Cancer: Poor referral blamed for late diagnosis

Patients see eight to 10 doctors without being referred to a cancer specialist.

Health workers in primary healthcare facilities fail to refer cancer patients for specialised treatment early, due to lack of awareness of symptoms, experts have said.
This leads patients to get an accurate cancer diagnosis at advanced stage, even though they sought care when the cancer was in its early stages when interventions are more possible.
“I have seen many patients with advanced cancer, who have seen close to 13 general doctors without being guided on where to go,” said medical oncologist Fredrick Chite during the two-day Roche MPANGO conference that brought together cancer specialists from Kenya, Ghana, Nigeria, Uganda, Tanzania, Cameroon the United States, Belgium and France in Nairobi.
Dr Chite said that practitioners in health centres and dispensaries – the first stop for patients who are unwell – keep treating patients who make several visits without reprieve instead of referring them to specialists. He added that by the time a patient is being diagnosed with stage four oesophageal cancer, they have been treated for acid reflux so many times, and by the time they are seeing an oncologist, the condition is so serious, that they cannot swallow solid food.
He dismissed the notion that cancer patients are diagnosed at a late stage because they seek healthcare late.
“Every patient we see has seen eight to 10 other health workers for their problem. For six months or so they have been seeking medical attention,” said Dr Chite.

Medical oncologist and University of Nairobi lecturer Andrew Odhiambo said that without referrals, there are delays in getting patients to the expert care they need.
“As our leaders advocate for cancer centres and launch them hoping that patients will find their way there, this cannot happen unless we have a working referral system,” said Dr Odhiambo, adding that timely referrals would improve outcomes for cancer patients.
“A patient from West Pokot is referred to the Kenyatta National Hospital without being told which expert to see, the clinic days and the availability of tools. If someone goes to a health centre complaining that they have difficulty swallowing, they should be referred to a hospital with the right tools like endoscopy,” he said.
John Chudi Ojukwu, a surgical oncologist in Nigeria, said that in a working referral system, health workers should know the capability of higher level hospitals in terms of the services they offer, availability of doctors and clinic days.
“They can call the referral hospital and book the patients in advance rather than the patient walking in to try their luck. The current system drives away patients. They try their luck several times and give up,” he said, adding that such patients turn to traditional medicine and come back to hospital when the cancer is incurable and all they can get is palliative care.

Dr Sitna Mwanzi, an oncologist at the Aga Khan University Hospital and the chairperson of the Kenya Society of Haematology and Oncology said that healthcare workers in level one to four primary healthcare facilities should be trained and made aware of the referral system even as the public is educated on the importance of cancer screening.
“As we create public awareness, we also need to create awareness among healthcare providers in primary healthcare facilities so that we strengthen the referral system,” said Dr Mwanzi, adding that when a health worker can’t solve a patient’s problem, he or she should tell the patient where they can go to get help.
The experts called on the government to map out cancer centres to help patients and health workers know which services are available in which hospitals, to protect patients from quacks claiming to have cancer cures.


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