Trends in AIDS-Associated Cancers among Patients Attending a Palliative Care Service in Uganda in the ’Pre-HAART’ Era, 1994–2002.

Objectives: To describe the pattern of AIDS-associated cancers among patients referred to a palliative care service in the absence of HAART therapy.

Design: A systematic review of patient records as part of an ongoing quality assurance project.

Setting: A primary palliative care service centre for cancer and/or AIDS patients in Kampala district, Uganda.

Participants: All patient charts from 1994 to 2002 that met inclusion criteria (positive HIV test, or an AIDS diagnosing condition and AIDS-associated cancer) were selected.

Results – 657 out of 3,706 (17.7%) patients met inclusion criteria. Fifty-two percent were female and the median age was 33 years. Thirty-nine percent were referred for pain and symptom control, 51.9% for pain control only, 7.0% for symptom control only; and 2.3% were referred for other reasons. Ninety-six percent were in pain and 95% of these had moderate-to-severe pain. Kaposi’s sarcoma was the most common AIDS associated malignancy, accounting for 73.2% of cases followed by invasive cancer of the cervix (15.1%), non-Hodgkin’s lymphoma (6.4%) and squamous cell carcinoma of the conjunctiva (1.8%). 83.4% had their pain well controlled at the time of death.

Conclusions: The number and proportion of patients with Kaposi’s sarcoma declined over the study period. Pain control was achievable in most patients despite restrained resources.