Treatment Outcomes and Its Associated Factors Among Adult Patients with Selected Solid Malignancies at Kenyatta National Hospital: A Hospital-Based Prospective Cohort Study

Figures & data

Table 1 Socio-Demographic Characteristic of the Study Participants

Variable	Breast Cancer	Prostate Cancer	Lymphomas
	Frequency (%)	Frequency (%)	Frequency (%)
Age
< 60 years	80 (80.8)	9 (11.0)	43 (86)
≥60 years	19 (19.2)	73 (89.0)	7 (14)
Gender
Male	0 (0)	82 (100)	26 (52)
Female	99 (100)		24 (48)
Marital status
Single	23 (23.2)	0 (0)	16 (32)
Married	61 (61.6)	70 (85.4)	27 (54)
Divorced	9 (9.1)	2 (2.4)	4 (8)
Widowed	6 (6.1)	10 (12.2)	3 (6)
Educational status
Primary	33 (33.3)	27 (32.9)	6 (12)
Secondary	48 (48.5)	49 (59.8)	24 (48)
Tertiary	16 (16.2)	4 (4.9)	19 (32)
Illiterate	2 (2.0)	2 (2.4)	1 (2)
Occupational status
Housewife	12 (12.1)	0 (0)	2 (4)
Government employee	5 (5.1)	4 (4.9)	1 (2)
Retired	10 (10.1)	68 (82.9)	3 (6)
Merchant	7 (7.1)	3 (3.7)	5 (10)
Unemployed	23 (23.2)	3 (3.7)	23 (46)
Farmer	17 (17.2)	2 (2.4)	1 (2)
Daily laborer	13 (13.1)	0 (0)	2 (4)
Private employee	5 (5.1)	1 (1.2)	2 (4)
Other	7 (7.1)	1 (1.1)	11 (22)
History of substance use
Alcohol	4 (4.0)	18 (19.6)	5 (10)
Alcohol and smoking	85 (85.9)	29 (35.4)	9 (18)
Smoking cigarette	0 (0)	4 (4.9)	1 (2)
None	10 (10.1)	31 (37.8)	35 (70)
Family history of cancer
Yes	14 (14.1)	11 (13.4)	8 (16)
No	85 (85.9)	71 (86.6)	42 (84)

Table 2 Clinical Characteristics of the Study Participants

Variable	Breast Cancer	Prostate Cancer	Lymphomas
	Frequency (%)	Frequency (%)	Frequency (%)
Co-morbidity
Present	48(48.5)	41(50.0)	27(54.0)
Absent	51(51.5)	41(50.0)	23(46.0)
Number of co-morbidities
One	34(34.3)	26(31.7)	20(40.0)
Two	1(11.1)	13(15.8)	5(10.0)
Three	0(0.0)	2(2.4)	2(4.0)
ECOG performance scale
0	46(46.5)	19(23.2)	24(48.0)
1	33(33.3)	42(51.2)	14(28.0)
2	9(9.1)	14(17.1)	5(10.0)
3	8(8.1)	4(4.9)	3(6.0)
4	3(3.0)	3(3.7)	4(8.0)
Any distant metastasis
No	59(59.6)	21(25.6)	40(80.0)
Yes	40(40.4)	61(74.4)	10(20.0)
Site of metastasis
Lung	14(14.1)	0(0.0)	2(4.0)
Bone	12(12.1)	55(67.1)	5(10.0)
Brain	1(1.0)	0(0.0)	3(6.0)
Liver	2(2.0)	2(2.4)	0(0.0)
Bone and lung	5(5.1)	2(2.4)	0(0.0)
Bone and liver	1(1.0)	1(1.2)	0(0.0)
Liver, lung and bone	5(5.1)	0(0.0)	0(0.0)
Liver and lung	1(1.0)	0(0.0)	0(0.0)
Liver, bone and brain	0(0.0)	1(1.2)	0(0.0)
Type of co-morbidity
Dilated cardiomyopahty	3(3.0)	0(0.0)	0(0.0)
Diabetes mellitus	12(12.1)	8(9.8)	3(6.0)
Hepatitis	0(0.0)	0(0.0)	4(8.0)
Hypertension	30(30.3)	37(45.1)	4(8.0)
Pulmonary tuberculosis	1(1.0)	0(0.0)	3(6.0)
Asthma	2(2.0)	0(0.0)	1(2.0)
Chronic kidney disease	1(1.0)	3(3.7)	1(2.0)
Anemia	0(0.0)	1(1.2)	3(6.0)
Pneumonia	2(2.0)	0(0.0)	1(1.0)
Arthritis	3(3.0)	0(0.0)	0(0.0)
Deep vein thrombosis	1(1.0)	3(3.7)	4(8.0)

Abbreviation: ECOG, The Eastern Cooperative Oncology Group.

Figure 1 TNM staging of the disease among the study participants.

Table 3 Treatment Regimens Used for the Study Participants

Cancer Type	Frequency	Percent
Breast cancer treatment regimen
Radiotherapy, chemotherapy and surgery	14	14.1
Radiotherapy and chemotherapy	6	6.1
Radiotherapy, chemotherapy and endocrine therapy	5	5.1
Chemotherapy and surgery	8	8.1
Chemotherapy, surgery and endocrine therapy	11	11.1
Chemotherapy	14	14.1
Radiotherapy, chemotherapy, surgery and endocrine therapy	29	29.3
Radiotherapy, surgery and endocrine therapy	1	1.0
Surgery	1	1.0
Chemotherapy and endocrine therapy	10	10.1
Prostate cancer treatment regimen
Chemotherapy	1	1.2
Radiotherapy and endocrine therapy	12	14.6
Radiotherapy, chemotherapy, surgery and endocrine therapy	14	17.1
Surgery and endocrine therapy	10	12.2
Radiotherapy, surgery and endocrine therapy	19	23.2
Endocrine therapy	22	26.8
Chemotherapy and endocrine therapy	4	4.9
Lymphomas treatment regimen
Chemotherapy	40	80
Radiotherapy and chemotherapy	10	20

Table 4 Types of Endocrine Therapy and Chemotherapy Regimens Used Among the Study Participants

Endocrine Therapy of Breast Cancer Patients	Frequency	Percent
Tamoxifen	34	34.3
Herceptin	15	15.2
Anastrazole	4	4.0
Herceptin+tamoxifen	7	7.1
Letrozole	1	1.0
Endocrine therapy of prostate cancer patients
Goserelin	7	8.5
Bicalutamide	2	2.4
Goserelin + bicalutamide	64	78.0
Abiraterone	2	2.4
Goserelin+bicalutamide+abiraterone	7	8.5
Chemotherapy regimens of prostate cancer patients
Docetaxel+predisnolone	4	4.9
Docetaxel	16	19.5
Chemotherapy regimens of breast cancer patients
AC (doxorubicin and cyclophosphamide)+paclitaxel	40	40.4
Capecitbine+gemcitabine	3	3.0
Carboplatin+docetaxel	1	1.0
CMF (cyclophosphamide, methotrexate and fluorouracil)	1	1.0
AC (doxorubicin and cyclophosphamide)	35	35.4
MAC (methotrexate, adriamycin and cyclophosphamide)	1	1.0
TBC (thiotepa+busalfan+cyclophosphamide)	1	1.0
Capecitbine+docetaxel	2	2.0
AC (doxorubicin and cyclophosphamide)-docetaxel	6	6.1
FAC (5-fluorouracil, doxorubicin and cyclophosphamide)	6	6.1
5-FU-epirubicin+cyclophosphamide	1	1.0
Chemotherapy regimens of lymphoma patients
CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)	9	18.0
ABVD (doxorubicin, bleomycin, vinblastine and dacarbazine)	21	42.0
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone)	19	38.0
FCR (fludarabine, cyclophosphamide and rituximab)	1	2.0

Table 5 Status of Remission of the Patients During the Last Follow-Up Period

Remission Status	Breast Cancer	Prostate Cancer	Lymphoma
	Frequency (%)	Frequency (%)	Frequency (%)
Complete remission	14(14.1)	1(1.2)	1(2)
Partial remission	45(45.5)	37(45.1)	21(42)
None response	16(16.2)	14(17.1)	18(36)
Progression of disease	24(24.2)	30(36.6)	10(20)

Table 6 Mean Cancer-Specific Survival Outcomes Among the Study Participants

Survival Parameter	Breast Cancer	Prostate Cancer	Lymphoma
	Mean (in Months)±SD	Mean (in Months)±SD	Mean (in Months)±SD
Cancer-specific survival	11.4±2.1	11.5±2.3	10.7±2.7
Metastasis free survival	10.8±3.2	10.2±3.8	11.2±2.8
Cancer-specific survival after metastasis	10.9±2.8	10.4±3.6	11.5±2.1

Table 7 Mean Survival Estimate Among the Study Participants

Variable	Breast Cancer		Lymphoma		Prostate Cancer
	MSE (Months)± SEM (95% CI)	Log Rank Test (p-value)	MSE (Months)± SEM (95% CI)	Log Rank Test (p-value)	MSE (Months)± SEM (95% CI)	Log Rank Test (p-value)
Age (in years)		0.02*		0.04*		0.01*
<60 years	11.3±2.2(0.2–0.5)		11.4±2.8(0.5–0.9)		11.2±2.3(3.2–4.1)
≥60 years	9.2±2.3(0.4–0.7)		10.2±3.2(0.1–0.5)		9.5±2.7(0.2–0.8)
Co-morbidity		0.03*		0.02*		0.02*
Absent	10.5±2.1(2.6–3.5)		10.6±2.3(0.5–0.9)		11.4±3.9(0.2–0.7)
Present	8.5±1.3(0.2–0.9)		11.8±3.1(2.1–2.8)		10.2±2.4(0.3–0.9)
Distant metastasis		0.02*		0.03*		0.03*
No	10.9±1.6(0.2–0.7)		11.1±2.2(2.6–3.1)		11.2±2.6(2.4–3.1)
Yes	7.2±2.7(0.4–0.9)		8.2±2.4(2.5–4.2)		10.1±2.5(3.1–3.9)
Stage of the disease		0.04*		0.01*		0.04*
Early stage (I and II)	11.5±3.6(0.3–0.7)		10.6±3.1(2.4–4.2)		11.4±3.5(0.4–0.8)
Advanced stage (III and IV)	8.6±4.5(0.2–0.8)		8.1±2.6(2.2–2.9)		9.8±2.6(0.2–0.9)

Note: *Statistically significant.

Abbreviations: MSE, mean survival estimate; SEM, standard error of the mean.

Table 8 Predictors of Mortality Among the Study Participants

Variable	Breast Cancer				Lymphoma				Prostate Cancer
	Bivariate Analysis	P-value	Multivariate Analysis	P-value	Bivariate Analysis	P-value	Multivariate Analysis	P-value	Bivariate Analysis	P-value	Multivariate Analysis	P-value
	CHR (95% CI)		AHR (95% CI)		CHR (95% CI)		AHR (95% CI)		CHR (95% CI)		AHR (95% CI)
Age (in years)
<60 years	1		1		1		1		1		1
≥60 years	3.8 (0.2–0.7)*	0.01*	2.8(0.7–0.9)	0.001*	2.8(2–7)	0.001*	2.4(3–5)	0.002*	2.3 (0.4–0.8)*	0.01*	2.1(0.8–0.9)	0.01*
Co-morbidity
Absent	1		1		1		1		1		1
Present	3.2(0.2–0.6)	0.005*	2.2(0.2–0.8)	0.004*	2.1(0.2–0.7)	0.05*	2.3(0.5–0.9)	0.04*	2.2(0.4–0.7)	0.004*	2.3(0.2–0.9)	0.02*
Distant metastasis
No	1		1		1		1		1		1
Yes	4.2(0.2–0.7)	0.03*	3.1(0.3–0.8)	0.002*	3.2(0.2–0.7)	0.01*	3.1(0.3–0.9)	0.02*	2.2(0.3–0.6)	0.04*	2.4(0.2–0.9)	0.002*
Stage of the disease
Early stage (I and II)	1		1		1		1		1		1
Advanced stage (III and IV)	2.3(0.7–0.9)	0.02*	2.1(1.5–2.3)	0.01*	3.3(0.4–0.9)	0.002*	2.5(1.3–2.9)	0.03*	3.3(0.2–0.9)	0.02*	2.1(1.5–2.3)	0.003*

Note: *Statistically significant.

Abbreviations: AHR, adjusted hazard ratio; CHR, crude hazard ratio.

Table 9 Health-Related Quality of Life Among the Study Participants

Scale	Quality of Life Scale/Item	Breast Cancer		Prostate Cancer		Lymphoma
		Baseline (Mean± SEM)	Last Follow Up Period (Mean± SEM)	Baseline (Mean± SEM)	Last Follow Up Period (Mean± SEM)	Baseline (Mean± SEM)		Last Follow Up Period (Mean± SEM)
EORTC QLQ-C30	Global health status
	Global health status	56.4±3.2	66.4±2.2	47.7±2.3	77.7±2.1	46.1±4.6		60.1±3.4
	Functional scales
	Physical functioning	45.3±3.5	66.2±3.2	37.6±4.6	67.6±3.3	49.4±3.9		68.5±4.9
	Role functioning	40.4±3.8	60.6±3.5	41.4±4.7	61.4±3.7	38.0±4.2		55.0±5.3
	Emotional functioning	51.2±2.6	71.1±2.9	48.4±4.1	77.4±3.2	46.8±5.4		56.7±5.2
	Cognitive functioning	55.7±3.4	65.7±3.1	46.4±3.8	85.4±2.7	45.9±5.2		74.7±3.9
	Social functioning	44.0±3.6	64.0±3.0	43.3±4.9	81.3±3.3	39.2±4.1		55.3±5.1
	Symptom scales/items
	Fatigue	79.2±3.4	29.2±3.1	69.7±3.2	29.8±3.3	66.7±4.3		38.7±5.2
	Nausea and vomiting	80.4±2.6	20.5±2.9	75.5±1.5	5.5±1.6	69.2±3.2		13.3±3.0
	Pain	68.7±3.8	38.9±3.4	78.8±2.9	37.8±3.4	78.0±4.5		37.0±4.8
	Dyspnoea	65.6±4.7	25.9±3.6	88.4±3.5	7.3±2.4	69.2±3.5		19.3±4.5
	Insomnia	77.6±3.3	27.9±3.4	65.3±3.6	24.4±3.8	73.7±3.6		42.7±5.5
	Appetite loss	69.7±1.4	19.7±2.9	60.0±3.6	15.0±2.9	80.0±6.2		40.0±5.5
	Constipation	75.5±2.9	15.5±2.6	75.2±3.9	14.2±3.3	78.3±2.9		8.6±2.8
	Diarrhoea	74.1±3.8	14.1±2.6	66.4±1.9	4.1±1.8	61.2±3.4		11.3±3.2
	Financial difficulties	85.7±4.8	65.7±4.4	65.7±4.2	45.9±5.2	67.9±5.3		54.7±6.4

Abbreviations: EORTC QLQ-C30, European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire 30, SEM: standard error of the mean.

Figure 2 Overall health-related quality of life of the study participants in the last follow up period.