February 27, 2024
As the World Cancer Day 2024 (WCD) unfolds its final chapter under the banner ‘Close the Care Gap,’ a poignant question echoes across Nigeria by survivors and experts: How can the country bridge the divide in cancer care? Chinyere Okoroafor writes.
Cancer, a relentless foe affecting people of all backgrounds, has deeply embedded itself in societies globally, transcending age, gender, and socioeconomic boundaries. This is even as Nigeria faces significant challenges in cancer care, marked by limited screening access, insufficient treatment facilities, and daunting financial burdens. Urgent transformative interventions in the healthcare system are essential.
As the world commemorates World Cancer Day, survivors and a cancer care expert in Nigeria are calling on leaders at all fronts to enhance access to cancer care on a broader scale.
Folake Adeyemi, a survivor, who had a mastectomy on her right breast and underwent chemotherapy treatment on the left side, shared her challenging experience accessing necessary care in 2013 when she began battling cancer.
She highlighted the scarcity of hospitals with available radiotherapy facilities in Minna state and the exorbitant cost of treatment. To cope, she had to resort to selling some of her prized properties to cover chemotherapy sessions and required medications. In urging improvement, Adeyemi suggested that the Federal Government could implement better systems to enhance affordable access to cancer treatments for patients.
Emelda Oti, a survivor of endometrial stomach sarcoma, said she was under the impression that she had a terrible stomach ulcer.
“I patronised herbal medicine, which proved ineffective, and I would advise anyone with cancer issues not to try it. I faced rejection by three hospitals before finding admission at LUTH. They delivered a grim prognosis, stating that I had no chance of surviving due to the advanced stage of the cancer. LUTH only offered palliative treatment, indicating mere management without curative measures before they went on strike and I have to go before and later went to India. There is an urgent need for improved cancer diagnosis and treatment facilities in hospitals, the government should rise to the responsibility if they cared,” Oti said.
About WCD: World Cancer Day falls on February 4 annually, it was first observed in 2000 on the same month and date during the World Summit against Cancer for the New Millennium in Paris.
The 2024 theme, ‘Close the care gap: Everyone deserves access to cancer care,’ is part of a three-year-long campaign from 2022 to 2024.
The sub-theme for this year’s World Cancer Day, ‘2024: Together, we challenge those in power,’ marks the final year of the ‘Close the Care Gap’ campaign. It is calling for citizens to engage leaders in prioritizing and investing in cancer prevention and care and to do more to achieve a just and cancer-free world.
The World Health Organization (WHO) designates this day to raise awareness about cancer, emphasizing the need for collective efforts to enhance cancer care, detection, prevention, and treatment.
The Medical Dictionary explained that cancer is a diverse group of diseases affecting various organs or tissues. Cancer refers to the uncontrollable growth of cells, potentially spreading to different parts of the body.
In 2023, the sub-theme was ‘Uniting our Voices and Taking Action’.
In 2022, under the theme ‘Realising the Problem,’ the WCD website highlighted global inequities in cancer care on its website. The focus was on questioning the status quo, reducing stigma, and listening to the perspectives of individuals and communities affected by cancer to guide thoughts and actions.
Global cancer burden and Nigeria’s struggle: According to the World Health Organization (WHO), cancer, a global public health priority, claims 1 in every 6 lives globally, affecting nearly every household. It estimates that worldwide there were 20 million new cases and 9.7 million deaths from cancer in 2022. The global cancer burden is projected to increase by about 77% by 2050.
Yet, the burden falls disproportionately on developing countries like Nigeria, where over 60% of new annual cases and more than 70% of cancer deaths occur. Shockingly, low- and middle-income nations receive only 5% of the global spending on cancer care.
The Global Cancer Observatory (GCO), estimated that there were 124,815 new cases of cancer in Nigeria, and 78,899 deaths from cancer in 2020. With the five most common cancers in Nigeria including breast cancer, prostate cancer, cervical cancer, colorectal cancer, and liver.
In Nigeria, according to the National Cancer Control Plan (2018-2022), its impact is stark, claiming 72,000 lives annually, with 102,000 new cases reported. Breast, liver, and prostate cancers are primary contributors.
Highlighting the urgency for targeted interventions. A public opinion poll conducted and published by NOIPolls in June 2023 underscores a concerning lack of awareness, with 62% of Nigerian adults unaware of cancer causes, emphasizing the need for widespread education and awareness campaigns.
African disparities : The cancer situation in Africa is disheartening. In 2022, the Global Cancer Observatory (GCO) noted that Africa faced 1,173,771 new cancer cases and 756,531 deaths and with projections indicating a grim future of one million deaths annually by 2030 according to Bakary Sylla and Christopher Wild in a 2011 publication titled “A million Africans a year dying from cancer by 2030: what can cancer research and control offer to the continent?. It was published on the National Library of Medicine website.
This is so because cancer survival rates in Africa are currently only 12%, compared to over 80% in High-Income Nations. Nigeria is the number one contributor to these dismal statistics.
Major cancers in Nigeria : Speaking with The Nation, Consultant Ocular Oncologist, Dr. Abia Nzelu, said among other types of cancer deaths in Nigeria, breast cancer takes the lead, accounting for 25% of new cases, followed by prostate (14%), cervical (10%), colorectal (6.4%), and liver cancer (5.3%).
These “Big Five” contribute to over 60% of new cases, illustrating the pressing need for targeted interventions.
She said: “There were about 127,763 new Nigerian cancer cases in 2022 (48,096 cases in men and 79,667 in women). The five most common cancers were breast (25%), prostate (14%), cervical (10%), colorectal (6.4%) and liver cancer (5.3%). In 2022, there were 79,542 cancer deaths in Nigeria, with more women (46,637 deaths) dying than men (32,905 deaths).”
Challenges and the Care Gap : For Dr Nzelu, cancer patients in Nigeria face heightened risks due to late-stage diagnoses and limited access to quality treatment.
Similarly, WHO Director for Noncommunicable Diseases, Dr Bente Mikkelsen in a recent statement ahead of WCD24 noted that cancer patients in developing countries have a much higher risk of dying due to late diagnosis and poor access to quality treatment.
Highlighting major inequalities and a lack of financial protection for cancer patients worldwide, WHO emphasized the urgent need for accessible, affordable, and quality services.
“WHO’s new global survey sheds light on major inequalities and lack of financial protection for cancer around the world, with populations, especially in lower income countries, unable to access the basics of cancer care,”
“Despite the progress that has been made in the early detection of cancers and the treatment and care of cancer patients–significant disparities in cancer treatment outcomes exist not only between high and low-income regions of the world, but also within countries. Where someone lives should not determine whether they live. Tools exist to enable governments to prioritize cancer care, and to ensure that everyone has access to affordable, quality services,” Dr Mikkelsen said.
Role of lifestyle and prevention : Dr Nzelu, who is also the Executive Secretary of a cancer charity organisation named Giving Tide International (GTI), explained that tobacco use, obesity, physical inactivity, and infections like hepatitis B and HPV contribute significantly to cancer cases.
“The major risk factors for cancer include tobacco use, obesity/overweight, physthe liver and Human PapillomaVirus (HPV), which affects several parts of the body including the cervix, throat, mouth, anus, scrotum among others. Tobacco use alone accounts for around one-third of deaths from cancers. Other risk factors include high body mass index, alcohol consumption, family history, some health conditions, environment, and infections by certain viruses, and more.
“Vaccination against preventable infections remains crucial, yet challenges persist in Nigeria, where cervical, breast and liver cancers continue to claim lives.
“Inactivity, unhealthy diets, and air pollution. Some infections can also predispose to cancer, including Hepatitis B and C, which affect lung cancer as the most common cancer worldwide in 2022, with 2.5 million new cases (12.4% of new cases). Breast cancer ranked second (2.3 million cases, 11.6%), followed by colorectal (1.9 million cases, 9.6%), prostate (1.5 million cases, 7.3%), and stomach cancers (970 000 cases, 4.9%).”
“Nevertheless, each of us can make changes to reduce our risk of developing cancer, since 50% of cancers can be prevented by lifestyle modifications such as: avoiding smoking, reducing the intake of processed foods and increasing intake of fruits and vegetables, exercising regularly, and keeping up with recommended screenings and vaccinations,” Dr Nzelu said.
She noted that early detection is a game-changer in treating cancer, adding that it often leads to complete cure.
“While many cancers show no symptoms in their early stages, screening tests like mammography (for breast cancer) and PSA test (for prostate cancer) can identify cancer even before symptoms appear. This not only lessens the challenges of dealing with advanced cancers but also enhances the likelihood of successful treatment.
“Cancer screening programs, when well-organized and quality-assured, hold significant potential in improving outcomes. They can reduce mortality and even prevent certain cancers, such as cervical and colorectal cancer, which are major contributors to avoidable deaths in Nigeria,” she said.
The push for comprehensive cancer care : In pursuit of combating cancer, the primary focus of the Giving Tide initiative according to Dr Nzelu is the BIG WAR Against Cancer, operated by the National Cancer Prevention Programme (NCPP).
“Established by the mass medical mission, a non-governmental organization, NCPP has been at the forefront of community-based cancer prevention efforts in Nigeria since 2007.
“Recognizing the need for a more extensive impact, in 2017, NCPP acquired and deployed a fleet of Mobile Cancer Centres (MCC) to broaden the reach and effectiveness of their program.”
She said that the overarching objective of the initiative is to establish a Comprehensive Cancer Centre (CCC) in Nigeria. Unlike a conventional hospital with a radiotherapy machine, a CCC is an advanced, world-class institution that integrates cancer research, preventive measures, curative treatments, and palliative care under one roof.
She added that the significance of a CCC lies in its ability to enhance outcomes across various metrics, with a primary focus on improving cancer survival rates. These centers serve as guiding institutions, playing a pivotal role in the comprehensive implementation of national cancer control goals.
She said: “In comparison to other nations, Nigeria faces a considerable lag in this domain. While countries like India boast over 200 CCCs, largely funded by philanthropy, several African nations, including Egypt, Uganda, Tanzania, South Africa, Kenya, and Sudan, have already established such centers. Nigeria’s lack of a CCC translates into a pressing need to bridge the widening gap in cancer care, especially when other nations are actively working toward “closing the care gap.”
Dr Nzelu noted that the absence of a Comprehensive Cancer Centre in Nigeria is not only a healthcare concern but also a financial one, adding, “Cancer, being one of the most expensive diseases to treat, prompts Nigerians to spend over one billion dollars annually on foreign treatments. Remarkably, this amount could suffice to establish twenty CCCs every year. The consequence of seeking treatment abroad often involves delays in diagnosis and treatment, leading to unfavorable outcomes.
“Additionally, unforeseen circumstances, such as the challenges posed by the COVID-19 lockdown, may render medical tourism unfeasible, even for those who can afford it. Therefore, the urgent need for a CCC in Nigeria becomes not just a medical necessity but a strategic imperative to transform the landscape of cancer care in the country,” she said.
Call to Action : For Dr Nzelu, a select group of inspired, passionate, and dedicated heroes can be instrumental in liberating Nigerians from the pervasive ‘mass hysteria’ that has relegated the most populous black nation to the bottom across various developmental sectors, including health and cancer care.
According to her, the call is for heroes akin to Sir Dorab Tata and Mrs. Mazumdar Shaw, visionaries who founded India’s first and largest Cancer Centres, as well as the trailblazers behind the Sloan Kettering Cancer Center in New York, the inaugural Cancer Institute in the USA.
“To steer Nigerians away from the inertia of ‘mass hysteria,’ the imperative is to showcase a more exemplary path forward. Drawing parallels with the focus of World Cancer Day (WCD) 2024, “the objective is clear: to “challenge those in power” necessitates leading by example, with no alternative in sight.
“WCD 2024 stands as a pivotal opportunity for individuals and organizations to commit to supporting the innovative strategies formulated by Giving Tide. These strategies are specifically designed to confront and dismantle the deeply ingrained and resistant inequities in Nigeria, extending to disparities in cancer care.
“The emphasis lies on addressing the root causes of these inequities to ensure universal access to quality health services, regardless of location or circumstance. The rallying cry is clear – together, a collective commitment can pave the way for transformative change, creating a future where equitable healthcare is a reality for all,” she said.
The road ahead: While the challenges are substantial, Dr Nzelu added that a collective will to transform Nigeria’s cancer care landscape is the way forward.
“A collaborative effort between government bodies, NGOs, and healthcare providers also holds the key to creating a healthcare system that is not only responsive to the current challenges but also anticipates and meets the evolving needs of the population.
“As the nation confronts these obstacles head-on, the hope is to forge a path toward a future where cancer care is accessible, affordable, and effective for all Nigerians. The journey toward overcoming these challenges is a shared responsibility, one that demands unity, determination, and sustained commitment from all stakeholders in the fight against cancer,” she said.
– agency news
