By Chioma Obinna
Cancer has remained top of the list of diseases that are indiscriminately reducing the welfare and wellness of persons across the world, particularly, in developing countries like Nigeria.
Statistics provided by the World Health Organisation’s 2020 report shows that cancer tops the list of killer diseases with nearly 10 million deaths.
Nigeria has one of the highest cancer mortality rates in the world, with approximately four out of five cases resulting in death, according to the Global Cancer Observatory.
There is lack or no efficient public policy on cancer issues in Nigeria where about 10,000 cancer deaths are recorded annually with 250,000 new cases recorded yearly.
Good Health Weekly x-rays reasons behind the continued increase in cancer mortality among Nigerians who continue to die from cancer despite improvement in cancer care across the world.
Olufunmilayo Shonubi, a 15 years old cancer survivor attributes the whole development to the love of money.
“It’s all about the money,” she remarked. “The first lesson I learned from my long battle with cancer is that if there is no money, you cannot really survive cancer. I practically went begging and borrowing.”
Health watchers agree with Olufunmilayo, however, another poser that comes to mind is whether money is the only challenge?
A case in point is late Nkechi Odogwu, diagnosed of stage 1 cancer at but who lost the battle for life due to prolonged appointments, breakdown of equipment, high cost of care , among other treatment challenges.
Recently, notable Nigerians including rapper-songwriter Olanrewaju Fasasi, popularly known as Sound Sultan, lost his life to cancer. He was diagnosed with Angioimmunoblastic T-cell Lymphoma (AITL).
Similarly, the wife of reknowed Pastor Taiwo Odukoya, lost her life to cancer. These are just two out of several notable and prominent Nigerians that have died of one cancer infection even when money was not the issue.
While successes in cancer treatment is improving in the developed world with near 100 percent cure rates recorded in certain instances, the situation could be better in Nigeria where mortality from cancer is on the rise.
According to statistics by the World Health Organisation, WHO, cancer was responsible for over 78,800 deaths in 2020 with women often bearing the brunt, as breast and cervical cancers are responsible for the most deaths in Nigeria. Data also showed that at least 44,699 women died of cancer in 2021.
Globally, the WHO notes that cancer treatment, prevention and care has generally improved globally. In many of these countries, cancer is no longer a death sentence, rather, it is a chronic non-communicable disease that can be prevented, detected early and treated with better outcomes.
Regrettably, the situation in Nigeria paints a dismal picture. Currently, the situation about cancer care leaves much to be desired. From diagnosis and treatment, to care and support, cancer has more or less remained a death sentence even among the wealthy.
A common reason for the rising incidence of cancer morbidity and mortality is due to the fact that the federal and state governments are still paying lip service to issues around health.
In their argument, health watchers blame the low-level or absent funding, bad policy implementation and lack of political will and commitment for the persistence of the clogs in the wheel of progress of the fight against the menace of cancer.
In 2018, the federal government developed a Cancer Control Plan — a 4-year programme with a vision to reduce the incidence and prevalence of cancer over the next five years and beyond. This was also to involve state governors so that each state would have its own cancer control facility in order to plan, and key into the federal government’s wider programme.
ALSO READ: Cancer Society petitions Netflix, FilmOne, Ebonylife, others to remove tobacco scenes from Nollywood
The plan also includes investment and provision of prostate cancer screening for men, cervical and breast cancer screening for women. But three years on, the plan is yet to take off as expected.
Poor health funding
Nigeria was part of the historic 2001 Abuja Declaration, which mandates African Union Member States to allocate minimum of 15 percent of their national budgets to healthcare, but Nigeria has never fulfiled this recommendation.
The national health budgetary allocation for 2022 is below six percent even as political office holders continue to take capital flight for medical treatment overseas, depleting the country’s foreign reserve and worsening the medical tourism problem that consumes over $1 billion annually.
Findings show that the cost of treating cancer remains prohibitive. Most Nigerians pay out-of-pocket for their medical treatment as the National Health Insurance Scheme has failed woefully.
Currently, the coverage of the Scheme remains below 5 percent. Speciality care such as radiotherapy costs about N1 million per person per treatment cycle at the Lagos University Teaching Hospital.
Cancer patients that spoke to Good Health Weekly note that the cost of radiotherapy actually depends on the type of cancer, and the treatment differs.
But irrespective of the type of cancer, the average cost of treating cancer comprehensively for one individual is estimated at N20 million for chemotherapy, overall over time. Millions of Nigerians are unable to afford this in a country where the minimum wage hovers around N30,000.
No comprehensive cancer centre
For decades, Nigeria has lacked comprehensive cancer centres covering the sic geo-political zones of the country where all cancers and care around the disease can be taken care of.
The Executive Secretary of GivingTide, Dr Abia Nzelu, says a comprehensive cancer centre, is the only institution that can optimally tackle all stages and types of cancer and not a hospital with a radiotherapy machine.
“It is a world-class, stand-alone tertiary health institution, with all its units focused solely on cancer care. The comprehensive cancer centre houses first-class cancer research, preventive, curative and palliative care in one place resulting in better outcomes across a range of measures – including, most importantly, cancer survival.
“Sadly, whilst India has over 200 comprehensive cancer centres – most of which are philanthropy-funded non-profit / non-governmental institutions, Nigeria has none.
“Some African nations that have comprehensive cancer centre include Egypt, Uganda, Tanzania, South Africa, Kenya and Sudan. Rather, Nigerians now spend over $1billion on foreign treatment annually – an amount sufficient to establish 20 comprehensive cancer centres every year.”
“Unfortunately, most Nigerians who go abroad for treatment end up dying because of late diagnosis and delay in intervention. Moreover, unforeseen situations (such as the COVID-19 restriction) may make it impossible to go on medical tourism, even if one could afford it,” Nzelu noted.
Early detection is key
Good Health Weekly, established that cancer screening in Nigeria is still periodic whereas in most other countries, in a bid to beat cancer, national cancer screening programmes are adopted to mandate citizens to go for cancer screening whenever they visit any public health facility.
In Nigeria, people have opportunity to be screened for cancer during outreaches organised by non-governmental organisations.
Equipment and medication
Nigeria has four functional radiotherapy machines serving over 200 million persons across the 36 states and the Federal Capital Territory, FCT Abuja, even as there are no serious investments as regard cancer care.
It is worrisome that a number of clinical trialswith cancer medication are not carried out with Nigerians and experts describe this as a gap and a major factor in the efficacy of cancer drugs.
In the views of Nzelu, 70 percent of cancer deaths occur in developing nations like Nigeria due to lack of access to optimal care. Nigeria is currently estimated to have 233,911 cancer cases, with 124,815 new cases and 78,899 cancer deaths, yearly.
She said without bold action, an estimated 28.4 million new global cancer cases would occur in 2040, a 47 percent rise from 2020.
“The relative magnitude of the projected increase is highest in low Human Development Index (HDI) nations (95 percent), including Nigeria.
This projected increase in cancer incidence will be paralleled by increases in mortality rates, unless resources are placed within health services to appropriately treat and manage the growing cancer cases.
One of the major challenges that Nigeria faces is brain drain. Data by the Medical and Dental Consultants Association of Nigeria, MDCAN, showed that 139 consultants left 17 Nigerian hospitals within two years.
Worse still, contrary to the WHO recommendation of 1 doctor to 600 patients, in Nigeria one doctor serves 5,000 patients and 16.1 nurses and midwives per 10,000 patients.
Currently, Nigeria accounts for less than 90 oncologists.
On this year’s World Cancer Day, stakeholders are calling for greater investment and commitment towards cancer control and management, treatment and prevention, care and support. The need to prioritise healthcare for all citizens with adequate health insurance remains desirable.
Every year, on February 4, the global cancer community commemorates World Cancer Day (WCD) to inspire greater awareness of cancer and action to better prevent, detect and treat the disease. WCD 2022 marks the first year of a new three-year campaign centred on the issue of equity with the campaign theme ‘Close the care gap’. This year’s campaign raises awareness about the lack of equity in cancer care.
Factors causing cancer
According to a WHO report, one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol use, low fruit and vegetable intake, and lack of physical activity, the report says, adding that cancer-causing infections, such as hepatitis and human papillomavirus (HPV), are responsible for approximately 30 percent of cases in low- and lower-middle-income countries.