As the world celebrates World Cancer Day, cancer advocates have called on government at all levels to improve health services in Nigeria.
The World Cancer Day is an international event celebrated every February 4 to raise awareness of cancer and to encourage its prevention, detection and treatment
The Executive Director, Project Pink Blue, Runcie Chidebe, in an interview with Health reporter, Ayodamola Owoseye, to commemorate the day, explained why most cancer patients in Nigeria seem to die in spite of the timing of their diagnosis.
He also spoke on critical issues pertaining to cancer awareness, diagnosis, management and health care in Nigeria and the way forward.
Mr Chidebe is a cancer control advocate, researcher, and one of the leading voices advocating for Nigeria to make cancer control a national health priority. He has won lots of awards as a cancer advocate and is a member of many cancer committees
PT: Your organisation is involved in cancer awareness campaign in Nigeria. How will you rate the level of cancer awareness in the country?
CHIDEBE: We can say that many Nigerians are aware of cancer, no doubt, but the challenge is that so many Nigerians do not have accurate awareness/information about cancer.
These are two different issues. Being aware of the disease called cancer and having accurate information about the disease. Millions of Nigerians know that there is a disease that can affect a woman and once it affects a woman, the breast goes off and the person dies.
Many people also believe that there is a disease known as cancer but it affects only white people, and any black person it affects it is due to fetish means. Accurate cancer awareness has to do with everyone having the knowledge of the diseases, what are the symptoms, the predisposing risk factors of having the disease, such as smoking, family history, and the screening associated with types of cancer?
For instance, for breast cancer, being a woman alone is already a risk factor.
Many people are not aware that there are over 100 types of cancer and can affect any part of the body. It is accurate information on cancer that so many Nigerians do not have. Hence, we are doing everything we can to help people know that cancer is real, to know that men also have breast cancer, the types and what people can do prevent cancer or reduce their risk of cancer.
Creating awareness should be everyone’s business not just for NGOs or the media because, right now, we had an estimate of 70,327 cancer deaths in Nigeria in 2018. This means if care is not taken, we are going to have more thousands of deaths.
PT: How can we create accurate awareness of cancer in the public?
CHIDEBE: One major way to reach out massively to people is to get cancer awareness programmes to the rural area through primary health care centres.
We need to demystify cancer in Nigeria. Cancer is still a mystery to many people in Nigeria, including the literate and illiterate. You can’t believe that I was wearing a cancer T-shirt and somebody was asking me to stay away with that T-shirt! Can you imagine? We need to translate cancer information into local languages, translating it into the barest and simple terms that can make a lot of difference.
At Project PINK BLUE, we have translated breast cancer awareness materials into four languages, Hausa, Igbo, Yoruba and Pidgin English; and have distributed over 20,000.
We need to also use mass media adverts, digital media, social media, radio and other campaigns tools, massive outreach such as the ones employed for other diseases like HIV/AIDS. But that is not happening because priority is not given to cancer and other non-communicable diseases (NCDs). Government is more focused on infectious disease. Painfully, many people survive infectious disease and later die of non-communicable disease like cancer.
PT : How is cancer diagnosis in Nigeria?
CHIDEBE: Diagnosis for cancer sometimes takes a bit of time, hence, it may not be relatively easy and accurate. In the case of colon cancer, it may start with a colonoscopy, then biopsy, molecular tumour testing, blood tests, CAT scan, MRI and many others, depending on the physician.
Painfully, many patients in Nigeria have faced misdiagnosis or were underdiagnosed. Working at Project PINK BLUE as a patient navigator, we have seen a patient who has been treated for a particular subtype of breast cancer known as triple-negative by a certain facility, and when a review was done by another facility it showed that the patient has HER-2 positive breast cancer.
In some other cases, some patients are told they have cancer in facility A and they visit facility B with the same sample and they were told no evidence of cancer. Misdiagnosis is a very serious issue in cancer care. If a healthcare professional gets a diagnosis wrong, the treatment will be wrong; no patient can get better treatment outcome from a wrong diagnosis. At my organisation, we always encourage people to go for a second opinion to be doubly sure.
Another area of concern is cancer screening. In Nigeria, cancer screening is sporadic, not systematic or organised. What we have today is NGOs organising pockets of breast, cervical and prostate screenings in different communities; this is good. However, we need a more robust and organised way of cancer screenings. We need an organised or systematic cancer screening which mandates eligible men and women to be screened once they visit any hospital, just as we did in HIV/AIDs control.
If we have a health system that makes screening compulsory by embedding it into the primary health care system, then we can capture a lot of cancer cases early and this can reduce the number of cancer-related deaths in the country because treatment would be much easier to administer.
Mandatory cancer screenings can help increase early detection and reduce cancer-related deaths.
PT: How can Nigeria manage more patients if cancer is detected early?
CHIDEBE: Nigeria is currently having challenges in its healthcare, because the health system is unhealthy and cancer is more affected.
Maybe the question should not be about more cancer patients being detected because anyone who already has the risk of having cancer already has it.
But detecting it on time is an increased avenue for survival, not detecting it on time because of the fear of having more cancer patients. It is a problem because it will still be detected and by then it may be at a very late stage.
For instance, cervical cancer which is 99 per cent preventable, is the second leading cause of cancer mortality in Nigeria. Cervical cancer is a type of cancer that if people are accurately aware, they can prevent it through vaccination.
The question is: how many people are aware that there is a vaccine for cervical cancer? This is a very serious issue. The truth is if cancer is detected very late, it is more expensive to treat, compared to if it is detected early.
Painfully, 70 per cent of women that present breast cancer in Nigeria present stage 3 and stage 4.
PT: On average, how much does cancer treatment cost?
CHIDEBE: Sincerely, treatment of cancer is not relatively cheap. Let me try and give a break-down of what I know in the cost of cancer care.
The cost of treating prostate cancer is low relatively or comparatively to breast cancer. A diagnosis of prostate cancer could cost around N147,000, a surgery could cost N350,000 to N950,000; sessions of chemotherapy could cost N150,000 to N360,000.
In total, a patient needs about N1.3million to N3.3million to treat prostate cancer in Nigeria.
In the case of breast cancer, a woman may have to pay over N200,000 – N300,000 for diagnosis, N670,000 –N3million for surgery and over N2 million for chemotherapy.
If the breast cancer type is HER-2 positive then, the patient will need about N5million for the targeted treatment. The patient will also need N600,000 for radiotherapy.
For cervical cancer, it may cost N20,000 to N27,000 for diagnosis, N200,000 to N500,000 for surgery; N1milion to N2.4million for chemotherapy and N600,000 for radiotherapy.
How many Nigerians can afford to pay this kind of money from their pocket to get treated? Some may just decide to stay back at home and die.
With the poor national health insurance, it has become more financially stressful to cope with the financial burden of cancer in Nigeria. Very few families can afford to foot the bills of diagnosis, surgery and treatment. I am happy that the National Assembly is initiating a bill to make health insurance mandatory through National Health Insurance (NHIS).
PT: Do you think Nigeria has gotten to the point of successfully treating cancer?
CHIDEBE: Yes we are already at that point, just that the government has not been able to make cancer a national health priority. Presently, we have fantastic and passionate professionals who are willing to go the extra mile to give better care to their patients. However, there is a great inadequacy in cancer infrastructures. All over the country, we have just two facilities where patients can do a bone scan, sometimes they cannot do the scan because of the absence of reagents.
There is no single PET scan in Nigeria. Doctors, pharmacists, nurses, medical physicists, pathologists and other oncologists need constant training.
What I am saying is that, we are currently getting what we are giving. We cannot get the best cancer treatment if we don’t give the best infrastructures and training. These are some of the reasons why Nigerian medical doctors are leaving Nigeria to UK, USA, Canada and others every single day. Health care workers cannot do magic in poor infrastructures.
Last year, Project PINK BLUE in partnership with U.S. Mission in Nigeria, trained 44 cancer doctors from all over Nigeria. Training like this is supposed to be an annual activity to keep the caregivers updated because science is alive and growing every single day.
Government needs to invest in cancer control. If the federal government gets committed to cancer control and gives it all necessary resources, we will emerge the West African hub for cancer treatments.
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We talked about cancer treatments being very expensive. An instance is that there are some cancer drugs in Nigeria which are very expensive as compared to other countries because those drugs get in through middle men and marketers who use the platform to enrich themselves.
If the government is more committed, reduce taxation for cancer drugs or gives waiver in totality, the cost will come down.
The government can work directly with such pharmaceuticals to supply such expensive drugs directly to the hospital where it will be available for the patients. The government needs to listen to the plight of cancer patients and make this a national health priority issue and this will ensure that there are a reasonable budget and priority for it.
PT: Nigeria has about eight radiotherapy machines that are unreliable. How have cancer patients cope with these unstable machines?
CHIDEBE: Hmmm, access to radiotherapy is another serious challenge. Actually, there are nine radiotherapy centres in Nigeria.
About six Linac machines. National Hospital Abuja has two, University of Benin Teaching Hospital has one and not working for years, Lagos University Teaching Hospital (LUTH) Lagos has one, University of Nigeria Teaching Hospital (UNTH) Enugu has one and Usman Danfodio Teaching Hospital (UDUTH) has one. University College Hospital Ibadan, Ahmadu Bello University Teaching Hospital, ABUTH Zaria, and Eko Hospital, Lagos have Cobalt-60 radiotherapy machines, a type of machine that is no longer in use in many countries.
Project PINK BLUE once had to fly a patient from Abuja to Lagos because she needed urgent radiotherapy treatment. When we reached out to ABU Zaria, they said their machine was working but she needed to wait for six to 12 weeks. This is what most Nigeria cancer patients go through.
A cancer patient has everything on earth except time. So imagine a patient waiting for 12 weeks before she can get radiotherapy? As it is today in Nigeria, radiotherapy is one of the biggest challenges for cancer treatment in the country.
The radiotherapy machines are so old that every day they got spoilt and we keep hearing promises that they are going to fix them, but nothing is being done.
The World Health Organisation said one radiotherapy machine must be made to serve 1 million to 2 million persons; instead, what we have in the country is quite alarming. Nigeria has over 202 million people and has about nine radiotherapy centres and out of these nine, five of the machines are not working. In the whole of South-South Nigeria, there is no single working radiotherapy machine. So where is the hope for cancer patients?.
PT: What are the most pressing needs for a cancer patient?
CHIDEBE: Let me answer this question by saying that the most pressing need in Nigeria’s health care now is not just brain drain, but also patient drain. Nigerians affected by cancer are leaving the country every single day, they no longer trust the health care system.
Fixing cancer infrastructure is key and one of the greatest needs of cancer patients in Nigeria, followed by the cost of treatment. If I am down with cancer today, I cannot afford it. Millions of Nigerians cannot afford cancer treatment.
Once the government invests in the infrastructures, many other investors can come in to provide other care.
As we speak today, some pharmaceutical companies are closing down and leaving Nigeria.
PT: So you do not think that the government is doing enough in cancer control and health care?
CHIDEBE: No! The health of Nigerians is in the hands of foreign donors, not in the hands of Nigerian government nor the Nigerians themselves. If foreign donors withdraw their funding from Nigeria’s healthcare, we are all gone.
The funding for health care is extremely poor, same is applicable to cancer control. We cannot make a difference in cancer control if we do not increase funding for health care.
As from 2015 – 2018, N2.3billion has been budgeted for cancer control. But we really don’t know what has been released or used for cancer control.
In 2018, Nigerian government launched the National Cancer Control Plan (2018-2022) and stated that Nigeria needs N97billion ($308million) to fight cancer for the next five years. Shamefully, nothing remarkable has been done from the cancer control plan. The only remarkable experience was the launching, beautiful and expensive launching. After the launching nothing else. The government needs to walk the talk.
Nigeria has the highest cancer burden on the African continent. How can a country like Nigeria be giving four per cent of its entire budget to health when other countries like Rwanda, Botswana have increased their own to 13 per cent and 15 per cent and the Abuja Declaration that we all stand upon was actually made in Abuja, in Nigeria. And this is about 10 years after the declaration was made.
PT: Do you have any relationship or collaboration with the government?
CHIDEBE: We have been partnering with the Federal Ministry of Health and the National Cancer Control Programme.
I am a member of the Ministerial Committee on National Cancer Control Plan (NCCP 2018-2022) and National Cervical Cancer Prevention Plan. We have had fantastic relationships with them, most especially in the areas of advocacy and training.
Painfully, the cancer control desk is under-funded. In some cases, the funds are budgeted and not released. Clearly, cancer control is not a priority for the government. Thanks to President Muhammadu Buhari for signing the bill to establish the National Institute on Cancer Research, Treatment and other connected purposes on December 29, 2017. However, three years now, the bill is yet to be gazetted and budgeted.
PT: Is there statistics of people with cancer in Nigeria?
CHIDEBE: Yes, cancer is now a critical public health problem in Nigeria with 115,950 new cases of cancer and 70,327 cancer deaths in 2018 and 102,079 new cases of cancer and 72,000 cancer deaths in 2012.
Comparatively cancer incidence and deaths are on the increase in Nigeria, according to (World Health Organisation (WHO)/International Agency for Research on Cancer (IARC)). Breast cancer is the leading cause of cancer death in Nigeria with 26,310 cases and 11,564 deaths.
Followed by cervical cancer with new cases of 14,943 and 10,403 deaths; and prostate cancer being the third leading cause of death with 13,078 (11.3 per cent) new cases and 5,806 deaths in 2018.
On a daily basis, at least 31 women die from breast cancer, 28 women die from cervical cancer and 15 men from prostate cancer in Nigeria.
Other leading cancers are colorectal cancer, liver cancer, non-Hodgkin lymphoma, stomach, pancreas, ovary and leukaemia. Painfully, over 70 per cent of cancer are diagnosed at late/advanced stages in Nigeria.