Familial clustering of cancer in two tertiary care hospitals in Nairobi, Kenya.

OBJECTIVE: To describe the occurrence of cancers in families of individuals diagnosed cancer. DESIGN: Cross-sectional descriptive study. SETTING: Outpatient cancer clinics at Kenyatta National Hospital (KNH) and Radiotherapy Clinic at Nairobi Hospital. SUBJECTS: Patients with a tissue histological or cytological diagnosis of cancer. MAIN OUTCOME MEASURES: A reported family history of cancer. RESULTS: A total number of 485 cancer patients were recruited, 382, from KNH and 103 from Nairobi Hospital. These index cases had 45 different types of cancer, with the most common being breast and uterine-cervical malignancies. Prevalence of family history of cancer was found to be 18.8% and was highest among 1st degree relatives. Documentary evidence was seen in 48.4% and history of cancer corroborated by medical personnel in an additional 11%. In 18.7% of cases more than one relative was interviewed to confirm the family history of cancer. Educational levels of the index cases correlated with knowledge of family history of cancer, with those of higher educational level having been more informed about their families' medical history. There was a prevalence of familial cancers of 30% at Nairobi Hospital patients and 15.7% at KNH patients. CONCLUSION: We found the prevalence of family history of cancer in our population to be 18.8% and was highest among 1st degree relatives. This has implications for targeted screening and therefore early diagnosis which is beneficial.

Incidence of chemotherapy-related tumour lysis syndrome at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To estimate the magnitude of laboratory defined Tumour Lysis Syndrome (TLS) at Kenyatta National Hospital (KNH), identify its pattern of presentation, resolution, and determine the biochemical outcome of affected patients. DESIGN: Prospective patient-treatment cohort study. SETTING: Kenyatta National Referral and Teaching Hospital, between November 2004 and April 2005. SUBJECTS: One hundred and forty two patients receiving first course chemotherapy. MAIN OUTCOME MEASURE: Laboratory defined Tumour Lysis Syndrome (TLS). RESULTS: One hundred and eleven patients completed the study protocol. Forty two patients (37.8%) developed TLS. The incidence in haematological malignancies was 75.5% while in non-haematological malignancies was 3.6%. Hyperphosphataemia and hyperkalaemia were the most consistent diagnostic parameters while hyperuricaemia occurred in only one patient. No patient developed hypocalcaemia. Ninety five percent of patients developed TLS within the first three days of receiving chemotherapy while 55% resolved in the first week. Two TLS case mortalities occurred. CONCLUSIONS: The incidence of TLS in this cohort study was 38%, and was highest among haematological malignancies. No cases occurred in breast cancer patients. Majority of the cases were diagnosed on the basis of increase in serum phosphate and potassium; uric acid did not rise predominantly due to prophylactic uricosuric therapy. A majority (95%) developed within three days of commencing chemotherapy.