted for 82.14% of NSCLC. Clinical data was available on 10 of the 34 cancer patients and indicated Stage IV in 80% of them. Setting III: Of the 279 malignant cases from the private lab facility, Primary lung cancer had 209 patients (74.9%). Other metastatic cancers;Metastatic carcinoma 4.7%, CUP 4.3%, Neuroendocrine 3.6%, Carcinoid tumor 1.8%, sarcoma, spindle cell tumor, lymphoma and others. M:F 116 (55.5%) vs 86 (41.2%). 61 av. age at diagnosis, range 23-94 yrs. NSCLC was 91.8% of all cases, SCLC was 8.2%. In NSCLC, Adenocarcinoma 129 (61.7%), SCC 20% and others 20% Others-TB, Pna, Aspergillosis, Benign tumors, Fibrosis, Bronchiolitis Obliterans etc.
Conclusion
High index of suspicion, education and training is needed to improve diagnostics in Lung cancer in Kenya. Bio-banking of tissue and more research i.e Evaluation of mutations; EGFR, ALK, ROS1, MET, BRAF, HER2, PDL1, MAPK, PI3K signaling pathways may be useful to define mechanisms of drug sensitivity and potential molecular targets in our setting. There is a need to fully characterize, optimally treat and measure outcomes of lung cancer in Kenya.
*MLCCP is a Multi-National Lung Cancer Control Program with Dr. Asirwa the overall PI for Kenya, Tanzania, Swaziland and South Africa. Funding for the program has been provided by Bristol Myers Squib Foundation (BMSF) *MLCCP Team is the Team for this Kenya Program Component
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P1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 186)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.16-16 - Lung Cancer Control in Sub-Saharan Africa: Experience at Ampath Oncology in Western Kenya (Now Available) (ID 1661)
09:45 - 18:00 | Author(s): Hillary Kibet
- Abstract
Background
Objective To find out the cause for the under-diagnosis of Lung Cancer (LC) at AMPATH by using community engagement and high-risk screening at the TB clinics. Methods FGDs with community cough monitors in counties were done due to overlap of LC and TB presentations.
Method
Consequently through establishing a multinational-lung cancer control program (MLCCP) to improve diagnosis and patient journey for lung cancer patients in our settings, we classified patients with symptomatic lung disease (chest pain, cough, SOB, weight loss, hemoptysis) and negative gene expert/negative sputum for AAFB as high-risk for further evaluation. CT scans were done for anyone with a chest mass/lesion and Image-guided biopsy offered.
Result
Results Jan 2018-Mar 2019, 331 high risk clients were evaluated. 214 with masses CT scans of which 205 were lung and 9 were mediastinal. 131/214 had biopsy, of which 83 (60 LC, 23 secondary mets) while 48 were other conditions.These included: Lung Fibrosis, Aspergillosis, Chronic granulomatous inflammation, TB, Thymoma, viral histiocytosis, Granuloma and unconfirmed diagnosis For the biopsied lung masses-131/214, 60 had confirmed LC. This represented 45.8% of those biopsied. Male to Female ratio was 1:1, median age at diagnosis was 62 with 55-74 age range accounting for 73.2% of LC cases. The mean duration of symptoms was 8 months, range of 1 to 12 months. >50% of the cancer patients made 7-10 hospital visits before diagnosis, with 25% making more than 14 visits. NSCLC accounted for 92.2% of the diagnosis with SCLC 7.8%. Adenocarcinoma was the commonest diagnosed histological sub-type at 66% of NSCLC. Majority of the patients were diagnosed at stage IV, 78.1% with only three patients diagnosed in stage II. 39% (25/64) patients are alive and on follow-up.
Conclusion
Conclusion Early detection is key. Poor referral patterns and lack of LC knowledge and diagnostic skills by HC professionals causes late stage at diagnosis. Patients do not present Late. Community engagement and embedding simple protocols for prompt referrals/diagnostic work-up in TB control programs may lead to improved outcomes. Prevention measures should also be rolled out. Cough monitors were essential to improving the LC patient's journey.
*MLCCP is a Multi-National Lung Cancer Control Program with Dr. Asirwa the overall PI for Kenya, Tanzania, Swaziland and South Africa. Funding for the program has been provided by Bristol Myers Squib Foundation (BMSF) *MLCCP Team is the Kenyan Team for this Western Kenya Program Component
