ADEOLA OTEMADE reports the rising cases of cancer in the country, including the experiences and challenges of patients as the world celebrates Cancer World Awareness Day today.
According to Cancer Atlas, a publication that intended to provide basic information on the global burden of cancer in a user-friendly and accessible form for cancer control advocates, 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, breast, colorectal, lung, cervical and thyroid cancer are the most common. According to Cancer Atlas, 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), Nigeria inclusive.
On a daily basis, new cases present at the hospital. After examination some patients are lucky to discover that the disease is still at the early stages. Sometimes, it might be almost too late, leading to a long-Doctorawn battle for survival.
Ifeoluwa Bayero (not real name) was nine months old when her mother died. Ife, as she is fondly called didn’t have the luxury of a mother’s love as the latter battled with cancer of the breast which later claimed her life. Since then, things have not been the same again.
Initially, it was just a lump in the woman’s breast when she was pregnant. He husband took her for several tests. She was eventually diagnosed with breast cancer but she could not be operated on then because she was pregnant.
By the time she stopped breastfeeding and was ready for surgery, the cancer had festered. The family had to source for money by borrowing from different sources to pay for the procedure. Aside the physical pain the woman went through, the family was also traumatised after she died despite all the efforts made to ensure she survived.
For Mrs Bello (first name withheld), a widow, whose husband had died 18 months before her ordeal began, ignorance was her undoing because she had always believed cancer is hereditary. When she first noticed a lump in of her her breasts just over three years ago she ignored it, but within a short time the situation got worse to the point that she is now confined to a wheelchair.
“My cancer problem started in June 2018. After some time, I called my husband and showed it to him, and he referred me to his sister, who is a registered nurse.
“The lady gave me some native grease and said that once I applied it, the lump would Doctory up. She tried to reassure me that all was well, saying that sometimes, a lump may appear on woman’s breast, especially after monthly menstruation. So, I was calm. But after some time, some health practitioners came to our church on a health sensitisation visit. I showed the lump to them, and they said I should visit the hospital,” she recalled.
After visiting a hospital, the doctor recommended immediate surgery and for the removed lump to be taken to a laboratory for medical examination to determine if it was cancerous. But instead of following the doctor’s instructions, the couple threw away the lump. Four months after the operation, the spot where the lump was removed began to swell.
“I wish we had heeded the man’s advice that day, but we didn’t and four months after, the spot where the lump was removed became swollen. When the problem came back, I showed it again to my husband and he said we would go back to the private hospital to remove it again. But I didn’t agree. I told our pastor and he advised me to go to the Ikeja General Hospital to get a referral letter to take to the Lagos University Teaching Hospital, Idi-Araba,” she recounted.
According to Mrs. Bello, at LUTH, it was confirmed that the sore on her left breast was stage-two cancer. This was May 2019. From the ward where she underwent tests including biopsy, she was referred to the oncology department for chemotherapy. She took only two cycles of neo-adjuvant chemotherapy before her husband, who had been footing the medical bills, died on Thursday, November 7, 2019.
Her grief notwithstanding, Mrs Bello managed to complete the remaining cycles of chemotherapy in the last week of January 2020 and thereafter went for mastectomy. The operation was scheduled for February, but Mrs. Bello said she was not able to undergo the surgery until six months later due to COVID-19 restrictions. By then, the cancerous cells had spread to other parts of her body, including her bones which later confined her to the wheelchair.
“After I submitted my letter for surgery, the doctors asked me to go home and watch the condition of the sore on my breast and that if there were complications, I shouldn’t wait before coming back to the hospital for surgery.
“For the entire period of April 2020 till June, I could not access the hospital and could not be treated, so the sore got worse. I went through hell during that period. In July when I was able to access the hospital again, the doctor told me that if I had been treated earlier, the situation could have been contained. It was a difficult time for me,” she narrated.
Not all cancer patients suffer from breast cancer. Others suffer from ovarian cancer. Sixty-five year-old Madam Fatimo Yusuf, who is also known as Mama Ibadan within her extended family, is one of them.
Her daughter who spoke with Sunday Tribune on the condition of anonymity said: “She told me that she was experiencing some pains in the lower part of her stomach. She said I should call my siblings so that we could come and take her to the hospital because she could not understand her state of health.
“We ended up taking her to a private hospital in Ibadan. When we got to the hospital, they gave her first aid. They told us that she would have to undergo some tests, which won’t be immediate, because she was weak. But two days later, they directed us to a laboratory to conduct some tests. After the tests, we took the result back to the private hospital, where a doctor told us that Mama had ovarian cancer based on what he read in the test result.
“I could not imagine my mother having cancer as no one in our family ever had it. But while I was agonising over the news, the doctor came and immediately told us to take Mama straight to the UCH. But we could not get into the hospital until 12 days later, due to the COVID-19 restrictions at that time, though the state only had a dusk-to-dawn curfew. When we finally got to the UCH, the registration process was demanding.
“We kept moving from one department to the other, because we didn’t know the exact section we were supposed to go to as the doctor that referred us at the private hospital didn’t mention any particular department. He only told us to take mama to UCH. When we went back to the doctor to explain how hard it was to access the treatment centre at UCH, he only told us to continue using the Doctorugs we purchased at his hospital until we were able to access the UCH centre,” she narrated.
According to Madam Yusuf’s daughter, it took two weeks of visits to the UCH before they were attended to. The diagnosis was confirmed, but by then the woman’s condition had visibly deteriorated. It was later learnt that her spinal cord had been affected as she could no longer sit up voluntarily.
Between July when the sickness began, and December, the family had been financially Doctorained and emotionally exhausted as they ran from pillar to post to cover the cost of medical tests and treatment. The doctor later confirmed that the cancer had spread from her ovaries to other parts of her body.
Sunday Tribune spoke to medical experts on different types of cancer, their prevalence and how they could be managed. According to Doctor Idowu colorectal carcinoma is a strain of virus that affects the colon, and there had been a surge in recent times.
According to him, “Colorectal cancer is also known as colon cancer, a cancer that affects the colon. According to American Cancer Society, approximately 4.3 per cent of men and 4 per centof women will be diagnosed with colorectal cancer in the United States, with five-year relative survival rate.
Doctor Omolaraeni Owootomo said there had been an upsurge in the number of patients with liver cancer, although the most common forms of cancer in the country are breast, cervical, prostate and colorectal carcinoma cancer.
“The most common cancers in Nigeria are breast and cervical for females, while men suffer most from prostate and colorectal carcinoma cancer. However, while working at the Emergency Department of the University College Hospital, Ibadan, I noticed an upsurge in patients with liver cancer. I didn’t write a paper on it though, but since the hospital has a Cancer Registry, I hope something comes out soon. Others are cancers of the stomach, lung and thyroid.
“Aside the fact that getting current statistics in Nigeria is a herculean task, we can’t have the 2021 statistics until after the year, so say 2022 or even beyond. However, in March 2021, The Global Cancer Observatory reported 78,899 mortalities in 2020, she revealed.
Challenges of Cancer treatment
Cancer patients often experience long-Doctorawn battles with the disease. One of them is that the health situation may relapse after initial improvement following therapy. Mama Ibadan’s experience is a typical example. After her cycles of chemotherapy, she felt better in January 2021 as she started walking again. But during the last 10 days in February, her condition worsened as the weight loss, stomach pains and loss of strength in her legs returned.
“Her condition took us back to UCH in March 2021. She underwent a blood transfusion, after which she was placed on another round of treatment. We have been on it since March. It is really baffling because it is like the disease is coming on and off and we have been spending lots of money again,” Mama Ibadan’s daughter said.
Speaking on the challenges cancer patients face, Doctor Atobatele Rahmat explained that access to health care services is the major challenge.
“Inadequate access to healthcare services is a problem in Nigeria, most tertiary health institutions are in the urban areas. People living in rural or semi-rural areas have to travel to seek care. This discourages most patients and that’s why they usually present their cases very late when little or nothing could be done.
“Finance also poses a challenge. Cancer treatment usually takes months and years and this can dig a big hole in patients’ pockets. Cancer treatment is not covered by health insurance so patients have to make out-of-pocket payments. The Doctorugs are not readily available and very expensive. Also, hospital accommodation for the duration of chemotherapy, cost of laboratory or radiological investigations, feeding and support for the patient and the attending relative can’t be measured. It is a daunting task and families are usually Doctorained financially by the time the patient completes the treatment,” he said.
Doctor Atobatele further explained that in most cases, the hospitals lack the capabilities of providing health care for patients as most of them do not have required equipment for the diagnosis.
According to her “Inadequate infrastructure- equipment needed for diagnosis, staging and treatment of cancers are not available in most public hospitals. Most of these equipment, where available, have broken down or need upgrades. Up-to-date equipment are necessary to know what kind of cancer the patient has, the severity and the Doctorugs or therapy needed to achieve a cure.
“Another problem is an overwhelmed health care services by patients. Available date show that in 2019, the ratio of doctors in Nigeria was 3.8 doctors to 10,000 people. This makes it almost impossible for patients to be seen by doctors all at once. Long appointments are given which could be disastrous to the patient. A stage 1 cancer can become a stage 4 by the time the patient is seeing a specialist.
“In addition, there are no specialized cancer centres in Nigeria. A cancer patient on chemotherapy should be treated in a special ward where the possibility of getting an infection is near zero. This is because a patient on chemotherapy has very low immunity and the chances of getting rare and difficult infections are high. Sometimes, patients die of infections and not the cancer itself.”
Doctor Emmanuel Idowu of the College of Medicine, University of Ibadan, while speaking with Sunday Tribune corroborated the problem of financial challenges, among others often faced by cancer patients.
“The problems faced by cancer patients are principally finance, ignorance or inadequate knowledge, suboptimal health system support from the governments and psychological issues, including care-givers, just to mention a few. So many people die at the end as a result of poor medical attention, poor health and support system from the government.
There is a differential cost implication from different cancer treatment centres (secondary and tertiary) depending on the chemotherapy agents making up the regimen, the number of courses and a gamut of other chemotherapy-related factors. The average cost range is in tens of thousands and millions especially in private centres for full course treatment. Hence, there is the need for top-notch external aid from governmental and non-governmental organizations,” he said.
For Doctor Omolaraeni Owootomo, a medical doctor at the University College Hospital (UCH), Ibadan, poverty and ignorance are the major factors contributing to the increase in cancer mortality over the years as many patients fails to show up at the hospital for medical attention until the disease gets to the last stage before showing up.
“Poverty is a menace. It is responsible for deaths arising from cancers, while ignorance is another factor. A combination of the two will make patients not present to the hospital until it is worse, and at that point, you can only offer palliatives (end of life care).
“Another challenge is money; this virus attacks everyone and there are no exceptions. To take care of a cancer patient Doctorains lots of money with little chances of survival or no survival at all. To be honest, I have no idea how much but I know it’s quite expensive. It also depends on the type and stage of the cancer. Nonetheless, I won’t be wrong if I say that patients will spend about N100000 ($250) on Doctorugs only every week,” she stated.
Place of early detection
According to Doctor Olaitan Oyedun, a consultant in Public Health and Community Medicine at the Academy for Health Development (AHEAD), early detection of the disease increases the chance of survival, and may reduce the cost of treatment.
“Early detection is critical because effective cancer treatment if commenced early, increases the likelihood of survival and may even reduce the cost of treatment. The method for early detection is screening for abnormalities that may suggest pre-cancer or early signs and symptoms of cancer, so they can immediately be referred for diagnosis and treatment.
“Effective screening for cancers includes self-breast examination for breast cancers, pap smear for cervical cancers and Prostate Specific Antigen (PSA) levels for prostate cancer.
Cancer treatment is evolving and advancing and is usually done by multidisciplinary experts called oncologists and involves a combination of surgical removal, use of cancer Doctorugs (chemotherapy) and use of carefully calibrated ionizing radiation (radiotherapy) that targets the cancerous cells,” he said.
Doctor Eyitayo Adunmo, a consultant family physician, also noted the importance of early detection, as the ignorance of many often make them ignore pains in their body, seeing it as normal stress.
“Early detection of cancer can reverse or delay the course of progression of cancer because of screening and also taking some preventive measures. Screening for some cancers such as colorectal, breast and prostate cancers give rise to early detection on such. Prevention especially at both primary and secondary levels can reduce or eliminate the risk of cancer,” she added.
Government intervention
Doctor Idowu opined that government intervention will go a long way in adDoctoressing issues relating to the disease, especially by creating awareness and treatment. According to him, one way this can be achieved is by establishing routine cancer screening centres which people can have access to.
“Routine cancer screening centres at highly subsidised rate and provision of chemotherapy sessions at little or low cost will reduce mortality and morbidity outcomes of patients living with cancer. Palliative services in line with multi-disciplinary care will go a long way and should be sponsored and encouraged by state and federal governments,” he said.
Doctor Atobatele corroborates this asking government to build well-equipped cancers centres and also employ more expert doctors.
“Government can help by building cancer centres and stocking it with equipment and manpower needed for it to function efficiently. We can have cancer centres in each geopolitical zone. Cancer knows no religion or tribe; it knows no class or level of education. It can happen to anyone and care should be made available to everyone equally.
“Another way the government can help is to provide funds for cancer patients. Taxes from tobacco or sugary Doctorinks or other things can actually be directed towards this.
“Access to health care can be improved by providing more healthcare facilities in rural areas where patients can get diagnosed or continue treatment in their communities. This will reduce cost of going for treatment in cities all the time. It will also reduce the risk of travelling,” he said.
Healthy living
Though cancer is deadly, many people have survived it. According to Doctor Eyitayo, cancer is not a death sentence. She narrated the story of the mother of one of her friends.
“She was diagnosed with breast cancer at a late stage. The surgeons didn’t see any need for it to be operated at that stage. Her daughter, who is my friend, decided to get her some nutritional supplements to boost her immunity along with some lifestyle changes. This helped to improve the quality of her lifestyle and delayed progression of the cancer cells.
“After some months, it healed and it was easy for the surgeons to operate on it. She also had chemotherapy and she lived for five good years afterwards. She actually died as a result of the news of the demise of her son. I shared this because even at the late stages, all levels of prevention (primary, secondary and tertiary) are still very important and crucial.
“People usually believe it is a death sentence, but it has been seen that the rate of progression/ death varies. It depends on when it was detected and the treatment received. Even in cases where it was detected late, some lifestyle changes, nutritional supplements along with medical treatment can increase their chances of survival,” he said.
Doctor Atobatele also supported healthy lifestyles, maintaining that healthy living would help curb the increase in cancer cases.
“Individuals can help by providing support to families that are affected. Food, shelter and care are the most important. The society has a big role to play. Non-governmental organisations, church groups, Muslim societies, communities usually know those that are well to do among them. They can connect the needy to philanthropists thus helping financially or in kind.
“For example, Africa Cancer Foundation, a non-governmental organisation in Kenya, helps cancer patients by getting philanthropists to donate cone farms and provide seedlings for them to grow vegetables. Their relatives participate by growing these vegetables, selling out of it to buy essentials like food and Doctorugs. They also eat the fresh vegetables to provide adequate nutrition thereby increasing their chances of survival.
“To avoid lung cancer, stop smoking cigarettes and shisha. To avoid skin cancer, use creams that have an SPF (Sun Protection Factor). Eating fruits and vegetables has been associated with good health. Sedentary lifestyle is associated with obesity which is linked to several cancers. So exercising reduces this risk,” she admonished.
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