Barriers to effective childhood cancer control in Kenya (BECK) study, 2019-2020: A mixed methods study in a national tertiary facility and 10 regional cancer treatment centers.

10018 Background: Globally, 80,000 children die from cancer annually; 80% in low- and middle-income countries (LMICs). Childhood cancer cure is possible in more than 80% of cases, in all economic settings. This study aimed to identify barriers to effective management of childhood cancers in Kenya, for program and policy intervention. Methods: We reviewed childhood cancer cases diagnosed at Kenyatta National Hospital in the period 2015-2019. We also assessed capacity of ten recently established regional cancer centres for childhood cancer diagnosis and treatment. We conducted focused group discussions among childhood cancer survivors’ caregivers and key informant interviews among childhood cancer specialists and policy makers from the Ministry of Health and the National Cancer Institute of Kenya. We estimated diagnostic delays, mapped service availability and deductively summarized the qualitative data into main themes. Results: We abstracted 1,764 cases; median age 6 years (IQR 9); 1013 (57.5%) were male. Most affected age group was 0-4 years (47.3%). Most common cancer types were retinoblastoma (23.3%), nephroblasoma (10.4%) and acute lymphoblastic leukaemia 10.3%). Cases managed at KNH decreased between 2015 and 2017, and then recovered. The median total delay (symptoms onset to treatment initiation) was 32 days (range 0-3666). Regional cancer centres lacked specialized workforce for childhood cancer care. Caregivers identified inadequate cover by National Health Insurance and disorganized care process as major challenges. At health system and policy level, low awareness, fragmented referral systems and in-effective policy implementation are major challenges to childhood cancer control. Conclusions: Increasing number of specialized personnel, creation of a differentiated financing package for childhood cancer and restructuring of referral and the care process can improve childhood cancer outcomes in Kenya.