CANCER is one of the most dreaded health conditions. It is categorized as one of the non-communicable diseases (NCDs), thus, rarely attracts the attention and support of international donor agencies. Though, the burden of the disease is high and still rising, it has not been so favored. In fact, the higher percentage of death from cancer compared to any other type of disease in our teaching hospitals is a pointer that attempts to control the disease have not been so effective. The international network for cancer treatment and research (INCTR) has opined that while cancer incidence is higher in more developed countries, these countries record better survival rates compared to low and middle income countries where cancer incidence is lower and survival rates dismal.
The Honourable Minister for Health, Prof Isaac Adewole, in the forward to the well articulated Nigerian Cancer Control Plan (NCCP, 2018-2022), affirmed that the Government’s commitment to safeguarding the health of Nigerians assumes greater urgency in the case of cancer because unlike most other disease conditions, it is complicated by psychological, social, economic and emotional consequences.T Achieving the seven laudable goals of the NCCP geared towards reducing the incidence of common cancers in Nigeria, improving financing from the government, private sector and non-governmental organizations, and reducing morbidity and mortality through early detection methods need more commitment to executing action plans than is currently being witnessed. The cancer narrative in Nigeria and indeed in most part of the developing world has largely been a dirge. A song of a story fraught with a high level of poverty and poor health literacy and practices which often result to patients presenting in our hospitals with advanced diseases and invariably high mortality. An appreciation of the fact that well informed and healthy people make a wealthy nation would perhaps have encouraged the government to channel more funds into the education and health sector than was done in the 2019 budget and those before it.
Some of the predisposing factors resulting in cancer are often preventable health risk behaviours like smoking tobacco and it’s related products; alcohol and high dietary fat consumption; low fruit and vegetable intake and living sedentary lifestyles. When people are less educated and unable to afford health care, they are more likely to engage in risky behaviours that may compromise their health. If the situation is not addressed, the ability of the populace to combat poverty is further reduced. More so, the current state where at any given time there are three or less functional radiotherapy machines of the nine available in the country is deplorable. Chemotherapeutic agents are expensive and often unaffordable for the ordinary Nigerian. No wonder many have come to equate a diagnosis of cancer to a death sentence.
But then, cancer is not necessarily a death sentence. As right here in Nigeria there are a few cancer warriors who fought and won the battle against cancer well past the 5years survival period. Yet, there is a need to improve on the numbers of our cancer survivors. One of the ways to effectively change the cancer narrative in Nigeria is to showcase and celebrate the success stories of cancer survivors. The culture of silence about cancer should be broken. The wife of the Ondo State Governor, Her Excellency Betty Anyanwu-Akeredolu is an example in this regard. Her cancer story has encouraged many women who came in contact with her to go ahead and screen for breast cancer and receive treatment if need be. Showcasing such success stories go a long way in pressing home the truth that cancer is not necessarily a death sentence if we are proactive.
Then again, there’s need to address apathy to cancer screening through quality cancer health literacy. Developed countries like the United States of America, carry out opportunistic cancer screening as part of their protocol when patients present for certain procedures or to access care for certain health conditions. This could be emulated within our healthcare system. Moreover employers of labour should ensure a healthy workforce by mandating some cancer screening for people within certain age brackets. Mobile screening initiatives as already embarked upon by some non-governmental organizations should be further intensified for those in the rural areas so they are not left out. Women are encouraged to do their mammogram, clinical/self breast examination for breast cancer. Papsmear for cervical cancer screening should also be done as and when due by women who have been exposed to sexual intercourse. The most common cancer among Nigerian men is prostate cancer. Hence men should do digital rectal examination or have a prostate specific antigen test done as they cross forty years of age. Prompt treatment after early detection through screening is germane to reducing cancer mortality in Nigeria.
A moral dilemma is often expressed in the wisdom of encouraging people to screen for a disease whose treatment they cannot afford. However, developed countries have been able to use different instruments to help their citizens cross the hurdle of the cost of managing cancer to some extent. One of this is through developing comprehensive health insurance schemes that is inclusive of cancer. Some cancer non-governmental organizations (NGOs) such as the Project Pink/Blue in Nigeria have used crowd funding techniques to generate funds to support cancer patients through their treatments. Corporate organizations could increase patients’ access to cancer treatment through providing drugs at highly subsidized rates. They could also contribute to research by providing grants to fund clinical drug trials to promote the manufacturing of drugs that are customized for our genetic make-up thereby increasing the chances of more positive treatment outcomes. There is need to intensify effort to further improve on the current public private partnership (PPP) initiative in our healthcare system. Hospitals where cancer patients are being managed in Nigeria could be equipped with radiotherapy machines through more investments in the PPP. Having more of the machines in the different geopolitical zones of the country will help reduce the cost in money and time incurred by patients in traveling from pillar to post in search of a working radiotherapy machine, much as there is a need for healthcare providers to strive to reduce the incidence of heath system delays that could result in more advanced stage of disease at the time treatment is to be commenced. How cancer diagnosis and/or prognosis is communicated is also important in encouraging the patients to go ahead with their treatment in the hospital rather than opt for other less proven options. And with the adoption of these new orientation and steps, we would be able to positively change the current depressing narrative of cancer in Nigeria.
- Dr. Akin-Odanye is of the University College Hospital, (UCH), Ibadan.
