Prior to the outbreak of the coronavirus in Nigeria in 2020, cancerous infections had killed thousands of Nigerians and consigned many others to the sick bed. IMOLEAYO OYEDEYI, after visiting four of the largest cancer treatment centres across the country, reports how the pandemic’s containment efforts increased the fatality rate of cancer and disrupted the treatments of its survivors.
FIFTY-eight-year-old Adewale Oyediran (not real name), a civil servant, knew all was not well with his body when he saw blood in his urine sometime in March 2020. The worst he imagined was gonorrhoea, given the pain he felt while urinating, and his first thought was to seek herbal medication. However, his pain persisted.
Then came COVID-19
By the time he realised he needed to go to the hospital, the COVID-19 pandemic was in full swing. As with the rest of the world, the Federal Government of Nigeria had introduced restrictions, including temporary lockdowns in parts of the country. Public hospitals were also limiting operations to make COVID-19 a priority. Oyediran chose to go to the University College Hospital (UCH).
“I couldn’t access the UCH at that time, because of the lockdown which also coincided with a strike by the college staff. But as I was about to leave the hospital entrance, I saw one of my friends who works there. I explained my condition to him and he immediately put a call through to one of the doctors, who asked him to tell me to proceed to a private hospital. This was because the hospital was not attending to patients because of COVID-19 restrictions and also the strike. So, I proceeded to the recommended specialist clinic,” Oyediran recounted.
Test results delayed for six months
According to Oyediran, when he got to the private clinic, the man he met referred him to another hospital after carrying out a test on him.
He said: “The man told me he couldn’t handle my case, because he didn’t have the necessary equipment. He then redirected me to the Catholic hospital in the Oluyoro area of Ibadan. But to my surprise, after doing a test, the nurses at the Catholic hospital told me that they did not discover anything serious, but that if I came back in two weeks, I would be able to see one of their consultants.”
But as the pain in his stomach increased, Oyediran said he called his friend at the UCH to help him appeal to one of the doctors at the hospital for him to be examined. When he was allowed in for medical tests, he waited nearly six months before he received his test result — he had cancer of the bladder.
‘I couldn’t access any hospital’
Olanipekun Ayomide, who resides in Abeokuta, Ogun State, said she first detected a lump in her breast in February 2020.
Narrating her experience to Nigerian Tribune at the waiting wing of the oncology department of the Federal Medical Centre (FMC), Abeokuta, she said:“When I first saw it, I thought something had hit me there. So, I applied menthol on it. Afterwards, I showed it to one of my neighbours who is a pharmacist, so that she could prescribe a drug for me. But when she saw it, she said she couldn’t prescribe any drug for me, but I should go for a medical check-up first. So, I called my family doctor and explained to him. Then he asked me to come home for an examination.
“By that time, we had entered the middle of April and the federal government had announced restriction of movement. In fact, it was exactly when the lockdown started. And because of this, I couldn’t travel home (to Akure where her family is). And I couldn’t access any hospital in Abeokuta because some of them didn’t open at all, while those that opened only attended to COVID-19 patients.
“All through the COVID-19 lockdown period until August, I was just at home. And this affected my condition because the lump grew during the periods.”
Ayomide explained that she called her family doctor in Akure, requesting a drug prescription to manage the growth in her breast. But the doctor told her he could not prescribe any drug because he had not examined her.
As soon as the lockdown restriction eased, and she was able to travel, Ayomide said she went back home to Akure, where her family doctor, on examination, recommended her for surgery. Histological examination of the lump confirmed that she had been living with breast cancer for over six months. She was immediately referred to the FMC, Abeokuta, where she began her chemotherapy in November 2020. It was at the Centre where she spoke to this reporter in June 2021.
Cancer, one of the deadliest diseases in the world, is caused by unusual growth of body cells. According to Cancer Atlas, cancer is the second leading cause of premature deaths in 134 of 183 countries in the world. In 2018, there were an estimated 18.1 million new cases and 9.6 million deaths from cancer, with lung, prostate, colorectal, stomach and liver cancer being the most common of its types among men. Among women, it is breast, colorectal, lung, cervical and thyroid cancer that are most common. Cancer Atlas says the predicted global burden for cancer will double to over 30 million new cases by 2040. The greatest increases are expected to occur in Low and Medium Income Countries (LMICs).
WHO says no fewer than 14,274 other women in Nigeria died from breast cancer or breast cancer complications in 2020, nearly all of them during the COVID-19 lockdown. WHO also points out that the breast cancer incidence rate of 28,380 was the highest out of the 35 types of cancer that plagued the country in 2020. Globally, breast cancer is also the most common type of cancer in women, comprising 25 per cent of all cancers.
According to Healthline, bladder cancer occurs in the tissues of the bladder, the organ in the body that holds urine. It occurs when abnormal cells grow and multiply quickly and uncontrollably and invade other tissues. According to WHO, no fewer than 1,241 Nigerians had the disease in 2020, but only 557 survived.
Generally, people living with bladder cancer witness symptoms, among which are fatigue, weight loss, bone tenderness, blood in the urine, painful urination, frequent urination, urgent urination, urinary incontinence, pain in the abdominal area and pain in the lower back.
More cancer deaths during COVID-19 pandemic
In February 2020, Osagie Ehanire, minister of health, said an estimated 72,000 people died of cancer yearly in Nigeria. However, according to the Global Cancer Observatory (GCO) statistics on cancer in 2020, out of 124,815 cancer patients, 78,899 deaths were recorded.
A medical consultant, Dr. Tunji Olawale, who spoke on the development, noted that while the margin between the cancer records of the past two years shows how injurious the prevalence of the coronavirus was to the survival of cancer patients in 2020, it is also indicative of the pitiable state of cancer management in the country.
Weak health system, outdated machines
Before the outbreak of the coronavirus, Nigeria, like other LMICs in Africa, was already bedevilled by weak healthcare delivery systems. This has made the epic growth in cancer disease in recent years even more difficult to manage. Experts suggest that the nation’s top hospitals that are designated cancer treatment centres are lacking in both equipment and manpower in the form of oncologists to provide reliable treatment/care. Cancer care management starts with prevention, and includes screening and diagnosis, treatment, patient follow-up, and of course palliative care. Logistics of access to any of these and supply of cancer drugs and other essential commodities for the patients are crucial human aspects of the care management.
For a health system that was already overwhelmed in every area before COVID-19, the provisional arrangements put in place within public hospitals to manage the virus suggested that attention shifted significantly from patients in need of critical lifesaving care.
In an article entitled “Oncology practice in the COVID-19 pandemic: A report of a Nigerian expert panel discussion”, published in the Pan African Medical Journal in July 2020, eight Nigerian oncologists (five from the South-West, one from the North, one from the South-East and one from the South-South) explained some of the predicaments that their respective patients faced during the lockdown.
One of the oncologists, Adedayo Joseph, from the Nigerian Sovereign Investment Authority/Lagos University Teaching Hospital (NSIA/LUTH), Idi-Araba, Lagos, disclosed that about 50 per cent of patients receiving care at the facility before COVID-19 were unable to continue their treatment at the centre in 2020 due to the lockdown. The patients were mostly from Lagos and Oyo states.
His colleague, Olusegun Biyi-Olutunde, from the University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, said the fear of contracting the coronavirus from health workers also scared some cancer patients away from going for their treatments as they believed that hospitals were high points of COVID transmission.
Babatunde Olutoye from the Radiation Oncology Department of UCH added that the UCH stopped taking new patients until the lockdown was lifted.
Joseph further said despite the centre’s outpatient facilities at NSIA/LUTH not operating in full lockdown mode, only patients that were critically ill were given attention — including chemotherapy for those in need. While rooms were set aside to attend to potentially curative patients and those seen as emergencies, elective surgeries were cancelled.
According to Nwamaka Lasebika of the department of Radiation Medicine at the University of Nigeria Teaching Hospital, Enugu, patients who had been initially booked for surgery before the lockdown were asked to leave following the COVID-19 outbreak.
Runcie Chidebe, Executive Director of an Abuja-based Non-Governmental Organisation (NGO) cancer advocacy, Project PinkBlue, corroborated the position of the oncologists on the general rationing of care to cancer patients.
Chidebe said: “The first Nigerian to die of COVID-19 was a cancer patient. Cancer patients just like other people living with underlying conditions have greater chances of getting COVID-19 and dying of the virus. This pandemic affected cancer screening, diagnosis, treatment and survivorship in many ways.
“Firstly, many cancer NGOs could no longer host cancer awareness and screening events across Nigeria. Secondly, due to the fear of the virus, many people could not go for diagnosis or even see doctors when they had symptoms of cancer last year. Thirdly, we had patients who had stage I cancer by 2019 and by 2020 their cancer progressed to stage II, because their treatments were delayed due to this pandemic.
“In my personal opinion, COVID-19 pandemic repressed the cancer control progress that we achieved over the past 10 years in Nigeria. It would require enviable leadership to get Nigeria back on track in cancer control.”
National Cancer Control Plan ‘grounded’
There is a federal government National Cancer Control Plan, which was set to run between 2018 and 2022. But according to Runcie Chidebe of the PinkBlue project, the plan had been hindered by what he calls lack of coordination between the federal ministry of health and the ministry of finance.
“To the best of my knowledge, the federal government always brings up fantastic and ambitious plans; the challenge has always been budgeting for the implementation of the plan. In some cases, when it is budgeted by the federal ministry of health, the funds are not released by the federal ministry of finance. We need to think collaboratively and get the finance and health ministries to work more together in the control of cancer.
“Presently, cancer is affecting over 100,000 Nigerians every year, but this disease is controlled by a desk known as National Cancer Control Programme with a limited number of staff and structure. To make progress, the Secretary to the Government of the Federation (SGF) needs to gazette the bill for the establishment of National Institute on Cancer Research and Treatment signed by President Buhari in December 2017,” he said.
Chidebe added that “the institute can be held accountable for the implementation of the plan (NCCP), conduct research and also coordinate the funding for cancer control,” even as he noted that with the current financing of cancer control plan in Nigeria, he doubts whether the federal government could achieve the targets of the NCCP.
Speaking further on how late detection and poor referral system worsen the condition of cancer patients, the PinkBlue project boss said: “Late presentation is an issue in surviving cancer in Nigeria. However, having spent years working for cancer patients, the greater issues are as follows: early treatment and affordability of cancer treatment.
“Some patients present breast cancer early, but are expected to travel from Yenegoa to Abuja or Lagos to access radiotherapy, or diagnosed with cervical cancer in Sokoto and expected to travel to Gombe to receive brachytherapy. For instance, there is no single working radiotherapy machine in the whole South-South region. So, we need to also work to make sure that people can access treatment early while advocating for early presentation,” he added.
‘Govt needs to map out clear plans for cancer patients’
In its 2020 budget, the Federal Government allocated about N700 million to support indigent cancer patients in the country. Chidebe, however, points out that till date, “there is no clear channel on how indigent Nigerians diagnosed with cancer can access these funds.”
As affordability to cancer care is key to surviving cancer, Chidebe said the government needs to map out a clear programme of support for Nigerians living with cancer. What would Ayomide Olanipekun and Adewale Oyediran, the two cancer patients mentioned in this report, not give to have that second chance?
- This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its Free to share project.
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