Challenges of cancer management in Nigeria

by Alexander Chiejina
In recent times, cancer has emerged as a major public health problem in many developing countries, matching its effect in industrialised nations. Africa is no exception and with Africa's biggest population, Nigeria has a big share of the problems

Recent reports from the World Health Organisation (WHO) reveal that there are 100,000 new cancer cases in Nigeria annually although observers believe the figure could become higher than the stipulated figure.

With lung, stomach, liver, colon and breast cancer causing most cancer deaths annually and tobacco use been the single most important risk factor for cancer, medical experts have called for a co-ordinated approach towards preventing and treating cancer in Nigeria.

In an interview with Edamisan Temiye, Chairman, Nigerian Medical Association, Lagos State Branch, Temiye said that cancer accounted for 7.4 million deaths or around 13 percent of all deaths globally in 2004 and deaths from cancer are projected to continue rising globally with an estimated 12 million deaths in 2030.

Temiye stated that tobacco use, alcohol use, chronic infections from hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papilloma Virus (HPV) are leading risk factors for cancer in low- and middle-income countries, with about one-third of the cancer burden likely to be decreased if cases were detected and treated early.

“In Nigeria, there seem not to have a co-ordinated approach to the prevention and treatment of cancer. The individuals who are stricken with cancer are left to fend for themselves with high cost of treatment, poverty, superstition, lack of appropriate facility for care and other factors which has made cancer an extremely deadly disease in Nigeria,” Temiye revealed.

Lending his view, Samuel Eyesan, consultant orthopaedic oncologist, National Orthopaedic Hospital, Igbobi, Lagos, said that problems of impeded access to health care, ignorance, and poverty have resulted in delayed diagnosis. The consultant orthopaedic oncologist noted that lack of coordination of issues of health education has gone a long way in complicating the management of cancer.

He hinted that the economic cost associated with the management of patients with cancer are expensive, with imaging facilities such as computerized tomography (CT) and Magnetic Resonance Imaging (MRI), used for imaging patients not readily available in every health institution. He added that when such facilities are available, the cost of such studies are prohibitive – putting them out of reach of the average citizen.

“The same argument of high cost applies to chemotherapy. While pathology services are generally available, the scope of services is limited. Molecular diagnostic methods are not widely available and surgery is often performed by surgeons whose primary clinical practice is not oncology, and there is a very limited scope for multidisciplinary cancer care. There is also the challenge of public enlightenment strategy, which is poor, institutional factors (such as infrastructural decay, inadequate trained personnel) etc, which we are a nation are confronted with in the management of cancer,” Eyesan disclosed.

Taking a cursory look at the entire scenario of cancer management, the absence of proper cancer data is a major factor militating against cancer management in the country. This is evident in cancer registration which officially began in 1960 but it was not until 1990 that a National Headquarters of Cancer Registries was established in Ibadan. How functional this registry is still in doubt.

With early detection of cancer based on the observation that treatment is more effective when cancer is detected earlier, educating people through electronic and print media on the need to recognize early signs of cancer and seek prompt medical attention for symptoms, which might include lumps, sores, persistent indigestion, persistent coughing, and bleeding from the body's orifices is of utmost importance.

At the meantime, calls have been made to the federal government to establish a functional cancer registry centre for proper statistical data and analysis of the disease. The centre, when established, would help in the control and management of cancer in the country even as doctors and nurses at the primary health care level should be trained to diagnose cancer to help in early detection.

For Temiye “we need to encourage the government at all levels to assist the populace by way of providing care to those who are affected. Non-governmental organisations specializing in the provision of education materials and support for the prevention and treatment of cancer should be encouraged and supported by all concerned. For successful management of cancer, team work is needed by all concerned in the treatment.”

In the estimation of Lewis Nwoku, Professor of Oral, maxillofacial plastic surgery at the Lagos University Teaching Hospital (LUTH), Idi-Araba, “there is the need to increase political commitment for cancer prevention and control; Develop standards and tools to guide the planning and implementation of interventions for prevention, early detection, treatment and care; Facilitate broad networks of cancer control partners at regional and national levels; as well as strengthen health systems at national and local levels.”