Experience of communication among cervical cancer patients in Kenya

Communication influences patient disclosure, treatment adherence, and outcome, adaptation to illness, and bereavement. Different cancer patients and caregivers communicate their various experiences in unique ways. These distinctive experiences are necessary to be told, because it empowers both the teller and everyone who hears and shares that experience. However, there is little research documenting the experiences of cervical cancer patients and caregivers in Kenya and the rest of Africa. This study therefore sought to assess the communication experience among cervical cancer patients and their caregivers. This study was a qualitative study employing the phenomenological method to obtain data from cervical patients and caregivers. It was carried out in Uasin Gishu County, Kenya, where a range of in-depth interviews were held with eight patients and eight caregivers purposively sampled. Data from the interviews were analysed thematically and presented in narrative form using paraphrases and quotations. Ethical issues such as informed consent, confidentiality and official authorisation were observed at all levels. To enrich this study, hermeneutic theory, which explains more about the individual's experience, was used. The findings of the study indicated that communication is therapeutic, although most of the patients and the caregivers were reluctant to talk about their illness. The findings of this study will be of interest to scholars, policy-makers and caregivers of terminally ill patients.

Evaluating the urban-rural paradox: The complicated relationship between distance and the receipt of guideline-concordant care among cervical cancer patients

OBJECTIVE

Urban-rural health disparities are often attributed to the longer distances rural patients travel to receive care. However, a recent study suggests that distance to care may affect urban and rural cancer patients differentially. We examined whether this urban-rural paradox exists among patients with cervical cancer.

METHODS

We identified individuals diagnosed with cervical cancer from 2004 to 2013 using a statewide cancer registry linked to multi-payer, insurance claims. Our primary outcome was receipt of guideline-concordant care: surgery for stages IA1-IB1; external beam radiation therapy (EBRT), concomitant chemotherapy, and brachytherapy for stages IB2-IVA. We estimated risk ratios (RR) using modified Poisson regressions, stratified by urban/rural location, to examine the association between distance to nearest facility and receipt of treatment.

RESULTS

62% of 999 cervical cancer patients received guideline-concordant care. The association between distance and receipt of care differed by type of treatment. In urban areas, cancer patients who lived ≥15 miles from the nearest surgical facility were less likely to receive primary surgical management compared to those <5 miles from the nearest surgical facility (RR: 0.77, 95% CI: 0.60-0.98). In rural areas, patients living ≥15 miles from the nearest brachytherapy facility were more likely to receive treatment compared to those <5 miles from the nearest brachytherapy facility (RR: 1.71, 95% CI: 1.14-2.58). Distance was not associated with the receipt of chemotherapy or EBRT.

CONCLUSIONS

Among cervical cancer patients, there is evidence supporting the urban-rural paradox, i.e., geographic distance to cancer care facilities is not consistently associated with treatment receipt in expected or consistent ways. Healthcare systems must consider the diverse and differential barriers encountered by urban and rural residents to improve access to high quality cancer care.