Improving cancer care management in Nigeria

February 4th is commemorated globally as ‘World Cancer Day’, with the primary goal of significantly reducing cancer-related illness and death by 2020, by advocating for the adoption of preventive measures, early detection, and the availability of effective treatment.
According to the World Health Organization (WHO), cancer is the second leading cause of death globally, and responsible for 8.8 million deaths in 2015. Globally, nearly 1 in 6 deaths is due to cancer. The number of new cases is expected to rise by about 70% over the next 2 decades. Around one-third of deaths from cancer are due to leading behavioral and dietary risks: high body mass index (BMI), low fruit and vegetable intake, lack of physical activity, tobacco use, and excessive alcohol intake.

Inherited genetic mutations play a major role in about 5 to 10 percent of all cancers, research have shown. Researchers have associated mutations in specific genes with more than 50 hereditary cancer syndromes, which are disorders that may predispose individuals to developing certain cancers. In addition, cancer causing infections, such as hepatitis and human papilloma virus (HPV), are responsible for up to 25% of cancer cases in low- and middle-income countries.

Nigeria is currently witnessing an epidemiological transition stemming from rising prevalence of Non Communicable Diseases (NCDs) within the context of persistent communicable disease burden. Whilst health inequalities in cancer incidence exist in Sub-Saharan African countries, the most common types in Nigeria include cancer of the breast, cervix, prostate, colorectal, and liver cancer, research has shown.

While cancer is a major public health concern in the country, the economic impact of cancer is significant and increasing. Rising cases of cancers and the enormous cost of illness has huge negative economic implications for the Nigerian healthcare system and the society at large. With less than 5% of Nigerians currently covered by the country’s health insurance scheme (NHIS), increasing cancer prevalence has a potentially impoverishing effect, considering the high diagnostic and treatment costs, significant out-of-pocket payments and accompanied lost income, especially in advanced cases.
Added to this is a combination of risk factors such as exposure to environmental factors (like carbon-monoxide from automobiles and generating sets, tobacco use,) increasing urbanization and rising population, including changing lifestyle such as healthy diet, lack of physical activity and harmful alcohol usage.

Against the backdrop of high economic fluctuations, average income levels remain stagnated, yet cost of illness is rising; a recent market survey revealed average spend for minimally-invasive diagnostic services have gradually risen from N10, 000 (in 2014) to between N20, 000 to N25, 000 (in 2017) for a breast scan, and as much as N40, 000 or more for biopsy. This is aside other ancillary costs for radiotherapy, chemotherapy inducing drugs.

The burden of cancer in Nigeria is unknown largely due to lack of accurate statistics or under-reporting. This is not peculiar to Nigeria but most parts of Africa. Although available data are either population of hospital-based, it is perceived that cancer incidence is rising in Nigeria. Other reasons for under reporting include inadequate diagnostic facilities, limited access to care, inadequate technical manpower and infrastructure as well as quality of cancer data systems all contribute to inaccurate data on cancer burden.

Source – World Health Organization – Cancer Country Profiles, 2014.(Nigeria)

An interplay of intrinsic (individual) and extrinsic (environmental) factors modulating the incidence and prevalence of cancer in Nigeria, reflects the need for a collective action for reversing the trend of rising prevalence, and reducing the negative influence of cancer on individual lives, households, communities, and the larger society.
When identified early, cancer is more likely to respond to effective treatment and can result in a greater probability of surviving, less morbidity, and less expensive treatment. Significant improvements can be made in the lives of cancer patients by detecting cancer early and avoiding delays in care. Some of the most common cancer types, such as breast cancer, cervical cancer, oral cancer, and colorectal cancer have high cure rates when detected early and treated according to best practices.

There is already a compelling financial/ economic argument for investing in the prevention of cancer. The Return on Investment (ROI) in taking on proven strategies for cancer prevention, early detection and health systems strengthening cannot be overemphasized.
Building the economic case for investment in cancer can change mindsets and allow government to justify placing cancer prevention and control at the heart of the national health plan. Planning an integrated, evidence-based and cost effective interventions throughout the care continuum (research, prevention, early detection, treatment, and palliative care) is one of the most effective ways to address the problem and ease the discomfort caused to patients and their families.

A significant reduction of cancer prevalence will be enhanced by a government-led approach to adopting population-wide people-centered interventions which address risk factors, sustaining primary healthcare measures, prioritized packages of essential interventions, and ensuring availability of options for qualitative treatment and palliative care.

Increased awareness of cancer will no doubt lead to an increase in the number of new cases. On the other hand, training and re-training of health personnel concerned with Cancer diagnosis and management cannot be over-emphasized.
Whilst having a National Cancer Institute will inspire research and training in Cancer, there is the need to create innovative partnership to strengthen advocacy efforts. No doubt, the knowledge and spheres of influence of the private sector to increase investment in cancer prevention measures will go a long way to address inequities in access to quality affordable cancer treatment and care, and reduce premature deaths from the disease.
There are high expectations for the government’s Nigeria Cancer Control Plan in the areas of advocacy/awareness creation, cancer prevention, early detection/screening and cancer management.

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