Addressing high cost of cancer treatment in Nigeria
While, Nigerians joined the world on February 4 to mark this year’s World Cancer Day, the hydra-headed challenges that have long beset the disease in terms of adequate treatment continues to linger.Indeed, challenges such as huge cost of treatment, inadequate infrastructure, late presentation, insufficient manpower, and economic downturn remain the major setback to the fight against cancer.
Experts who spoke with The Guardian affirmed that the nation’s dwindling economy is taking enormous toll on cancer patients and families raising the death rate of the disease in Nigeria to 80 per cent. This is why cancer is now the world’s most expensive and deadliest disease.
A consultant radiation and clinical oncologist of the Lagos University Teaching Hospital (LUTH), Dr. Lolade Kehinde, said many patients attribute high cost of treatment and the nation’s poor economy to why they report late. This late presentation leaves the patient to having little or no hope of survival.“Although the year’s theme for World Cancer Day is “We can, I Can”, there is no respite in view for cancer. The aim is to individually and collectively fight and reduce cancer,” he added.
The Guardian investigation revealed that everything about cancer treatment is extremely expensive. Drugs are purchased as much as N300,000 monthly, while chemotherapy or radiotherapy goes for N200,000 or more, which obviously cannot be afforded by the common man.The increasing death rate of cancer in Nigeria is largely connected with poor infrastructure. Currently, there are few comprehensive cancer centres, hence, patients are compelled to seek treatment in more than one hospital or simply travel abroad. Most of the cancer treatment machines are broken down and even the ones that are working are not performing optimally. Kehinde revealed there are only two functional linear accelerator machine in the country meant to serve over 165, 000 million people.
He added that if government can provide one functional linear accelerator for each state, patients would not have to travel from Lagos to Abuja or Ibadan.“This would reduce the cost of treatment,” he added.Oncology doctors are usually overwhelmed due to the increasing numbers of patients and the few hands available to care for them.
Addressing the need for more oncology doctors, Kehinde said this would reduce human error and doctor being irritable after being overworked. “Cancer patients are afraid and need a lot of empathy, which the few hands available cannot provide”, he added. On the need for creating more awareness, the clinical oncologist said that many people ignore some obvious signs of malignancy and probably think that it does not matter, they rather attribute the signs to something else and might not seek prompt medical attention.
“These signs include post menopausal bleeding, blood discharge after sexual intercourse, irregularity in the breast shape, or anything at all that is abnormal should be reported to the hospital,” he noted.Kehinde said that LUTH is taking this year’s cancer campaign to the religious centres. “We would go to the mosque on Friday and church on Sunday to inform and encourage the congregation on what signs to watch for.
“It is observed that many religious people hide under the name of their religion to abscond from seeking medical help, even when the cancer is malignant. We want to change this orientation and also encourage the religious leaders to support the fight against cancer,” he added.He advised that people should get screened regularly, and government should put their words to actions to cushion the scourge of cancer care in Nigeria.
Minister of Health, Prof. Isaac Adewole, in a statement, yesterday, said: “In 2018 it is estimated that there will be 14 million new cases of cancer while eight million people will die from the disease globally.“In today’s commemoration I urge all Nigerians to get active and help combat this deadly disease… I want to encourage all patriotic Nigerians to be more active in the fight against a disease that, in less than two decades will directly affect up to 21.7 million persons per year.
“I want everyone listening to me to harness the power of sport by encouraging sports fans, organisations and personalities to use their voice and react through the ‘support through sport’ initiative. As we know a healthy lifestyle is one of the weapons in the fight against cancer and a lot other non-communicable diseases.”
A radiologist at the Radiation Medicine Department at University of Nigeria College of Medicine (UNCM) and University of Nigeria Teaching Hospital (UNTH), Enugu, Prof. Ifeoma Okoye, told The Guardian: “In Nigeria, the rising incidence of cancer and the paucity of institutional facilities and specialist man-power imply that the burden of care rests largely on relatives. We assessed the severity of indices of psycho-social and economic burden among relatives of women with breast and cervical cancer; and its relationship with patients’ psychosocial distress.
“The financial burden is more problematic than the effect of caring on family routines; and these two factors significantly predicted global rating of burden.
Thus, in Nigeria apart from the disruption of family life, the colossal amount of funds required for diagnosis and treatment are crippling. The death of a cancer patient often means the loss of a breadwinner or total impoverishment of survivors due to high cost of treatment which often drains the resources of victims and their family members.”
The oncologist added: “On its part, the WHO said about 24.6million people live with cancer worldwide while about 12.5 per cent of all death is attributable to cancer. It further estimates that over 100,000 Nigerians are diagnosed with cancer yearly, while about 80,000 die from the disease. This brings the consequences of the cancer epidemic to 240 Nigerians every day or 10 Nigerians every hour, dying from cancer. It noted that the country’s cancer death ratio of four in five affected persons is one of the worst in the whole world.”
Okoye, who is also the founder of a non-governmental organisation, Breast Without Spot (BWS), hailed passage of the Bill for Act to provide for the establishment of National Institute for Cancer Research and Treatment by the Senate. She said the grim statistics underpinned the earnest quest by the 8th National Assembly to urgently tackle the dire health challenge posed by the incidence of cancer to Nigerians and to lay a solid legal foundation upon which present and future superstructure of interventions aimed at the control, treatment and prevention of the disease in the country would take root. “It is worthy of note that while it has been introduced by both the Red and Green Chambers, the Senate has already considered and passed its own version of the ‘Bill for an Act to provide for the establishment of the National Institute for Cancer Research and Treatment.’”
To increase in the level of awareness of cancer and related issues and ultimately the death rate, the Minister of Health, said the FMoH has developed jingles on cancer awareness in five Nigerian languages viz English, Pidgin, Hausa, Igbo and Yoruba and these are available for broadcast to general public on Radio and social media.Adewole said the Ministry would partner with the Nigeria Union of Road Transport Workers (NUWRT) to broadcast the awareness jingles on 1000 long distance buses.
The Minister said: “The commissioning of a new radiotherapy centre and the National Hospital Abuja are for easy access to radiation treatment and another new machine kindly donated by the Shell Nigeria Exploration and Production Company (SNEPCo) is already within the country and will be operation in the next few months. He said the Ministry is also in the process of refurbishing the existing centres that are down currently to full functioning centres for radiotherapy treatment.
“Ministry has approved a community based free cancer-screening project and the pilot phase will commence from Gwagwalada Area Council, Abuja, before the end of this month.”He said the 2018 – 2022 National Cancer Control Plan with the vision, “To reduce the incidence and prevalence of cancer in Nigeria,” should be launched at the end of this month.Adewole added: “There is revitalization of Primary Healthcare Centres (PHCs) across the country with the aim of having a fully functional PHC in every word in the country; this is so that early referral from this PHC will pick up cancers and other diseases early to prevent avoidable late detection and costly treatments with low favorable outcomes.
“Governments have also commenced the Phase II Rapid Result Initiative programme to the screen breast, cervical and prostate cancers for 750,000 eligible Nigerians in total and treat detected malignancies.“The Ministry also plans treatment of between 1000 – 2000 indigent cancer patients within this calendar year and the modalities are been worked out as this has the effect of attracting investments for cancer as payment for services would be guaranteed across the whole spectrum of cancer care.”
The Minister said despite these giant strides, there still remain some factors which militates against these efforts to effectively combat the scourge of cancer in this country. “The key barriers to treatment of cancer in Nigeria include lack of non-governmental investments, low number of skilled health care personnel, Funding Gaps, among others,” he said and added: “Government plans to overcome these key challenges to include the development of Public Private Partnership (PPP) Strategies to address the funding gaps and manpower shortages.
“The Federal Ministry of Health in this regard is calling on interested stakeholders, both in the National and International arena to partner with us so that more laudable achievements can be recorded in the management of cancers in this country.” Chairman, Senate Committee on Health, Senator Lanre Tejuoso, while presenting the report on the Bill to the Senate for the third and final reading, explained that cancer has been identified as one of the public health problems worldwide. “The disease affects all categories of humanity. Cancer is known to be the second common cause of death in developed countries and third leading cause of death in developing countries of which Nigeria, with its population is highly affected,” Tejuoso said.
He said the control, treatment and research on cancer has tremendously improved in the developed economies and even in some developing nations like India – where efforts of science and improved national strategy against cancer have been harnessed and deployed to fight cancer related deaths – such achievements were only made possible through the establishment of advanced cancer research infrastructure, new cancer centres and improved treatment procedures.
“It is sad to note, that Nigeria has not done enough to fight cancer as evident by lack of adoption of a national strategy that focuses on research, improved awareness and provision of treatment centres. This certainly must be the reason the spread of the ailment is not abating in Nigeria,” he stated.
The bill is meant to bridge this yawning gap in the national efforts to properly diagnose and manage the cancer pandemic. The objectives of the Bill among others is to provide a national leadership in cancer research, prevention, control and treatment; guide scientific improvements to cancer research prevention, treatment and care; coordinate and liaise between wide range of groups and health providers with an interest in cancer; and assist with the implementation of government policies and programmes in cancer research, prevention, control and care. Highlighting the relevant provisions of the legislation, Tejuoso noted that the broad-base participation at the public hearing conducted by the Committee, agreed with the intentions of the Bill. “Its intent is to ensure that all forms of cancer disease are prevented, controlled and treatment and care for cancer patients provided, with national strategies that focuses on cancer research,” he said.