As Nigeria joins the global community to mark the 2021 World Cancer Day today, experts have expressed concerns over shortage of cancer specialists in the country, lamenting delays in the diagnosis and referral of patients.
According to the experts, there are less than 70 consultant radiation and clinical oncologists in Nigeria.
They noted that no priority is given to cancer care services by healthcare planners at all levels, as cancer care is not seen as an emergency in the country.
Senior Research Fellow and Consultant Radiation and Oncologist, National Hospital Abuja, Dr. Chinedu Aruah, says there are prolonged waiting times and delays due to the limited number of healthcare workers and the large patient load.
Speaking on the current status of cancer treatment in Nigeria, challenges and solutions, Aruah said besides shortage of manpower, the country also lacks treatment facilities, revealing that there are only seven radiation oncology centres owned by the government and one private centre.
According to the World Health Organisation, there are currently 43.8 million cancer patients worldwide, with over 18 million new cancer cases yearly.
Cancer is now responsible for one in six deaths globally, with 9.6 million deaths from cancer each year, WHo said, noting that 70 percent of cancer deaths occur in developing nations like Nigeria.
The National Cancer Prevention Programme says there are currently over 200,000 cancer cases in Nigeria, with over 100,000 new cases occurring every year.
According to NCPP, about 200 Nigerians die every day from cancer, with 32 of these daily cancer deaths resulting from breast cancer, 28 from cervical cancer, 16 from prostate cancer and 14 from liver cancer.
World Cancer Day is held every 4th February to raise awareness about the disease. The theme for this year’s commemoration is ‘I Am and I Will’, which has been continuing since 2019.
Giving insight into the shortage of manpower for cancer care in Nigeria, Aruah said, “There is a limited number of specialist in cancer management in Nigeria, taking cognisance of cancer incidence, prevalence and population size.
“Most university teaching hospitals lack basic pathology laboratory and rarely undertake molecular studies on cancer.
“There are less than 70 consultants radiation and clinical oncologists in Nigeria. This figure is also reflected in the number of medical physicists, therapy radiographers and oncology nurses involved in cancer treatment in Nigeria.
“There are prolonged waiting times and delays due to the limited number of healthcare workers and the large patient numbers.
“More than 70 percent of cancer patients in Nigeria present with locally advanced disease, hence may benefit from adjuvant, neo-adjuvant and palliative chemotherapy.
“There is no availability of an up-to-date National Drug Formulary in Nigeria, hence no practical guide on drug administration and use.
“Most of the hospitals do not have enough drugs in their pharmacy stores, thereby worsening access to oncology drugs by patients.
“There are challenges of affordability, quality assurance and access to oncology drugs as most pharmaceutical companies have their plants outside Nigeria.
“Nigeria has no laid-down process for accessing narcotics and analgesics for pain management in cancer patients. Access to immunotherapy and targeted agents are quite limited in Nigeria.”
Decrying the lack of treatment facilities, the specialist said Nigeria has limited oncology facilities and radiotherapy treatment centres when compared to her population size.
Aruah explained, “There are only seven radiation oncology centres owned by the government and one private centre. 90 percent of these centres are not functional and operate without a treatment planning system . And two of the government owned facilities still use cobalt-60 machines with challenges of reduced source activity due to exceeded half life
“Only one centre, the National Hospital Abuja, can boast of a treatment planning system and a CT simulator. This centre also suffers challenges of source replacement and limited manpower. Almost 90 percent of Nigerian radiation oncology centres lack cancer registration system using mosaiq (R&V system).”
Recommending the way forward, he noted that with strong political will and commitment of the health providers, Nigeria will emerge as the next hub of radiation oncology treatment and cancer research taking cognizance of huge human potentials and material resources.
The oncologist also called for increased enrollment in the National Health Insurance Scheme to reduce out of pocket expenditures by cancer patients.
National Coordinator, NCPP, Dr. Abia Nzelu, says Nigeria has less than 10 radiotherapy machines, against WHO recommended minimum of one radiotherapy machine for every one million people. “Worse still, most of Nigeria’s radiotherapy machines are outmoded or faulty” Nzelu noted.
According to her, it is more urgent now than ever to escalate the big war against cancer to stem the scourge in Nigeria.
“WHO projects that if things remain the same, there will be a 60 percent increase in cancer cases within two decades, with the greatest increase (over 80 percent ) occurring in developing countries, including Nigeria.
“This projected increase is likely to be even greater, because of the multiple negative impact of the COVID-19 pandemic on cancer care (budgetary diversion of local resources towards addressing the COVID-19 crisis; restriction on crowding which is required for mass cancer screening; increased strain on health personnel and infrastructure; and restriction on medical tourism).
“The disproportionate burden of cancer mortality in developing countries is largely because the health services of the poor nations are not equipped to prevent, diagnose and treat cancers. For instance, whilst India has over 200 Comprehensive Cancer Centres, most of which are the products of non-governmental/nonprofit endeavors, Nigeria has none”, she said.
The oncologist called for the establishment of a comprehensive cancer centre in Nigeria.
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