Government is expanding cancer treatment access – Osotimehin

With the celebration of the 2010 World Cancer Day yesterday, Appolonia Adeyemi reviews the federal government’s cancer control programme February, 2004. At 7.15 am, Ama Jonathan was the first patient to arrive the Oncology Unit, University College Hospital (UCH), Ibadan, Oyo State. Having been diagnosed of breast cancer, a private health facility in Port Harcourt, Rivers State, had referred AMA to UCH, which has medical facility and personnel to treat the condition. Arriving the unit that deals with cancers, she took her turn to see the doctors and did further tests to aid treatment but as dusk began to set, she became apprehensive on where to spend the night. Ama had no relation nor friend in Ibadan but had to follow up on the mastectomy, which the doctors recommended as the only way to nip her breast cancer in the bud. A mastectomy is surgery to remove a breast and it is performed either to treat or prevent breast cancer.
With nowhere to go to, Ama finally joined other patients who had accommodation problems in an uncompleted structure being developed in UCH. She spent the night there. The following day, she followed up on the treatment. After spending two weeks in UCH and getting a four week appointment for the surgery, Ama left for Port Harcourt.
Undoubtedly, moving back and forth from Port Harcourt where she lived to Ibadan, the location of the facility providing cancer treatment was an added burden to the health condition Ama faced but she was not alone. The problem of limited cancer treatment access was major a problem facing cancer patients in Nigeria.
Before the era of former President, Retired General, Olusegun Obasanjo, only six hospitals were designated as cancer treating centres. These were the UCH in Ibadan, National Hospital, Abuja, University of Nigeria Teaching Hospital, Enugu, Lagos University Teaching Hospital, Lagos, University of Maiduguri Teaching Hospital, Maiduguri and Ahmadu Bello University Teaching Hospital, Zaria. What this meant was that a patient residing in a rural area in Calabar could be referred to seek treatment in Abuja, Maiduguri or Zaria, depending on the health facility that had the requisite equipment and personnel for the case at hand. Of course, many poor people who had cancer must have missed out on treatment, resulting in the high incidence of cancer deaths in the country.
Cancer is a leading cause of death worldwide. World Health Organisation (WHO) estimates that 7.6 million people died of cancer in 2005 and 100,000 new cases are currently seen annually. This is estimated to rise to 500,000 new cases annually by 2015 if prevention and screening services strategies are not implemented urgently.
According to the Federal Ministry of Health, recent studies in Ibadan reported an annual incidence of 10,000 cervical cancer cases in the south west of Nigeria.
In Nigeria, the main types of cancer leading to overall cancer mortality among men each year are cancers of the prostate, liver, connective tissue, skin, larynx, Hodgkin disease, colon and rectum, Nasopharynx, bladder and nose. Among women, the commonest cancers are cancers of the breast, cervix, uterus, ovary, liver, non Hodgkin, lymphoma, colon, thyroid, soft tissue and bone.
With the increased incidence of cancer, the Federal Ministry of Health (FMOH) has upgraded more hospitals and increased their capacity to optimally treat cancer while others are still in the process of being upgraded. The process which was initiated by Retired. General Obasanjo with the rehabilitation of some tertiary hospitals is continuing to date, said the Minister of Health, Prof. Babatunde Osotimehin.
According to him, hospitals that are presently being upgraded to treat cancer are the University of Benin Teaching Hospital, Benin City, Edo State, Federal Medical Centre, Gombe, Usman Danfodio University Teaching Hospital, Sokoto, University of Ilorin Teaching Hospital, Ilorin, Kwara State and University of Port Harcourt Teaching Hospital, Port Harcourt. “Recently, Federal Medical Centre, Gombe received cancer treating equipment,” said Dr. Patience Osinubi who is the coordinator of Cancer Control Programme at the Federal Ministry of Health.
It is import to expand treatment centres because 30 per cent of cancers are preventable while about 40 per cent are easily detectable in the pre-malignant stages, thereby providing the opportunities to stem the course of the disease and increase the chance of cure.
However, another major problem facing the treatment and management of cancer in Nigeria is that many cancer cases present to the hospitals at advanced stages when effective intervention is not possible. “This has been one of the major reasons for the high mortality rates,” said Dr. Osinubi.
According to her, the FMOH has tremendously stepped up cancer prevention and early diagnosis through regular cancer screening. This will prevent late presentation of cases, she said.
For instance, in Nigeria, cervical cancer kills more women than any other form of cancer. The National Cervical Cancer Prevention Programme (NCCPP), a non government organisation and an initiative of the Mass Medical Mission (MMM), which is working on cancer, states that “Every two minute, a woman dies from cervical cancer.” Yet cervical cancer’s cancerous lesions can be detected through routine examination, making it easy to cure.
To stem the tide, in 2009, Prof. Osotimehin directed all Federal Tertiary Hospitals to set up cancer screening services to increase accessibility to cancer screening for the three major cancers in Nigeria – breast, cervix and prostate cancers.
Similarly, the NCCPP with support from governments, corporate organisations, among others is currently expanding access to awareness and screening for cervical, breast and prostate cancers. With screening and counseling centre already established in its Surulere Headquarters in Lagos, it plans to establish screening centres for the three major cancers in all 774 local government councils in the country.
Other activities at the FMOH to control cancer include awareness and advocacy through the media and partnerships with NGOs. “Many state governor’s wives are partnering with the Federal Ministry of Health to carry the cancer awareness and advocacy to the local government and communities,” Dr. Osinubi said.
In addition, the FMOH is partnering with the International Atomic Energy Agency (IAEA) on a programme called Programme of Action on Cancer Therapy (PACT). Going by government plan, within the next eight years, nuclear medicine equipment, which can diagnose cancer efficiently and more radiotherapy equipment (linear accelerators) will be available in more federal tertiary hospitals.” The federal government has committed to counterpart funding of $37.5 million dollars for the successful implementation of this programme, said the coordinator of the Cancer Control Programme at the FMOH, adding, “Nigeria has already paid the first $2 million to the IAEA to initiate the programme.”
Although, Dr. Osibubi admitted that currently, the cancer diagnostic and therapeutic facilities and trained manpower, especially in the area of radiotherapy and nuclear medicine physicists are still inadequate to meet the needs of the 140 million population, “we will have enough facilities to treat cancer patients by the end of the IAEA partnership.”
In Nigeria, an average of one linear accelerator per 20 million is available when compared to 3.4 and 8.2 radiotherapy machines per million population in the United Kingdom (UK) and the United States (US).
Cancer treatment is expensive globally and the major challenge facing patients in Nigeria is the inability of the National Health Insurance Scheme (NHIS) to fund cancer treatments. Although, the current co-pay of about N550 is inadequate to support the funding of cancer treatment, the scheme funds cancer screening and simple mastectomies and prostatectomy for breast and prostate cancers.
Following the huge cost of cancer treatment, the primary focus of the government is cancer prevention because it is far more economical to prevent the disease than allow for the onset of the condition.
Although, the federal government signing of the Framework Convention on Tobacco Control is laudable, domesticating the protocol will reduce tobacco consumption and ultimately prevent cancer.
On cervical cancer, the National Cervical Control Policy states that girls from nine years should be eligible for the vaccine, Gardasil, which prevents the onset of human papilloma virus that causes cervical cancer. The FMOH is trying to get Global Alliance for Vaccines and Immunisation (GAVI) country assistance to procure these vaccine at an affordable cost to sustain its inclusion in the National Programme on Immunisation (NPI).
In addition, the FMOH advocates for breast cancer prevention by encouraging self and clinical breast examinations and mammography. This should be done at least every two yeas from age 35 years and above for early detection of breast cancer. Abnormal breast lumps can be evaluated this way for very early treatment intervention, Osinubi said. A mammogram an x-ray of the breast to detect cancer, goes for, which is between N3,000 and N5,000 in public hospitals.
Furthermore, while current government policy urges men to check the serum levels of their Prostate Specific Antigens to detect any unusual rise in its level. High levels may indicate early onset of prostate cancer. Also, skin cancer protection programme is being pursued for albinos. Through Albino Foundations, the FMOH is advocating for the use of sunscreens and protective covering like hats, long sleeve clothing to reduce excessive exposure to sunlight, among others.
If Nigerians responds to the various awareness and preventive programmes in place, medical experts believe that it will translate into routine cancer screening exercises and result in preventing cancers. On the other hand, for those who get cancers like Ama, the increasing cancer treatment centres in the nation will bridge the gap created by limited cancer treating facilities.