Dr Foluke Sarimiye, a Radiation/Clinical Oncologist and Psycho-oncologist expert at the University College Hospital (UCH), Ibadan, in this interview with SADE OGUNTOLA, speaks on why cancer treatment must be wholesome, including psychosocial support at its different phases.
H OW common is cancer in Nigeria and what are common challenges patients with cancer face daily?
Cancer is common in Nigeria, although we have challenges and limitations on adequate and proper record-keeping on cancer data and information. However, in Nigeria, an estimated 72,000 cancer deaths occur annually and more than 2,000 new cancer cases are diagnosed.
What is psychosocial support and can this help cancer patients cope better with their everyday challenges?
Psychosocial cancer care is whole-person approach to cancer care. It addresses the psychological, emotional, social, spiritual and functional aspects of the patient’s journey right from screening to detection, diagnosis, treatment, follow up after treatment, rehabilitation, survivorship as well as end of life care. It also includes getting the patient family support or established into a family support group.
The psychosocial care entails a multidisciplinary approach with different specialists coming together to give holistic care to the patient. Providing psychosocial care for cancer patients is an emerging field in Nigeria, though it has been in the global cancer space for a while now. For example, I belong to the group of the first Psycho-oncologists in Nigeria. Some tertiary health institutions like University College Hospital (UCH) Ibadan that has department of Radiation Oncology provides psycho-oncology care for its patients.
Which group of individuals can benefit from psychosocial support. Is it only meant for individuals with cancer?
Being healthy is not just the absence of disease. We are spirit beings with minds living in bodies. Hence, the spiritual, emotional, psychological and social aspects of our lives are important which psychosocial care helps to address.
Chronic diseases, such as cancer, take a toll not just on the patient, but also affects the family caregivers and healthcare professionals like the oncologists taking care of these patients. They sometimes suffer burn out. Having a well-structured and functional psychosocial care system in the cancer space is really needed. This will offer holistic cancer care.
There are general psychosocial issues that cancer patients face: they deal with anxiety, depression, the fear of death, fear of reoccurrence, stigmatization, challenges with rehabilitation, some late side effects of treatment like sexual dysfunction that might affect family life as well economic and financial constraints. So, psychosocial support addresses all these aspects by utilizing several disciplines such as social workers, psycho-oncologists, clergies and imams, and so on.
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What has been your experience working on the field of providing psychosocial support in cancer care?
Providing psychosocial care for cancer patients have been challenging and yet rewarding and fulfilling. Challenging, in situations where patients access to health care is impeded by lack of finance because majority of our patients still pay out of pocket. Rewarding and fulfilling, in situations when your patients come out as cancer survivors. It is what I love and I am passionate about. I am a Radiation and Clinical Oncologist as well as a Psycho-Oncologist which helps me in providing holistic cancer care to my patients.
Are there technological innovations, apps or skills that individuals with cancer can adapt to cope with the stress, depression and fatigue of coping with cancer?
A lot of health apps have come up to help patients cope better with whatever form of illness they might have. There are few cancer apps that patients can download to ask questions, talk to a clinician or any discipline that is concerned with cancer care and they can get basic help.
January is designated cervical cancer month. What will your advice to women be?
Cervical cancer is cancer occurring in the cervix, the lower part of the womb. So, that means this cancer can only occur in women. It does not occur in men like colon cancer that occurs in male and female.
Now, why is the knowledge about cervical cancer so important? It is important because it is preventable cancer through HPV vaccination and scheduled screening that is available from the ages of nine to 65 years. Cervical cancer takes about 10 to 15 years to occur in a female. Hence, there is a window of opportunity to get screened and in some cases treated for precancerous lesions within this time and avoid coming down with cervical cancer.
About 90 to 95 percent of cervical cancer is caused by human papillomavirus (HPV) infections. Some of the infections might go away, but some may persist over a period of time causing dysplastic changes in the cervix and if it is not treated at a precancerous stage, it will eventually lead to cervical cancer.
Cervical cancer screening does not identify cancer. The screening helps to identify precancerous lesions, which are abnormal changes in the cervix. These precancerous lesions can be treated with cryotherapy or thermal aberration to prevent cervical cancer developing. So, screening is so important for cervical cancer eradication. The incidence of cervical cancer has drastically reduced in other parts of the world, but we still have many cases in Africa because there’s a low uptake of screening by our women due to lack of knowledge and awareness of cervical cancer.
We have women in rural communities that have never heard about cervical cancer and so they don’t understand. Even when they see its signs and symptoms, they don’t know what to do.
So, it’s important that we keep up on education and awareness creation on cervical cancer. We all should use our sphere of influence to educate people. Most of the time when a patient comes in for consultation, with their permission, I always ask to see their accompanying relations and family caregivers. I use that opportunity to educate them about modifiable risk factors, basic screening and tests available for cancer prevention.
Early cancer detection, which is through screening saves lives and prevention is not just better, it is also cheaper than cure or treatment. Nigerians should have a mindset of having a routine medical check-up, especially from the age of 40 years.
Particularly for cervical cancer, a 25 years old lady, sexually exposed needs to start regular screening. There are three options. The first option is a pap smear that involves screening once in three years until she is 65 years. The second option is HPV DNA testing once in five years until 65 years. The third option is called co-testing which is also once in five years and if in the last 10 years of screening, the results of the test have been negative and no abnormal cervical findings, then the lady can stop screening.
HPV vaccination is available for adolescents and young adults between ages nine and 25. The vaccines are available in tertiary hospitals like UCH, Ibadan.
Early detection saves lives, please go for scheduled screening. The common cancers among females in Nigeria are breast and cervical cancers and among males is prostate cancer. There is screening available for these common cancers. We all need to imbibe the culture of routine medical check-up, especially as we get to the age of 40.
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