Towards a cancer free society - taming a deadly disease

As the world marked World Cancer Day on Monday, it provided an opportunity to reflect on the challenges posed by cancer in our society in recent times, and opportunities for reducing this threat in the future. Cancer cases have continued to be increasingly reported in our region, and indeed in the rest of Africa. Malignancies are now among the leading causes of death in East Africa.

The most common cancers in the East African region are cancers of the breast and cervix uteri in women and cancers of the prostate, esophagus and kaposi sarcoma in men. In addition, there are continued reports of patients getting these cancers at exceptionally young ages.

Challenges to care:

The high cost of health care and the generally limited funding available to provide healthcare adversely affect health-seeking behaviour. Patients have to travel long distances to access diagnostic and curative services, which leads to a further delay.

Another giant hurdle is the lack of knowledge and due to this, patients end up presenting late. Cancer patients must also often deal with the stigma that comes with the disease, and for some, this means shunning society and not seeking care. Cancer care needs specialized equipment and appropriately trained personnel.

This has been an Achilles heel across different settings in our region. There is a large gap to be filled, as few are opting to specialize in oncology or related fields, leading to a small number of cancer specialists serving a large population. The equipment is also costly to run and maintain.

And for the cancer treatment chain to be complete you also need other specialists- radiologists, radiation oncologists, surgeons and specialized nurses. Brain drain to other parts of Africa and the world has also contributed to this specific challenge. In order to inform policy makers, there is also a current need to improve the coverage of cancer registries in the region.

Palliative care

Unfortunately, a large majority of cancer patients still present late and care for patients at this stage becomes more costly and is more painful and debilitating. Pain relief, patient support via social and family networks, and provision of a dignified end to life becomes the priority. One example of responding to palliative care challenges is the care of esophageal cancer in Kenya. Globocan 2018 estimates show that esophageal cancer is the top cancer killer in the country.

This cancer is so deadly because the first symptom that a patient notices is usually difficulty in swallowing, but this is in fact a sign of advanced disease. By that time the tumor is already large, and the surgery required to remove it is too invasive for many patients to endure.

The palliation for this cancer is either via a surgical feeding tube, or placement of a feeding stent which is less expensive but may not be easily affordable. As part of the African Esophageal cancer Consortium (AfrECC), we have been working on a collaborative effort to provide quality, affordable stents in the region as well as training clinicians in placing these tents. This project has initially kicked off in Kenya and Tanzania and will expand to other areas soon.

Making research a priority:

Research drives innovation. There is a paucity of cancer data from the African continent, but there has also been a steady increase in publications and research-driven findings from our continent.

Each of our countries has made strides through the establishment of government-funded research institutes and also supporting researchers through professional associations at the national and regional levels to nurture African scientists, encourage collaboration and grow research capacity.

AfrECC is an example of an entity that was borne out of researchers across the African continent who were working on esophageal cancer coming together to leverage their collective strengths and diversity.

With more attention being focused on cancer care, there are many strides that have been made towards reducing cancer deaths. Each of the countries in our region have set up cancer institutes and have also rolled out National Cancer Control Plans aimed towards meeting the Sustainable Development Goals of reducing premature mortality from NCDs by a third.

Training of specialists is one high priority need, and this represents relatively low hanging fruit that we should be able to reach if we work together to implement a few relatively simple solutions.

To mitigate brain drain, proper remuneration and establishment of county-level centers of excellence for cancer care will enable specialists to be able to fully utilize their skills after receiving training.. Cancer is curable if caught early. There are notable examples in breast and cervical cancer screening.

The effort now should be to centrally fund these projects along with continued advocacy exercises to spread awareness about these programs. Ultimately, after implementing all of this, we hope to one day reach the goal where there are fewer deaths due to cancer.

What does the future hold?

Cancer care is now a public health priority in the region. Kenya has begun the road to Universal Health Care and is piloting it in some counties. The national health insurance platform has already helped a lot by adding cancer care packages.

There has been an expansion in the number of public and private facilities that now offer chemotherapy and radiotherapy services, and an expanded acquisition of diagnostic imaging and laboratory machines across the counties.

Uganda recently installed a new radiotherapy machine and will host a regional centre of excellence for cancer. Rwanda has made great strides in the training of oncologists by opening up a regional cancer treatment centre. Tanzania has been providing free care for cancer patients. The war on cancer is being waged and won, one small step at a time.

Dr Mwachiro is a general surgeon and endoscopist. He is a founding member of the African Esophageal Cancer Consortium and the Director of Endoscopy services at Tenwek Hospital