Why we are engaging TB clinics in the battle against lung cancer

In Kenya, out of the 794 lung cancer cases reported in 2020, about 729 deaths occurred. [Courtesy]

Cancer is rapidly becoming a global public health issue requiring a more focused public health approach to reduce its impact. November is the lung cancer awareness month. It presents an opportunity for us as a country to retrace our steps and reflect on innovative ways to enhance public awareness on this type of cancer, its risk factors, mitigation and treatment options.

Lung cancer is the second commonest cancer type (in terms of absolute numbers) and the leading cause of cancer deaths globally. Studies show males are more affected by lung cancer than females largely due to differences in smoking rates.

Therefore, as the world marks Lung Cancer Awareness Month, there is need to refocus our efforts to reduce its public health impact, through innovative multi-sectoral approaches. National and county governments must enhance collaboration on policy and practice guidelines to support lung cancer early detection and specific interventions like expansion of integration of lung cancer in tuberculosis (TB) control.

The outbreak of the Covid-19 pandemic last year significantly altered global public health systems. It is during this period, that an estimated 2.2 million new lung cancer cases were reported and 1.8 million deaths occurred globally.

In Kenya, out of the 794 lung cancer cases reported in 2020, about 729 deaths occurred. This translates to a case fatality of 92 per cent. These grim numbers require an enhanced approach to turn the tide and reduce the mortality rate.

To reverse this trend, we have embarked on a journey to strengthen awareness programmes and scale up capacity-building of both primary and community healthcare workers to enhance early detection and referral of suspected lung cancer patients, especially in TB/chest clinics.

There is a close co-relation between lung cancer and TB. First, the two conditions share identical risk factors, such as smoking as well as occupational and environmental exposures. Secondly, a previous TB diagnosis is a recognised risk for lung cancer - increasing the risk by up to six times. Lastly, lung cancer symptoms mirror TB symptoms such as chronic cough, night sweats, coughing blood, weight loss and lymph nodes enlargement.

Since Kenya is a high burden TB country, the possibility of delayed diagnosis cannot be disregarded. However, there is an opportunity to minimise this risk through integration of TB and lung cancer control programmes, awareness creation, case detection and screening for lung cancer in selected high-risk patients with current or previous TB diagnosis, especially those with unsatisfactory improvement after TB treatment. We urge all health facilities to adapt this approach.

Indeed, an ongoing pilot programme at AMPATH, Moi Teaching and Referral Hospital in Uasin Gishu County was able to detect 190 lung cancer cases within two years through integration of lung cancer awareness creation, screening and active case detection in TB/chest clinics. This was done in 15 sites where community health workers were heavily involved.

Additionally, to address the financing gap, we are exploring the possibility of integrating lung cancer awareness and stigma reduction, early detection and linkage to treatment within other programmes. This is meant to leverage on existing infrastructure to leapfrog lung cancer control as well as lung health.

To realise this, a new collaboration is being forged between the National Cancer Control Programme and the National Tuberculosis, Leprosy and Lung Disease Programme through the support of the Global Fund to integrate lung cancer awareness and screening into TB clinics.

This will begin with 10 high TB burden counties where health care workers will be trained to improve their index of suspicion for lung cancer and screening algorithms developed. The eligible patients will undergo screening using low-dose computerised tomography at county referral facilities. If well implemented and sustained, this integrated approach can increase lung cancer case detection and improve health outcomes.

A robust monitoring and evaluation framework will also offer impetus in tracking patients through the lung cancer screening-diagnosis-treatment-survivorship cascade. Systems already created for TB monitoring and evaluation can easily be adapted to support this function.

Finally, public health prevention interventions including tobacco control, cough hygiene, reduction of indoor air pollution and infection control are being rolled out. One such initiative is the development and dissemination of a facilitators guide for community health volunteers on household air pollution.

The training guide targets the community and community health workforce with the aim of reducing adverse health and environmental impact of household energy use of solid fuels, biomass and kerosene associated with respiratory illness including pneumonia, and lung cancer.

Let us rally together during the lung cancer awareness month and beyond to increase awareness on the risk factors to lung cancer and embrace preventive interventions to reduce the health and social-economic impact of the disease. Together we can lower the lung cancer mortality rate.

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