As the Breast Cancer Awareness Month comes to an end, WHO statistics paint a grim picture on with an expected 60 per cent rise in cancer cases over the next two decades if the current trends continue.
The situation worsened with the Covid-19 pandemic and its double burden on cancer patients already immuno suppressed. When the immune system is compromised, there is a greater risk for serious complications from viruses like Covid-19. This has exacerbated a strained oncology environment being weighed down by barriers to patients seeking cancer testing and/or treatment as well as to healthcare practitioners in delivering these services ultimately creating this perception that cancer is a death sentence, but is it really?
Cancer is the third leading cause of mortality in Kenya, accounting for about 7 per cent of annual deaths with breast and prostate cancer ranked as the most prevalent type among women and men respectively. Majority of breast cancer patients in Kenya display the disease at an advanced stage or in its late stages, a clear indication that diagnosis is still a major challenge, and in most cases making it impossible for them to achieve cure. However, this should not be the case.
Among women, breast cancer is the most common in Kenya, with more than 5,985 new cases and 2,553 deaths registered in 2018. Some 42 per cent of these women with breast cancer present in stage III and 18 per cent in stage IV (metastatic disease). Up to 30 percent of women diagnosed with and treated for early breast cancer will go on to develop metastatic breast cancer, which occurs when the cancer spreads beyond the breast.
WHO guidelines highlight a wide range of proven interventions to mitigate cancer prevalence. These include controlling tobacco use (responsible for 25 per cent of cancer deaths), vaccinations, screening and treatment as well as implementing high-impact cancer management interventions that bring value for money and ensuring access to palliative care including pain relief.
For breast cancer patients in Kenya, an innovative and much-needed new treatment option is now available to tens of thousands of women with HR+/HER2- metastatic breast cancer. When used in combination with the recommended hormone therapy, it increases the duration of tumor control and is generally well tolerated – and could delay the need for women with this type of advanced breast cancer to start chemotherapy.
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As we all know, metastatic breast cancer (stage IV) places a heavy burden on patients and by extension their families, financially or otherwise. And even though such novel treatments and drugs may have the potential to provide better quality of life and outcomes for them, there is the issue of costs and accessibility. Stakeholders must ensure such treatments or drugs are affordable.
Cancer drug costs typically higher than average drug costs and as a result most countries fund cancer drugs through public reimbursement programs which is meant to facilitate equal access for citizens by eliminating direct costs to patients and although we are on the right track here in Kenya, we still have a long way to go.
The Ministry of Health’s bid to develop a universal health care (UHC) benefit package that emphasizes need for early screening and detection of NCDs, including cancers is welcome and aligned to the Kenya National Cancer Control Strategy (2017–2022).
By 2014, only 20 per cent of Kenyans had access to health insurance with a large portion of the population only enrolling when they are unwell and need to be covered. Six years later and there has not been any major shift. Most Kenyan households rely on Out Of Pocket (OOP) spending for their healthcare needs, with the National Hospital Insurance Fund (NHIF) covering a limited package for inpatient and outpatient cancer services. Finally, the public and private sector need to embrace innovative access partnerships aimed at bridging the gap between accessing quality innovative cancer treatment options for all.
-The writer is Pfizer Laboratories Country Manager Kenya and East Africa Cluster Lead