By Sola Ogundipe
Nigeria does not have enough cancer specialists and also lacks enough adequately equipped facilities to tackle the high incidence of cancer cases.
As cancer rates are on the increase, the number of cancer specialists continues to drop as a result of brain drain and Nigeria is falling critically short of the specialists who can deliver required chemotherapy, radiotherapy and immunotherapy to tackle the rising number of cases.
Nigeria is one of the countries where the burden of chemotherapy is increasing but the chronic shortage of experts such as consultant radiation and clinical oncologists that specialise in cancer care and management is contributing to the high rate of death.
Anyone battling cancer in Nigeria today faces great challenges and the diagnosis of cancer is potentially a death sentence.
Findings by Vanguard revealed that Nigeria currently has fewer than 70 consultant radiation and clinical oncologists, even as the ratio of experts in other sub-specialties of oncology is abysmally low.
Currently, there are fewer than 2,000 radiographers and just a handful of trained radiation therapists in the country according to the Radiographers Registration Board of Nigeria. Radiographers are medical professionals who utilize x-Ray, ultrasound devices and other imaging devices in the diagnosis of cancer and other disorders.
According to statistics from the Global Survey of Clinical Oncology Workforce, and data sourced from the cancer registries in Abuja, Calabar, Ekiti and Ibadan by the Global Cancer Observatory, Globocan, Nigeria has an average annual cancer incidence of 100,000 -120,000 cases, and 72,000 – 80,000 deaths.
But with an average of 26 oncologists to cater for over 203 million population, there is an estimated ratio of almost 4,000 new cancer patients per clinical oncologist.
This pales in comparison to Egypt with 1,500 oncologists with 72,000 cancer cases annually, amounting to 77 new cancer patients per clinical oncologist, and South Africa, with 40 oncologists to cope with 77,000 annual cancer cases and 47,000 deaths, giving an equivalent of 1,925 patients per oncologist.
Past attempts towards improving availability of equipment for cancer treatment include installation of radiation equipment in eight Federal Teaching Hospitals across the country. In 2015, the Federal Government designated six federal tertiary hospitals in six states in the six geopolitical zones of the country as oncology centres of excellence.
The centres that were to be upgraded in collaboration with the private sector included the University College Hospital, Ibadan, in Oyo State; the University of Benin Teaching Hospital, Edo State; University of Nigeria Teaching Hospital, Enugu State; Usmanu Danfodio University Teaching Hospital, Sokoto State; University Teaching Hospital, Maiduguri, Borno State, and Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State. But this has not yielded the required result as cancer cases continue to increase.
Radiotherapy is recommended for about half of all cancer patients seeking treatment, but according to the Union for International Cancer Control, UICC, Nigeria has the biggest gap between radiotherapy machine availability and need for cancer patients. This is corroborated by the Society of Oncology and Cancer Research Nigeria, SOCRN.
The Nigeria Cancer Society notes that there are 13 functional radiotherapy machines in the country, but an equity gap case study on access to radiotherapy in Nigeria conducted by the Directory of Radiotherapy Centres of the International Atomic Energy Agency, IAEA, showed that access to the machines is limited or unavailable to those that require it the most.
A World Health Organisation, WHO, Cancer Country profile for Nigeria shows that radiotherapy is not readily available under the public health system and there are great inequities in access to radiotherapy services at all levels, coupled with shortage of trained personnel.
Nigeria only has an equivalent to 0.016 radiotherapy machines per one million populations, compared to 1 to 250,000 population in the developed world.
According to the World Health Organisation, WHO, cancer is one of the most expensive disorders to treat and manage.
Cancer is an expensive and impoverishing disease that both the poor as well as the rich do not always survive. Even though scores of Nigerian cancer patients troop abroad for treatment, the average cancer patient is compelled to spend a fortune annually on treatment.
The average patient, on regular screening, clinical assessment and chemotherapy, over the course of a year, may easily accumulate N20 million to N30 million or more in medical bills, depending on the type of cancer, the treatment and where the treatment is being accessed.
Five years ago, cancer was one of the world’s top 10 most expensive disorders, but today, it is among the top three. In Nigeria, the cancer patient usually pays out of pocket for treatment. With no subsidy for cancer care, access is fast becoming inaccessible.
A decade ago, the typical new cancer drug coming on the market cost about N600,000 per month but over the last three years, the average cost has risen above N1.6 million.
The overall consequence of this is that the average Nigerian cancer patient is less likely to get regular screening tests, such as pap tests and colonoscopies, which catch the disease in its early, more curable stages.
Among most people without health insurance, cancer prognosis is worse as the cancer is more likely to have spread by the time they see a doctor. The person is less likely to get high-quality cancer treatments and benefit from state-of-the-art technology. Cancer patients with no access to chemotherapy, radiotherapy or surgery constitute the bulk of those who inevitably die.
In Nigeria, cancer is now ranked among the deadliest and most expensive disorders. Every year, over the last five years, the economic toll of cancer has cost an estimated one trillion dollars.
Cancer is recognized as the most expensive disorder to treat in the short-term, and the disorder is also the most expensive long-term sickness, according to a report by the American Cancer Society because the treatment costs more in productivity and lost life than AIDS, malaria, and other diseases transmitted from person-to-person, the report noted.
But in Nigeria, cancer is not primarily covered by health insurance; although some of the higher and comprehensive plans may offer limited coverage, no insurance company is ready to pay out the huge sums for the treatment and disability payments of cancer management every year. Because of this, uninsured cancer patients are more than twice as likely to die within five years compared to insured patients.
Although medical experts note that cancer is treatable and curable if detected early, they pointed out that the perception of a death sentence is often applicable to patients that present late in hospitals.
Common cancers
Former President of the Nigeria Medical Association, Professor Innocent Ujah, asserts that common cancers of public health importance in Nigeria include breast and cervical cancers among women of reproductive age, while prostate cancer among adult males as well as cancer of the lungs.
He maintained that early detection and appropriate interventions were key to cancer prevention and control, while urging all women of reproductive age and men aged 40 years and above to avail themselves of available screening methods rather than skepticism about whether cancer is real, so that Nigeria will reduce the cases of new cancers to acceptable levels.
Professor Clement Adebamowo, of the Department of Epidemiology and Preventive Medicine, School of Medicine & Institute of Human Virology at the University of Maryland, describes cancer as the most important risk factor for poverty and loss of social status among the middle class in Nigeria.
“We need to let our people know that cancer occurs in Nigeria just like other parts of the world and it does not mean the end of life. With appropriate care, someone can live a better life. Early presentation is important, many of these cancers don’t make you have a fever, to vomit or experience body pain but they are deadly,” he stressed.
A clinical pharmacist, Adaku Efuribe, observed that cancers can be treated if detected early, even as she urged the federal government to facilitate cancer treatment by increasing the annual health budget.
“We all know that the health budget is not adequate for over 200 million people. The Federal government can also make public health preventive measures compulsory for local governments and public health care centres in the local areas, and we can start to help people to enhance public health prevention measures education for the population. We can start encouraging people to live healthy lifestyles.
She called for enhanced salaries and improved work conditions for cancer specialists with the right tools, to discourage the brain drain syndrome.”
Efuribe said lifestyle management can help. “We do not do enough preventive medicine. Prevention is better than cure, so lifestyle management, patient education, and public health initiatives would go a long way to prevent certain cancers. Continuous training for cancer specialists and improving their salaries and work conditions and also increasing the health budget can all help.”
Noting that cervical cancer is preventable, she said there should be routine immunisation for teenagers, while women can be having their routine smear tests to check for changes.
“The federal government should also partner more with civil society and NGOs and to train specialists in the hospitals. To help discourage the brain drain there is the need to encourage training and professional development. The government should develop policies to ensure that specialists engage in continuing professional development.”
A Consultant Haematologist, Dr Uche Nwokwu, who noted that cancer could start from any part of the body, warned that its complications could affect the heart and urged Nigerians to go for regular screening for early detection of cancer.
A clinical pathologist, Dr Ndubuisi Nwosu, advised men to overcome the fear of prostate cancer and go for screening, saying early detection was key to effective treatment and management.
He explained that when a man has prostate cancer, more of the Prostate Specific Antigen, PSA, gets into the blood and if high figures are captured during screening, further tests would be carried out to arrive at a diagnosis.
“A man is eligible for the Prostate-Specific Antigen or PSA blood test, once he is 50 and above. The PSA test is a blood test used primarily to screen for prostate cancer. Prostate cancer usually develops slowly, so there may be no signs someone has it for many years.”
Public health concern
Prostate cancer is a public health concern and the second most common cause of cancer deaths in men, but there is no national prostate cancer screening programme, despite being Nigeria’s second deadliest cancer after breast
The International Agency for Research on Cancer (IARC) says that in Nigeria, prostate cancer constitutes about 1 in 3 of all male cancers and most men only find out they have prostate cancer when they start displaying symptoms—such as difficulty to urinate or a hot burning sensation.
Among the greatest obstacles to efforts in reducing the cancer burden in Nigeria is the limited number of cancer facilities and radiotherapy treatment centres when compared to population size.
In the views of Dr Chinedu Aruah, a consultant radiation and clinical oncologist, there are large and significant deficiencies in available components in cancer care in Nigeria, despite significant steps in bridging the gaps through direct government intervention with private sector collaboration.
“With strong political will and commitment of the health providers, Nigeria will emerge as the next hub of radiation oncology treatment and cancer research taking cognisance of huge human potentials and material resources.”
