Cancer of any part of the body, as we all know, is a deadly disease if not detected early. To have a success story in the management of cancer, we need to step up sensitisation campaign against cancer. Many people still don’t go for routine checks and delay in seeking medical attention even if they detect anything strange in their system.
Again, we need training and retraining of more medical personnel in the areas of early diagnosis of cancer and early referral to higher centres where cancers can be effectively handled. We also need to establish cancer centres in all the states of the federation, where patients can be screened for early detection of the ailment.
Cancer diagnosis and treatment should be highly subsidised to reduce burden of payment on the patients because cancer treatment is not cheap in any form. Government should step up National Health Insurance Scheme coverage of Nigerians as this will make patients to seek medical attention early, whether they have money or not, since this would have been covered in the scheme.
Dr Oboh Oseiwe (Consultant, Radiation and Clinical Oncologist)
We have a major problem with the management of cancer in Nigeria because the greatest burden we have is that most patients present their case very late. Most cancers basically have different stages – one, two, three and four. When it is in stage one, that is early and when it is stage two, something can still be done. But, the ones that come in three and four are usually already advanced. At those stages, you no longer talk about radical treatment but palliative treatment just to see how you can prolong the patient’s life and improve the quality of life. At the early stages, surgery, chemotherapy, radiotherapy and, in some cases, targeted therapy can actually achieve a cure.
In the advanced stages, we can talk about disease control in terms of controlling pain and helping to get good quality of life. In Africa, over 75 per cent of cancer patients go for treatment in the advanced stages, unlike in Europe where the patients present themselves early enough. At the advanced stages, even the best of cancer centres cannot do much to the patient because it has already spread to the entire body. So, the major challenge is that Nigerians don’t present themselves early because they don’t go for screening. There are many people who consult roadside chemists for antibiotics; some go to churches, claiming that cancer is not their portion, and others go to herbalists. And we have very poor health-seeking behaviour in Nigeria. Our people don’t go to hospital until it becomes “very advanced and very bad”.
So, the more people start getting better health-seeking behaviour and seeking medical treatment early enough, the more we can catch the cancers early and give them the treatment they deserve in terms of surgery, chemotherapy, radiotherapy, and we can have good control. The second challenge is facilities. Nigeria, with a population of over 170 million, has only eight centres for cancer treatment. I was in the United States in 2014 and I visited a private (cancer) centre with 15 cancer treatment machines. What the World Health Organisation says for developing countries is that there should be 200 patients to a machine. But here (in Nigeria), we have eight machines to 170 million people – that is over 20 million to a machine. That is bad enough.
But, that is not the end of the story. Are the machines functioning? The answer is no. As I speak with you, only one is working and that one is in the UCH, Ibadan. Probably, the capacity of the one in UCH is 60 to 70 patients every day. But, is that possible? I sent three patients to UCH on Thursday and that is how other departments and hospitals across the country send to UCH every day. Ibadan now has the whole country on its head. So, what happens to the machine? It is subjected to excessive pressure and it will eventually break down.
The machine in the University of Benin Teaching Hospital has a capacity of about 45 or not more than 50 patients every day. But we were taking 140 every day and we knew that there was a red flag. Before we knew it, our machine broke down.
Going forward, Nigeria needs more machines and we need to repair the ones we have that are not working. Most of the machines were purchased from foreign manufacturers. So, they can be contracted for maintenance. We need to encourage our engineers to understudy the foreign experts and get the technical know-how to do maintenance and repairs. Government can also partner private individuals and agree, through MoU, on how they can recoup their investments. That way, the machines work; patients are happy getting treatment; and doctors are happy.
Dr. Rotimi Adesanya (Child and Public Health consultant)
There should be a special intervention fund or something like a Cancer Tax Fund to support the government. This kind of public-private partnership is a way out. Basically, health is a social service and should be the government’s responsibility. But, with the current economic recession, the government is finding it difficult to make sure that equipment is put in place.
So, there is the need for the non-governmental organisations and corporate organisations to set up a fund for the treatment of cancer patients. They have to assist and support the government.
Also, the equipment for cancer treatment is expensive. The blame of government in this is that there is a lot of bureaucracy to change the equipment. Hence, the government has to review its Public Procurement Act.
For example, the Magnetic Resonance Imaging machine costs over N10bn to purchase. A patient pays up to N70,000 even in the government hospitals to do the test and most cancer patients may need this machine to take the test.
This is why international organisations and NGOs have to assist the government so that our masses do not suffer. We know that the rich may not be affected because they can travel abroad for medical treatment.
The machines are stressed up. There was a particular time that patients from all the states in the Southwest region had to go to Ibadan, Oyo State, because the machines in Lagos State had broken down. That is another challenge that the government has to address.
Musa Borodo (A Professor of Medicine, Bayero University, Kano)
Cancer affects every part of the body and the causes vary. Because the causes vary, the strategies vary. For example, the number one cause of cancer of the liver is viral Hepatitis B. So, you must avoid viral Hepatitis B if you don’t want to suffer from cancer of the liver.
The best way is prevention, which is to avoid what can cause cancer and watch out for early signs. Breast cancer is troublesome and has killed a lot of women. Women must know the early signs and go for appropriate diagnosis and course of treatment.
The Federal Government must sensitise the people and embark on health education so that people can know how to avoid cancer; know the signs and the treatment options. Cancer drugs are expensive, so government must make them available at subsidised rate.
There is also the need to have centres for radiotherapy; we have just about three in Nigeria. But, the drugs and the radiotherapy can only help if the cancer is detected early.
Prof. Abdulwaheed Olatinwo (Chief Medical Director, University of Ilorin Teaching Hospital)
The basic fact is that we have the personnel, but there is the need for the coordination of their activities. Basically, the component of early detection cannot be overemphasised. We have enough personnel to handle cancer patients in the country, but how do we relate it to the population? We talk of early detection and prompt treatment. Some cancers, when you identify them early, can be treated. So, there should be screening to identify people who are at risk. Early detection and prompt treatment are another component. For those who are now detected, the treatment will now be the component of the personnel, and we have a good number of people who are competent in dealing with the different types of cancer.
The major challenge is that of treatment modalities. Do you want to do radiotherapy? Are there centres where those things are functioning? The Federal Government is working on upgrading some of the centres with functioning radiotherapy equipment. Ilorin and Maiduguri do not have the equipment; we have been advised to fully start it so that they can fully equip the centres. Once the equipment is there, treatment becomes easier. The bottom-line is early detection. People should not come when the cancer is already advanced. They should come early when it is still localised. Then, the treatment can be quite good and you can have the prognosis of what normally should be done.
School, social organisations, religious bodies have to come in to enlighten people to come for screening and treatment, depending on the organs we are looking at. Of course, once there is early detection, it can be treated appropriately.