Amid poor medical facilities for diagnosis and treatment of cancer, many Nigerians, including men, women and children, continue to fall prey to various types of the disease, leaving their families and loved ones dejected, writes Olukorede Yishau
When it strikes, the agony stretches year long. The eyes of the children of the victims are often deadened. The widows or widowers battle to accept their new status. But, like day turning to night, they have got to live with their new reality of being orphans, widows or widowers. In some instances, where the victims have aged parents , they also have no choice but to live after their children.
Welcome to the world of children, fathers or mothers and aged parents whose statuses have been changed overnight by cancer of various sorts.
In their exclusive clime, sorrow and tears compete for attention because of the death of dear ones. Confusion often reigns too. And not a few keep asking: Why?
Cancer shows no mercy. The latest of its influential victims is Mrs. Olufunmilayo Olayinka. Until her death last Saturday evening, she was Ekiti State’s deputy governor. Her loss to cancer has left her husband, three children, aged parents and boss, Dr. Kayode Fayemi, among many others, disturbed.
Cancer has killed many prominent Nigerians and the poor, whose death are attributed to ‘brief illness’.
Only last December, the wife of the chairman of MicCom Cables and Wires and MicCom Golf Hotel and Resort, Olufunke Ponnle, was buried after losing the battle of life to cancer. The late Chief Gani Fawehinmi, ace broadcaster Yinka Craig and former First Lady Mrs Mariam Babangida also fell to cancer.
A nutritionist and mother of four, Mrs. Margaret Shogunro-Pitan, is also one of the victims of cancer. Mrs. Shogunro-Pitan in 2003 had Hysterectomy, the removal of her uterus and tubes because she had multiple fibroids. Not long after, she started feeling that her body was not functioning properly. She was feeling a lot of discomfort lying face down, especially with her right breast. But as a Christian and minister of God, she was quick to say ‘God forbid’ each time the reality of it being breast cancer crossed her mind. She headed for a private diagnostic laboratory for mammogram, a cancer screening test. But she never returned to the laboratory to ask for the outcome of the examination until two months later, when a doctor insisted on her getting the result of the diagnosis.
It turned out positive for breast cancer. It was decided that a second opinion should be sought. And in February 2006, it was confirmed that she had malignant lump. She went to the Eko Hospital. For 29 days, she was on admission at the A-rate hospital, where she had mastectomy with equipment she said were fully automated. She had to undergo six courses of chemotherapy, 22 sessions of radiotherapy and CT scan. She seemed to recover thereafter. But she later died.
The cost of treating cancer
Cancer does not just kill in one day. Before it does, it drains the families of the victims financially, emotionally and otherwise. The cost of treatment is killing. The cost varies depending on the type of cancer. But one ring cuts across all of them: they don’t come cheap. Before a patient can undergo chemotherapy and radiotherapy, a CT scan may be required. This costs between N30,000 and N40,000. And to ensure all the areas of threat are detected, the CT scan ought to be done for the brain, the chest, the abdomen and the bone marrow. To do all these, no less than N100,000 is required. But since most patients cannot afford this, an x-ray, which is less comprehensive, is adopted. The MRI scan, which is an higher form of CT scan, goes for at least N60,000.
For breast cancer chemotherapy, a patient may have to take Adriamycin, which, from checks at pharmaceutical stores, costs no less than N2,000 per bottle. But if the patient has a heart problem, he or she has to use another variant of the drug known as Eprirubicin, which is said to cost about N10,000 per bottle. A patient is expected to use six courses of this every three weeks. By the time a patient is through with this, he or she must have spent between N80,000 and N100,000 on drugs alone. There is, however, a cheaper drug, which costs N400 per tablet. It is known as Cyclophosphamaide, which, an oncologist said, is not commonly prescribed.
In the event that the patient needs surgery, the cheapest is Lumpectomy, which costs not less than N15,000. Mastectomy, which is the removal of affected breast, goes for about N50,000. As for radiotherapy done through linear accelerator machine for breast cancer, 20 sessions are said to cost not less than N100,000 anywhere in the country. The radiotherapy for cervical cancer costs about N50,000 more. If the breast cancer radiotherapy is done with Cobalt 60 machine, it costs less, especially in government-owned cancer clinics. The rate in private clinics is more.
A hormone positive patient has to use an anti-hormone drug known as Tamoxifen. A pack costs N600, which lasts one month. But the patient who tests positive to this is expected to use this drug for five years non-stop for efficient result. This drug can only be used by women who have not reached menopause. For the five-year period, a patient needs N36,000. Those who are over menopausal age have to use Tamoxifen for between two and three years before combining it with another higher treatment, which costs more.
The financial implications of all these drugs and treatments pale into insignificance when compared to what it costs to use the new wonder targeted therapy for women with HER 2+ breast cancer. The drug known as Herceptin costs N400,000 to acquire enough dosages for one month and a patient is expected to use it for one year. That means to enjoy the enormous benefit of this wonder drug, which can be an effective treatment both before and after surgery for people with HER2-positive breast, a patient needs N4.8 million!
What experts say
Prof. Muheez Durosinmi of the Department of Haematology and Immunology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Osun State, in a paper published by the International Network for Cancer Treatment and Research, identified high cost of hospital care as the major factor against cancer treatment.
His words: “The major limiting factors to successful treatment of cancer in Nigeria are the high cost of hospital care and the inability of a majority of the patients to obtain chemotherapy, poor supportive facilities and a high default rate. The unhealthy state of cancer therapy in this country is best illustrated with reference to our experience with the management of 213 patients with Burkitt’s lymphoma over a period of 13 years. Over 75 per cent of patients presented in advanced stages C or D; 132 (62 per cent) of the patients received less than the recommended number of cycles of chemotherapy before voluntary discharge from the hospital and, 41 (31 per cent) of these did not complete a single chemotherapy cycle.
“The default rate was unacceptably high, with 166 patients (77.9 per cent) failing to return for outpatient visits after a median follow-up period of 2.3 months (range = 0,67 months). A five year survival rate of only 1.9 per cent was obtained, compared to almost 50 per cent reported in E. Africa, using a similar combination therapy – cyclophosphamide, oncovin and methotrexate (COM). Our experience with Burkitt’s lymphoma is similar to that of most other cancers, in that a large majority of patients present very late and are unable to purchase anti-cancer drugs.”
Tales from survivors
Asurvivor told The Nation that she lost her hair, was generally weak, felt nauseated and lost appetite as a result of chemotherapy. Another said she was almost unconscious and had to take the last two doses with blood transfusion. Then another one claimed: “My skin darkened, my face was puffed up and swollen and my eye lashes disappeared.”
But they all agreed that it is better to experience withered hair and all and stay alive than run away and die a harrowing death. After treatment, they all got their hair back, and puffed up face and disappeared eye lashes returned to normal and they live normal lives.
There is also the problem of denial. When cancer is first diagnosed, not a few first engage in self-denial, looking for reasons why it could not be. Rahama Sani, a cancer survivor and social worker, said she faced this challenge and even latched on to a typographical error in her name to back her position that it could not be her.
Sani identified access to diagnostic facilities as a major barrier to cancer detection and treatment, a development which, she believes, is capable of promoting wrong diagnosis. Sani said the first three investigations she did failed to show she had cancer. “I did three investigations. I did mammogram; there was nothing. Three investigations; there was nothing, until when the pathologist said they should remove it and he examined it and he confirmed there was cancer. When I got the result, I was like this was not my own because there was a typographical error in my name. But when I went to see the pathologist, he confirmed it was mine. I said we should have a second opinion. This was done by a renowned pathologist in ABU Teaching Hospital, Dr. Rafindadi. I went to see him in Zaria and they did the test again and he confirmed the same result. I was so confused. But he counselled me,” said Sani.
Access to resources for global cancer control and care
All these barriers are compounded by the fact that Nigeria is a developing country with less than 10 percent of the resources for global cancer control and care. In the World Health Organisation (WHO) Technical Report No. 804 of 1990, it was reported that over 50 per cent of cancer victims live in poor nations like Nigeria, where a projection done some years back feared that this year, the figure of new cases could become as high as 500,000 as against the 100,000 cases annually previously. Of this figure, the Nigerian Cancer Society (NCS) says about 32,000 die annually. In 2005, cancer killed 89,000 people in Nigeria with 54,000 of this figure below the age of 70. It is feared further that by 2020, cancer incidence for Nigerian males and females may rise to 90.7/100,000 and 100.9/100,000 respectively. It is also anticipated that by 2020, death rates from cancer in Nigerian men and women may reach 72.7/100,000 and 76/100,000.
Yet, a WHO statement said: “of the 10 million cancer cases occurring annually, 1/3 can be prevented, another 1/3 can be effectively treated with early diagnosis, and palliative care can improve the quality of life of the last third.”
But with a pharmaceutical industry that is at best crawling, it has to depend on the developed world for drugs for cancer treatment. WHO findings show that the third world countries consume only five percent of cytotoxic drugs, while the rest is sold in the richer nations which account for only 39 percent of cancer cases.
Also disturbing is the fact that Nigeria, with a population of over 140 million people, has less than 100 practicing oncologists. The country also has no medical facility which specialises exclusively in cancer treatment.
Another barrier centres around the fear of chemotherapy. This has made some resort to alternative medicine products. But what really is chemotherapy? It is the treatment of cancer with drugs that can destroy cancer cells. In current usage, the term “chemotherapy” usually refers to cytotoxic drugs which affect rapidly dividing cells in general, in contrast with targeted therapy. Chemotherapy drugs interfere with cell division in various possible ways, such as the duplication of DNA or the separation of newly formed chromosomes. Most forms of chemotherapy target all rapidly dividing cells and are not specific to cancer cells. Experts say it has the potential to harm healthy tissue, especially those tissues that have a high replacement rate (such as hair, bone marrow and intestinal lining). These cells usually repair themselves after the therapy.
For now, in the face of these barriers, beating cancer may appear advisable. Experts say cancer – and by extension the attendant psychological, financial and emotional losses- can be beaten through early detection, avoidance of lifestyles that promote cancer such as smoking, exposure to industrial chemicals, consumption of excess fat and heavy use of alcohol, healthy sexual behaviours, and pursuing a lifestyle or diet that modifies cancer-causing factors.
A renowned gynaecologist and Medical Director, Medical ART Centre, Lagos, Prof. Oladapo Ashiru, said: “As soon as you attain the age of 40, you should go for a comprehensive medical examination. As from 50 and above, women should be undergoing procedures like a mammogram, ultrasound scan and blood evaluation.”
Associate professor and Consultant Obstetrician Gynecologist at the Oncology Pathological Studies Unit, College of Medicine (CMUL), Lagos University Teaching Hospital (LUTH), Dr. Rose Anorlu, also advised: “Don’t wait until they have symptoms before going for routine checks yearly for breast cancer, cervical cancer including pap smear and ultrasound scan. Post- menopausal women in particular should go for routine self-breast examination, a mammogram test and a pelvic ultrasound scan to check the ovaries.”
A consultant pathologist, head, Department of Histopathology, National Hospital, Abuja, Dr. Paul Jubrin, said there is also the need to evenly distribute cancer diagnosis and treatment facilities. Jubrin said: “The facilities for the treatment of cancer in Nigeria are actually up-to-date. But the problem is that it is not well-distributed. Cancer radiotherapy, one of the latest treatments of cancer, is only in Lagos, Abuja, Ibadan and Zaria. At least, you expect up to two of them in each geo-political zones of the country. If you come to the National Hospital, Abuja, the state-of-the-art equipment are there. We recently introduced nuclear medicine, which you can use to detect cancer in your body and apart from that we have an oncology unit. It is just distribution. National Hospital has started training for oncologists. The screening method for cervical cancer called pap smear is between N2, 000 and N3, 000. It is now available everywhere. Now, we have what we call visual inspection with iodine. You don’t even need a specialist for this.”
An environmentalist, Mr. Akinbode Oluwafemi, said effective tobacco control through the passage and implementation of the National Tobacco Control Bill would go a long way in helping to curb cancer. Akinbode explained that many types of cancer have been linked to cigarette, which contains over 4,000 toxic and carcinogenic agents. The bill, which President Goodluck Jonathan refused to sign into law after it was passed by the National Assembly, seeks to domesticate the WHO Framework Convention on Tobacco Control (FCTC), a global treaty that has the potential of checkmating the evil of tobacco use, among which is cancer. Smoking related cancer, he said, accounts for not less than 30 percent of cancer related deaths.
The bill has been represented at the National Assembly by a member of the House of Representatives, Dayo Bish-Alebiosu.
Sani said diagnosis must be done properly. She said: “I hope our government will put in place proper diagnostic facilities so that people won’t be wrongly diagnosed and they can take informed action. We need to improve the diagnostic system. I am sure a lot of people have been wrongly diagnosed.”
Betty Anyanwu-Akeredolu, a breast cancer survivor and president, Breast Cancer Association of Nigeria (BRECAN), believes early detection and treatment can help save victims and their loved ones from the pangs of cancer.