Who will tame the cancer monster?

Hesbon Odongo -Andrologist of Esis Health checking fertility of sperm cells during an interview on cancer and its effect on fertility in men and women. [David Gichuru, Standard]

When he took to the podium to address the over 6,000 delegates attending the inaugural National Cancer Summit, on behalf of the Council of Governors (CoG), Tharaka Nithi Governor Muthomi Njuki became emotional.

He took a few seconds to compose himself and told the attendees that his father and mother died of cancer.

Njuki said that when was he was 19 years old, his father, then a clinical officer, developed a pimple on his neck but went on with life not knowing death was beckoning.

The governor, who is the Health Chairman at CoG, said the pimple developed into a growth and when he sought treatment, he was diagnosed with stage four cancer.

"My father used to treat people but didn't know that he had cancer. He ignored a small pimple on his neck, instead of going for checkup. Upon diagnosis, he died within a short time," said Njuki

He said that when the mourning period was over, he made up his mind to take good care of his mother who remained as the only pillar in their family.

"For 27 years after the death of my father, I always ensured that my mother was on good a good diet, eating organic foods and anything she wanted. She later became critically sick and despite visiting many hospitals, medics were unable to diagnose what was ailing her," said the governor.

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He went on: "I spent one month with my mother at a leading hospital in Nairobi where we had at least eight specialists trying to guess what the problem could be until one day, a radiologist, from one of the X-rays he had taken, discovered that my mother had stage four cervical cancer."

According to Njuki, the radiologist advised the family to take the mother home and allow her to live a dignified life, instead of taking her for chemotherapy and radiology sessions.

The family did not heed the advice and put her on chemotherapy on grounds that they had the resources to look after her.

"I watched my mother die after six months when she had lost the hair and lost at least 20 kilogrammes. After her burial, I thought I should have allowed her to take a break from medication as advised by the doctor to allow her live a dignified life," said Njuki

He went on: "To date, I feel psychologically and emotionally affected when thoughts of losing my parents to cancer linger on my mind and imagine that I am next."

Cancer has been identified as the second leading cause of death among the non-communicable diseases.

Two out of every three people diagnosed with cancer will succumb since 70 per cent of the cases are diagnosed in advanced stages.

A report by the National Cancer Institute of Kenya (NCI-K) dubbed 'Status of Cancer in Kenya Report 2022/2023' shows that at least 42,000 new cases are reported annually. At least 27,000 patients succumb to the disease, translating to 75 people dying of cancer every day.

According to the report ,the burden of cancer has traditionally been documented through modelled estimates by Globocan.

"For the first time in Kenyan history, the cancer burden is reported from patient level primary data obtained from the National Cancer Registry. This report provides a snapshot of the first-year experience and status of reported cancers through examining the number of cases by sex, age, cancer types and county".

It was also found that high cost of treatment leave many families in financial distress. Cancers of the cervix and prostrate are the highest contributors to the disease burden locally.

"In Kenya, one chemotherapy session goes for Sh37,000 of which the National Hospital Insurance Fund (NHIF) pays Sh22,000 and the patient pays the balance of Sh15,000 after every two weeks. This takes a toll on families and end up losing their beloved ones to cancer," said Dr Githinji Gitahi, the NCI-K Chairman.

"Kenya urgently needs a renewed commitment to cancer care and treatment, if that is not done, by 2040, we shall be losing 150 lives every day. The cancer budget is a paltry 0.5 per cent of the national budget and yet it accounts for 10 per cent of the disease burden," he added

The report is based on an analysis of one-year data of cancer cases reported from 42 health facilities, where 7,502 cancer cases were registered between July 2021-June 2022. Of these, 6778 cases were included for analysis, based on the completeness and quality of data.

Out of 6,778 cancers cases analysed, 2,892 (42.6 per cent) cancers were reported in males and 3,886 (57.4 per cent) among females.

The median age of cancer diagnosis was 53 years for females and 62 years in males. The highest proportion of reported cancer cases across age groups differed between males (65-69 years) and females (45-49 years).

On disease burden, the most common cancers reported in the National Cancer Registry in the last one year were breast (15.9 per cent) followed by cervix (13.3 per cent) and oesophagus cancer at 11.8 per cent.

Prostate and colorectal cancers were the fourth and firth most commonly reported cancers accounting for 10.1 per cent, 7.1 per cent respectively on disease burden. Stomach cancer followed with 5.8 per cent, mouth and oropharynx (5.4 per cent), cancer of the bone marrow (2.8 per cent) and liver stood at 2.6 per cent. Other types of cancers accounted for 25.1 per cent.

In terms of gender, the most common cancers among men are prostate (23.7 per cent) followed by oesophagus and colorectal 15.9 per cent and 8.8 per cent respectively) while the most common for women are breast cancer (26.5 per cent) followed by cervix and oesophagus 23.2 per cent and 8.8 per cent respectively.

Childhood cancers (0-18 years) accounted for 2.0 per cent of all cancers reported to the National Cancer Registry.

The burden of childhood cancer cases when disaggregated by type of cancer, leukaemia accounts for the highest proportion of cases at 15 per cent followed by brain tumours 11 per cent, lymphomas at 10 per cent and other childhood cancers account for 47 percent.

Among the cancer patients notified in the reporting period, almost two thirds of them (64 per cent) are enrolled with NHIF, not enrolled (33 per cent) and those on other medical insurance providers stands at 3 per cent.

The top five (5) counties with the highest proportion of cancer cases reported to the registry are Nairobi, Nakuru, Kiambu, Machakos and Nyeri. Marsabit, Wajir, Mandera, Samburu and Lamu recorded the least cases.

The most commonly reported comorbidities among cancer patients were Hypertension, diabetes, and HIV. The leading cancer deaths are related to cancer of the oesophagus that accounts for 15.6 per cent of deaths, followed by cervix uteri cancer (10.4 per cent), breast cancer (9.6 per cent) and liver cancer 9.1 per cent.

Health Cabinet Secretary Susan Nakhumicha said that cancer has remained a burden in the health sector, with most families are unable to cater for its treatment.

"We are going to establish a Chronic Disease Fund to help in the treatment of non-communicable diseases (NCDs). This will also stop people having to fundraise to fly overseas fort treatment. We must stop that costly affair," said Nakhumicha

She went on: "We will be renaming the National Hospital Insurance Fund (NHIF) the National Social Hospital Insurance Fund (NSHIF) so that every Kenyan can access treatment. We shall do a major fundraiser to get Sh12.6 billion and the government will top up so that everyone accesses better healthcare."

Nakhumicha said another Sh150 billion will be fundraised to cater for referral of patients with chronic diseases, adding that treatment will be in Kenya as the country has capacity to treat NCDs.

At the continental level, Dr Ahmed Ogwell, the Director of Africa Centres for Diseases Control (CDC) said that a study they conducted between 2021 and 2022 year shows that cancers of the oesophagus, cervix and breast cancer are the leading killer diseases yet they are preventable.

Dr Ogwell said that the continent must invest in the prevention, treatment and control of NCDs at the community level, arguing that every disease starts at the community level and ends in the communities.

"Globally, 19.3 million new cancer cases and 10 million deaths were reported in Africa. We had 1.1million new cases and 711,000 deaths as a result of late diagnosis. Egypt, Nigeria and South Africa are listed as the countries with most cancer burden and if we don't take urgent steps, Kenya is also heading there," noted Dr Ogwell

According to Dr Ogwell, gaps in policy formulation and implementation was the biggest hindrance in Africa towards cancer prevention and treatment. That of the 55 member states, only 16 had proper policies while 28 countries have functional cancer registries.

He said only 15 countries in Africa have breast cancer screening services at primary healthcare, adding that limited access to treatment, high costs and lack of facilities with comprehensive cancer treatment were the reason for high cancer deaths.