Cancer kills 80,000 Nigerians every year

Eranga Isaac, CNS Correspondent, Nigeria
Nigeria marked World Cancer Day 2016, recording a significant increase in the number of deaths from common cancers during the last few years. As per data of the World Health Organisation, between 2008 and 2012, daily number of deaths increased from (i) 30 to 40 in women due to breast cancer; (ii) 24 to 26 in men due to prostate cancer; and (iii) 24 to 32 due to liver cancer. This significant increase is, to some extent, connected to the lack of quality cancer treatment facilities available in the country.

Oncologist Dr Bello Abubakardisclosed, in a forum to mark the 2016 World Cancer Day in Abuja, that Nigeria’s only cancer treatment machine located at the National Hospital, Abuja had outlived its utility— it was already 16 years old, while its life span is 7 years. Abubakar regretted that the only cancer treatment facility in the country lacked the basic infrastructure to function optimally. He therefore called for more funding and the provision of basic infrastructure to deal with cancer. On his part, the Deputy Chairman of House of Representatives Committee on Healthcare Services,Muhammad Usman regretted the ‘miserable’ amount of funds allocated for the fight against cancer in the 2016 health budget of the country, and called for more government funds for the procurement of equipment needed to diagnose and treat cancer.

According to Dr. Abia Nzelu, the WHO National Co-ordinator of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria), “Over 100,000 Nigerians are diagnosed with cancer yearly, and about 80,000 die (10 deaths every hour) with a dismal survival ratio of 1:5. The situation is worse for some specific cancers— the survival ratio for certain blood cancers in Nigeria is 1:20. This poor survival rate is mainly due to inadequate infrastructure for cancer care and lack of well-organised system of prevention.” Nzelu said Nigerians spend $200 million annually on cancer treatment abroad. “Incidentally, $200 million is also the approximate amount needed to establish three comprehensive cancer centres, or to acquire 300 mobile cancer centres.

Unfortunately, the outcome for Nigerians who embark on cancer-related medical tourism is often poor because of late detection. Nigeria has lost many precious and talented people to cancer. Cancer constitutes a preventable major drain on our human and financial resources,” she said. Meanwhile, the Federal Government of Nigeria has rolled out a new set of policies aimed at strengthening the nation’s cancer management and control. In a speech to commemorate the 2016 World Cancer Day in Abuja, the Nigerian Minister of Health, Prof. Isaac Adewole, while acknowledging that the growing burden of cancer in Nigeria is faught with ‘inadequacy of health systems, poor manpower, poor access to treatment facilities and lack of access to end of life care’, disclosed that the Buhari administration has recognized and prioritized cancer care interventions as a signature project of the health sector. In addition to the planned establishment of the National Agency for Cancer Control [NACC], the Minister also announced new measures for the control and management of the disease in the country.

These include the strengthening of the nation’s Primary Healthcare (PHC) Systems to ensure a strong referral system and a revision of the National Strategic Plan for cervical cancer control that would lead to the inclusion of Human Papilloma virus (HPV) vaccination in the routine immunization programme.  Adele gave an update on the steps taken by the government for cancer care and control. He informed that, “The pivot of the cancer control, starting from primary healthcare level, will be health promotion and cancer prevention. So we are working on strengthening PHCs across the nation, including building a formidable workforce to provide essential outreach services which will include health promotion. Our ‘one PHC per ward’ initiative will also link up with secondary and tertiary care through strong referral systems. Arrangements are also underway to commence a pilot of GAVI-supported demonstration on HPV vaccination in some selected states in Nigeria.”

“HPV immunization of girls for cervical cancer prevention was introduced in Nigeria by the government in 2011. Subsequently, HPV vaccination has been made available in health service outlets in both private and public hospitals. Government is making efforts to include it as part of the routine immunization programme. Furthermore, a National Policy/ Guideline on Prevention, Control and Management of hepatitis has been developed to address the rising incidence of hepatitis in the country. The policy is also targeted at the prevention and control of liver cancer associated hepatitis. The Federal Ministry of Health is committed to pursuing a policy for a waiver of import duties for cancer medication to encourage the pharmaceutical sector to bring in adequate amounts of cancer drugs to cater for our needs,” he said.

“The government is also planning to increase the number of radiation service outlets in the country through private public partnerships (PPP). Currently the Ministry is consulting with some organisations to upgrade 7 of these existing centres to oncology centres of excellence. In the second phase of the upgrade process, 7 more such centres will be created for comprehensive cancer care in Nigeria within the next two years”. “Efforts are also on to develop a palliative care policy for the country. The Ministry has been actively engaged with the African Palliative Care Association and the Nigerian Palliative and Hospice Care Association to design and implement research and training programmes in designated hospitals for palliative care, with focus on pain free management of terminal conditions. A training centre for palliative care, situated at University College Hospital Ibadan, trains healthcare professionals to conduct this service in health centres and to also provide palliative care as a community based service. In addition, the Federal Health Ministry has requested the National Universities Commission to implement curriculum review that will allow for the incorporation of palliative care in the training of nurses and doctors in Nigeria”, he informed. 

The Minister called upon all Nigerians to recognize the role they can play in reducing the burden of the disease, ‘so that we can reduce the unnecessary number of premature deaths from cancer and other NCDs to 25% by the year 2025’. In line with the theme for this year’s World Cancer Day: ‘We can, I can,’ Prof. Adewole noted that much could be done at the individual, community and government levels to ‘harness and mobilize solutions and catalyze positive changes’. He pledged that health service delivery improvement, provision for cancer and other disease conditions would continue, especially with the commitment of the Nigerian government to Universal Health Coverage and with the support of the National Health Act.

Eranga Isaac, Citizen News Service - CNS

Isaac Adewole, Nigeria Health Ministerq

Winning the Cancer Battle in Nigeria; A Call to Action

Nigeria Health Watch

Posted by Isaac Omo-Ehiabhi Eranga, Health Journalist and Author of the book- UNDERSTANDING BASIC FACTS ABOUT BREAST AND CERVICAL CANCERS

isaac_editorial@yahoo.com +2348059233001

Negeria Health Watch Editor’s Note: February 4^th was World Cancer Day, and this year’s theme is, “We can, I can.” For many people cancer is a dreaded word, understandably. In this week’s blog, two Nigerian cancer survivors share their stories of being diagnosed and overcoming the disease. We at Nigeria Health Watch look forward to a day when stories of cancer survival will be the norm in our country, and not the exception. If we put the right systems in place, we truly can win the battle against cancer. The stories below are shared with permission. 

Swatkasa

In November 2014, Swatkasa Gimba felt an unusual lump in her breast, “I went to the hospital, and met a young doctor, who examined me and told me I had nothing to worry about. But I insisted on having a scan done and that scan showed that the lump was huge.” Dr. Gidado, a visiting consultant from Jos examined her and told her that she needed a lumpectomy.

After the surgery, she was asked to take the lump to Army Hospital, Kaduna for a biopsy. This she did. Then came a long two week wait for the results. “While I waited, I kept telling myself, ‘Only old people get cancer’. I also knew that cancer was hereditary and since no member of my family had ever suffered from cancer, I wasn’t overly concerned,” she said.

In December, two weeks after the biopsy, she went back to the hospital to get her results and without any form of counselling or advice, the doctor handed her the results that stated that she had breast cancer. “When I got the report, I was devastated,” she said. “Thoughts flooded my mind as tears poured down my face. How could I have cancer? Cancer is for the rich. My mother is a teacher and my father, retired. How will they pay for my treatment? What is the chance that I can survive this? Even if I do survive, how will I live with just one breast?”

"I am happy to be alive", Swatkasa Gimba, 33 year old breast cancer survivor. Photo source: Swatkasa Gimba

On the 30^th of January 2015, Swatkasa had a mastectomy and was placed on chemotherapy. “Chemotherapy was awful. I lost my hair. My nails and palms, the soles of my feet and tongue became black; I could not eat and even when I tried, I threw it all up; and I was always weak,” she said.

She was then referred to the National Hospital, Abuja for Radiotherapy.  At the National Hospital, more tests were done, and she received more bad news. She had a particularly aggressive type of breast cancer which was HER2 positive. HER2 means human epidermal growth factor 2, and is a protein which, if not working properly, can promote the aggressive growth of cancer cells. She was told treatment would cost 13 million naira. “This was devastating,” she said. “Where was I to get N13 Million Naira? How?”

In Abuja, the crowd of people waiting to use the radiotherapy machine was overwhelming. “I was supposed to use the machine for 25 days, but there was such a long waiting line that I kept going back and forth for one month before I was enrolled into the programme,” she said, adding, “Because of the pressure put on it and its age, the machine kept breaking down but finally, I finished my treatment. Now, I had to start sourcing for funds to treat the HER2 diagnosis. My family, friends and church members rallied around me and the 13 million was raised”.

She said both government and private organisations can do more to help. “The government needs to wake up and do what is necessary to ensure that a cancer diagnosis is not a death sentence for the Nigerian citizen,” she said, adding, “Private organizations should also invest in cancer treatment centers. More survivors need to come out and tell their stories because people need to know that they can survive cancer. People also need to be encouraged to go to the hospital early – because early detection saves lives”.

Already private Cancer Centres like the Lakeshore Cancer Center in Lagos, founded by Dr. Chumy Nwogu, is playing a part in providing comprehensive treatment and care for cancer patients. But more needs to be done.

Swatkasa says despite her ordeal, she is happy. “Somedays I get moody, somedays I am afraid that the cancer may come back… but I am happy to be alive,” she said.

Theodora

As a teenager, Theodora Nwosu-Zitta noticed a lump in her breast, “When I told my mother, she told me that the lump was there because I had never breastfed a baby. This lump grew with me into adulthood”. In 2010, while taking care of her mother in the hospital, she walked into a seminar on cancer, and one thing the speaker said struck her; “The speaker at the seminar said, ‘All cancers start with a lump but not all lumps are cancerous’,” she said.

“In December of the same year, I went to Ahmadu Bello University (ABU) Teaching Hospital, Zaria. They checked me and told me it was a normal lump, but still encouraged me to take it out for a biopsy. I did a lumpectomy on the 23^rd of December, sent the lump off for a biopsy and immediately after, left for a training at the Immigration Training Institute. Sometime after, I was called back to ABU Teaching Hospital where I got the news that the lump was cancerous”.

Theodora didn’t let the diagnosis pull her down. “I didn’t tell any member of my family. All I did was go back to the Institute to complete my training”. She knew she had to be deliberate about fighting the disease, “Someone once said that cancer is like a snake; if you don’t cut off its head, it will keep growing. So, after my training, I went to Wuse General Hospital for a mastectomy and two days after, I informed my mother,” she said.

“Cancer is not a death sentence; If I can survive, you too can survive”, Theodora Nwosu-Zitta, 43 year old breast cancer survivor. Photo source: Theodora Nwosu-Zitta

Despite being advised against it, she opted to have both chemotherapy and radiotherapy together. “It was a horrible experience,” she remembers, “I couldn’t sleep, couldn’t walk - but the knowledge I had gathered gave me strength.” The treatment worked and from 2010 until 2015, her tumor marker test results were okay.

But sometime in 2016, the test results showed rising activity of cancer cells in her body and she was asked to search for a lump in her body. “I eventually found a lump in my hand and a biopsy showed that it was cancerous,” she said. “I turned to my doctor and said, “If I can cross the other one, I can cross this one” and then I walked out.”

She returned to chemotherapy sessions for the next two months, while also on the lookout for anything else she could do to beat cancer.  She said that was when she came across a website where a man beat stage 4 cancer by changing his diet.  Inspired by his story, she made dietary changes in her life, cutting out sugar and carbohydrates and eating more fruits and vegetables.  “In November, my tumor marker test showed ‘459’ and in December, it came down to somewhere over ‘230’,” she said.

She laments the inefficiency of government in caring for cancer patients in Nigeria. “I am not one of those who wants the government to do everything, but it is very annoying that our government doesn’t seem to care. In all of Nigeria, there are only 4 functional radiation machines – Zaria, Abuja, Ibadan and Port Harcourt,” she said, adding, “The one in Lagos hasn’t worked for years. Also, these machines don’t all work at the same time. When one breaks down, the other starts working, so cancer patients – who can afford to - are forced to move from one city to the other just to continue their radiation treatment. Those who can afford it, go to countries like Ghana and Kenya just to get uninterrupted treatment”.

Theodora shares her story to give others hope. “God saved me, but I can’t help but think about the millions of people who died when they did not have to,” she said. “I’m always willing and happy to share my testimony because it gives people hope. Cancer is not a death sentence; If I can survive, you too can survive.”

The Battle for Better Cancer Care

Swatkasa, who is now 33 years old, has lived cancer free for 3 years; Theodora, now 43, has also beaten cancer and has been living cancer free for 8 years.

Theodora and Swatkasa are not alone in fighting the battle against cancer. In Nigeria, over 100,000 people are diagnosed with cancer every year and about 80 percent (80,000) die from the disease. For many in Nigeria, a cancer diagnosis means either a death sentence, bankruptcy or worse still, both. Inequality in access to prevention, diagnosis, treatment and care makes reducing premature deaths from cancer difficult.

Gloria Orji, a six-year cancer survivor, says this should not be so. “Cancer patients have no business dying if the right things are put in place. NHIS stopped covering cancer in 2016. Even the tumor markers to detect cancer type in the body are no longer covered in the Scheme.”

Universal Health Coverage as defined by Dr. Ifeanyi Nsofor of Nigeria Health Watch means that all people – all means all – have access to the health care they need, when they need it without these services causing them financial hardship or catastrophic expenditure.

The notion that cancer treatment and prevention is beyond the scope of Universal Health Coverage is vehemently debunked by Rob Yates of UK Independent Policy Institute Chatham House. “There are some very cost-effective cancer prevention measures but also curative services too that really ought to be in a package of services that is available for the entire population.” Yates is quoted as saying in the article. “So, this notion that cancer services are too expensive and that developing countries can’t afford them is absolute nonsense, and it really should be the case that even low-income countries in their package of services that are available for the entire population should include cancer services too.”

Everyone has a part in the fight against cancer. As we wait for the government to develop a cancer institute, equip more health facilities with up to date radiotherapy machines and fix the erratic power supply, we must remember that the responsibility still rests largely on individuals who care… so we must care, if we are to hear more stories of survival like Swatkasa and Theodora’s.

What can You Do?

Make healthy lifestyle choices and educate others as well. This includes avoiding tobacco, getting plenty of physical exercise, eating a healthy diet, limiting alcohol, and staying safe in the sun.Know about signs and symptoms of cancer and early detection guidelines because finding cancer early often makes it easier to treat.Support cancer patients during their treatment and continue to encourage survivors even after treatment ends.Call on governments to commit adequate resources to reduce cancer deaths and provide a better quality of life for patients and survivors, as well as improve access to affordable cancer health care for all.Encourage schools and workplaces to implement nutrition and physical activity policies that can help people to adopt healthy habits for life.

Share With Us

Have you ever gone for a routine cervical smear test or other test for cancer (male or female)? If not, why not? Have you ever been diagnosed with cancer? If so, what was your experience accessing treatment? Do you know anyone who has gone through or is going through the experience of being diagnosed with cancer?

Please share your experiences and thoughts with us. We would love to hear from you. Let us work together to leave Nigeria a better, healthier place.

Source: Nigeria Health Watch