World Cancer Day: Closing the gap in cancer care in Nigeria

Cancer killed over 70, 000 Nigerians last year, with about 124, 000 cases recorded, according to Globocan estimates.

The data also show that Nigeria has already recorded over 10, 000 new cancer cases in 2023 barely 35 days into the year.

According to the President of the Nigeria Cancer Society (NCS), Dr Adamu Alhassan Umar, the situation on ground is a lot worse than the estimated statistics because there is poor data in Nigeria.

He said majority of the cancer cases die without going to the hospital, adding that it is only some of those that are captured in the dashboard of hospitals or die in hospitals that are recorded.

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Nigerians suffering from cancer and medical experts have continued to lament the poor access to cancer care. They say the country is bedevilled with inadequate number of treatment centres and functional radiotherapy machines, cancer specialists and high costs of treatment. Radiotherapy machines use radiation in treating cancer patients.

There have also been increased calls for the private sector to collaborate with government to improve cancer care services in Nigeria.

A patient who simply wants to be identified as Haruna, 40, said cancer patients suffer untold hardships travelling to other places as a result of non-functional radiotherapy machines in their state or geopolitical zone of residence.

He lamented that even when one gets to the centre with functional machine, the patient is often given very long appointment dates, adding “so you either have to travel back and return on your scheduled date or stay there and spend money on accommodation and feeding, especially in places you don’t have relatives.”

He said the cost of treatment has caused him to run into debts.

“Sometimes, I wait for a very long time before buying drugs prescribed for me because of lack of money, and it is not good for my health. Government should please prioritise supporting or subsidizing cost of treatment for cancer patients because a large number are dying daily because they and their families can’t afford the cost of treatment.”

Gloria Orji, a breast cancer survivour, said stigma is still prevalent against the disease. She said this makes some patients to shy away from care. According to her, the low awareness amongst the populace and attitude of some people towards cancer patients also frustrates the later who are already struggling through the pains and trauma.

Our reporter gathered during a visit to the radiology and oncology department of the Ahmadu Bello University Teaching Hospital, Shika, Zaria, that the old machine in the hospital used for radiotherapy treatment known as Cobalt 60 machine has not been in use since the third quarter of 2018.

So, patients requiring radiotherapy have to be referred to other centres. However, the brachytherapy machine and chemotherapy cancer treatment are effectively being conducted at the hospital.

The reporter learnt that cervical and breast cancer constitute the highest cases of cancer recorded almost on daily basis at the hospital.

Dr Adamu Alhassan Umar, of the Nigeria Cancer Society, said there are supposed to be functional radiotherapy machines at the six tertiary hospitals or cancer centres owned by the federal government, across the geopolitical zones at every point in time. However, he said most times some will be functional while others will not due to lack of maintenance.

He said since 2020, some centres with state-of-the-art cancer centres started coming on board, like the University of Maiduguri Teaching hospital, the Federal Medical Centre Katsina and the cancer centre in Sokoto.

He said other centres were recently commissioned in Rivers and Kano states, and have state-of-the-art technology in testing and treatment of cancer.

He also said some private facilities have emerged too with state-of-the-art equipment including radiotherapy machines.

“So, we can boast that we have about nine functional machines as at the last count,” he said.

However, he added that the number is grossly inadequate. He said Nigeria requires a minimum of 300 radiotherapy machines to meet the needs of cancer patients.

The president of the Nigeria Cancer Society said one of the major factors contributing to cancer care gaps in the country is the poor budgetary allocation to the health sector.

He noted that the country is still battling to meet up with the ‘2001 Abuja Declaration’ in which leaders from African Union countries pledged to commit a minimum of 15 percent of their annual budgets to the health sector.

He revealed that in Nigeria, the health budget often ranged between four and five percent, adding that even though there is an improvement in the allocation to health in 2023, it is still not enough.

He said, “Because there is inadequate provision for health in the budget, there is a commensurate lack of right infrastructure, trained skilled manpower, needed for cancer care as well as, deficit in screening services especially at the primary healthcare level.”

He said other major challenges is lack of awareness among the populace and expensive cost of cancer treatment.

He said while the vulnerable group fund in the National Health Insurance Authority Act shows promise for cancer patients, the implementation is a concern.

The expert lamented that Nigeria has less than 100 clinical oncologists (doctors specialized in cancer care), and even the number is depleting due to the brain drain in the health sector.

“Nigeria needs to develop a system of training and retraining so that there will be adequate manpower,” he said.

Founder of the Medicaid Cancer Foundation, and First Lady of Kebbi State, Dr Zainab-Shinkafi Bagudu, said access to treatment of cancer is out of the financial means of the persons fighting the disease in the country.

While noting that the treatment facilities are few and far between, she said there are geopolitical zones that have no radiotherapy machines in the country.

She mentioned some harmful life style practices that increase risk of having cancer to include physical inactivity, obesity, poor diet, alcohol abuse and smoking.

Way forward

Dr Umar said the way to close the cancer care gap is purposeful commitment by every stakeholder to address the myriads of problems affecting cancer patients.

He said there is need to scale up the cancer health fund that is presently being piloted across six hospitals in the country.

He also said it is important for the federal government to live up to its pledge of introducing the Human Papillomavirus (HPV) vaccine in the country’s routine immunization schedule this year.

“They promised third quarter of the year so we hope government will do as it promised this time by rolling it out nationally and free of charge.”

He said despite being a panacea for cervical cancer elimination, the HPV vaccine is not widely available in the country now and where available is too expensive for the ordinary Nigerian.

Umar noted there is need to increase awareness about cancer, saying major cancers are highly preventable when detected early.

He also called for increased involvement of the private sector in cancer care, saying public private partnership (PPP) will help make care available.

“So, with right commitment and political will-power, we will get there,” he added.

Dr Zainab-Shinkafi Bagudu said “It is not right that where you are born or live should continue to determine if you will live or survive cancer. Despite the technological advancement that we have seen in the last decade, we must all continue to address the global inequities by increasing cancer awareness, building sustainable partnerships and creating innovative financing vehicles that can help us to reduce the cost of treatment.”

She said First Ladies Against Cancer (FLAC), a non-governmental organization, would be leveraging its platforms to engage incoming legislators to ensure cancer care is privatised in resource administration.

“The plan to introduce HPV vaccine this year is a welcome development. Despite some implementation bottle necks, the cancer fund is also providing support to patients and their caregivers across the country.

“It is not designed as the final solution as many people see today. It is supposed to be a seed fund where everybody can contribute to,” she added.

Minister of Health, Dr Osagie Ehanire, said that prevention is the cheapest way to tackle cancer. He advised Nigerians to shun practices such as sedentary lifestyle that increase risk of cancer.

The minister, who said the federal government was working assiduously towards addressing the cancer care gaps in the country, including expanding cancer treatment centres, assured that government would introduce Human Papillomavirus (HPV) vaccine in the country’s routine immunization schedule this year. The HPV vaccine helps in the prevention of cervical cancer.