How COVID-19 has affected cancer treatment in Nigeria

As Nigeria and the rest of the world grapple with the COVID-19 pandemic, health experts and advocates say the virus has led to less attention being paid to other ailments such as cancer.

While cancer patients are disproportionally impacted by the COVID-19 partly because they are significantly more likely to die from the disease once infected, the greater risk is the altering of treatment regimens and cutting of funds, health experts say.

Treating cancer is expensive and for many years even before COVID-19, cancer patients and their families in Nigeria were left to pay with their life savings or sell properties as government assistance was barely in existence.

Cancer patients often relied on foreign aid and raising funds through social media, a situation health experts blamed on the country’s fragmented health insurance system, which does not cover key cancer treatment regimen.

Already acutely underfunded, cancer treatment was further relegated once the pandemic broke.

Cancer trust fund

Hope rose for cancer patients at the 2019 National Health Dialogue when the health minister, Osagie Ehanire announced a plan to institute a cancer treatment fund to reduce the financial burden of treating the terminal disease.

Held in October 2019, the yearly dialogue was organised by PREMIUM TIMES, PTCIJ, dRPC-PACFaH@Scale, International Society for Media in Public Health (ISMPH), Project Pink Blue and the Nigerian Governors’ Forum (NGF).

The minister made the announcement following a touching story of the painful battle against cancer shared by Serah Shimenenge Yugh, a breast cancer survivor.

“There will be a creation of a fund, either a cancer treatment fund or whatever we decide to call it. It is important and can be driven by investment or donation,” the minister said.

“It can be driven by any method that takes you beyond the point where health insurance cannot cover anymore in your treatment.”

The minister said the new fund will help reduce the cost of treatment and diagnosis, noting that the funding plan will draw support from the private sector.

But more than a year after the pronouncement, cancer communities in Nigeria say they are yet to start benefitting from the fund.

Repeated calls and text messages to the health ministry’s spokesperson to understand why the fund has not fully taken off were not responded to.

Meanwhile health experts and cancer patients say the funding plan was stalled by the shift in priority to COVID-19 and lack of political will.

‘Inaccessible trust fund’

Gloria orji, the president of Abuja breast cancer support group, who is part of the committee overseeing the setting up of the fund, said while N700 million has been approved, the fund remains inaccessible more than a year, a situation she described as “unfortunate”.

“There was an approval of over N700 million but the unfortunate thing as we speak now is that cancer patients have not been able to access that fund.

“It is quite demoralising because just in our group, for the past one year, a lot of cancer patients have died. We have lost about seven members in our support group alone and we lose them majorly because there is no money,” she said.

“Some of them stopped their treatment because they needed to do radiotherapy but couldn’t do it. Some of them couldn’t even afford the drugs and yet the fund is lying there and nothing is being done.

“Though the committee was inaugurated, the fact that no cancer patients can access the fund yet means nothing has been done to me.

“When I receive appeals for assistance in our Whatsapp group, my mind goes to the trust fund. Only if the funds were accessible, these problems would have been solved,” said Ms Orji who is also the president of Network of persons impacted by cancer in Nigeria.

For Adamu Alhassan, a public health expert, the offtake of the fund with N700 million is significantly poor compared to the funding gap in cancer treatment in Nigeria.

He said the fund has not taken off due to lack of concrete planning by the government.

“You see the problem with us as a country is the fact that we say a lot of things and we don’t follow up. Sometimes, these statements are made without a very concrete plan of action already in place,” Mr Alhassan told PREMIUM TIMES on Monday.

“Look at the construction of the International Cancer Centre, you don’t hear much about it. What we are saying to the government is that whenever they want to make a statement, they should ensure that they have a clear road- map and clearly stated timelines. They should also ensure they have a period of execution and deliverables that can ensure proper scrutiny, monitoring and follow up.”

‘Inaccessible cancer machines’

A year before the ministers’ announcement, the Nigerian government in 2018 launched the country’s $250 million National Cancer Control Plan for 2018-2022 with the goal of reducing the cancer prevalence and mortality rates.

To improve treatment, the plan aims to increase the “number of comprehensive cancer care centers in the country that can offer radiotherapy as part of treatment for cancer patients.”

But experts said this investment is pointless if poor cancer patients cannot afford to pay for the use of the machines.

Radiotherapy is one of the key routines in the painful fight against cancer.

A cancer patient often needs the treatment at one point or the other. Experts say it is often better not to start it than break the sessions.

Access to radiotherapy treatment has been the bane of cancer patients in Nigeria.

The National Hospital in Abuja received a new radiotherapy machine in 2019. It was donated by the Nigerian National Petroleum Corporation (NNPC) and Shell Nigeria Exploration and Production Company (SNEPCo).

With the addition, Nigeria could now boast of eight government-owned radiotherapy machines located in different hospitals across the country.

But many of the old machines have broken down and those functional are not functioning at full capacity.

The Abuja addition has, however, helped in treating only a few patients who can afford the high cost of radiotherapy.

Costly

Radiotherapy treatment costs N600,000 at the national hospital, according to Chinedu Aruah, the head of the Department Radiation and Clinical Oncology at the facility.

“We know it is difficult for a lot of people to afford cancer treatments, that’s why we advocate for NGOs and other well-meaning individuals to support cancer patients. Lots of individuals make donations to treat cancer patients free of charge. Some of these individuals also pay in money for research so it’s only in Nigeria people do not make such donations,” he said.

Speaking on the high cost of radiotherapy in a country where about 100 million citizens live on less than a dollar a day, Mr Aruah said: “These treatment machines run 24hrs without going off. The AC must be on for 24 hrs so the cost of maintenance is high. So the N600,000 is just marginal”.

He said Shell “also paid for us to be treating indigent patients which we have been doing. We have a list of the patients and we have been reporting back to Shell.”

He said the major reason why patients die from cancer most times is due to late case presentation.

“What the doctor can do at that stage is manage the case to ensure the conditions doesn’t get worse but the damage has already been done,” the official noted.

“When people report to the hospital early, the case can be well managed. People have been treated for the past 15 to 20 years and they are still alive. Such people come in here to advise our cancer patients, so early reporting is actually key to defeat the disease.

“But when people keep going from one prayer house to another, avoiding the reality and reporting to the hospital when the case has worsened, there is not much the oncologist can do.”

COVID-19 and Cancer

As COVID-19 spread in Nigeria, much focus and effort was channeled to the fight against the novel disease while funding for cancer treatment suffered the more.

The outbreak attracted donations from rich corporations and individuals with several funding commitments by the government amounting to billions of naira.

In just four months into the pandemic, the Nigerian government said it had already spent “N30.5 billion, representing 84 per cent of the N36.3 billon public funds and donations received to respond to COVID-19 between April 1, 2020 and July 31, 2020, leaving the balance of N5.9 billion.”

The Accountant-General of the Federation, Ahmed Idris, stated this in response to the Freedom of Information request dated August 10, 2020, and sent to him by Socio-Economic Rights and Accountability Project (SERAP) and Connected Development (CODE).

More deadly

While COVID-19 is a global health threat and should be among top priorities, health experts believe a similar attention should be paid to cancer.

Even though COVID-19 is a highly infectious disease, cancer, a non-communicable but terminal disease, is far more deadly in Nigeria, statistics showed.

About 70,000 deaths are recorded from cancer annually in Nigeria — almost 45 times higher than the 1,613 fatalities recorded from COVID-19 in more than a year.

In 2020 alone, 78,899 cancer-related deaths were recorded in Nigeria, according to Globocan statistics. Women often bear the brunt — breast and cervical cancers are responsible for more deaths than any others in Nigeria.

While 34,200 men died from cancer in 2020, 44,699 women succumbed to the disease, according to Globocan data.

Estimates from the Institute for Health Metrics and Evaluation suggest that the cancer death rate in Nigeria was 113.7 per 100,000 people in 2017.

Besides, experts believe the cancer figures are underreported because many patients cannot afford the costs and often abandon hospital tests and treatment, meaning they will not be captured in the data.

“This is the major reason why all stakeholders in the Nigerian Cancer Society (NCS) are bringing in new energy to be able to reawaken the consciousness of Nigerians because sincerely speaking the level of awareness is low,” Mr Alhassan said.

“We are advocating for more inclusiveness whenever it comes to funding and awareness creation. Cancer is a preventable disease. There is a saying that preventive medicine is better than curative medicine and this is the major reason why awareness should be the key priority.”

Surviving cancer amid COVID-19

Meanwhile, Ms Orji, the president of Abuja breast cancer support group, said the COVID-19 experience has not fared well for the 100 members in her group.

“We have not been having physical meetings for the past one year due to the COVID-19 pandemic. We were told not to come together because we are at higher risk of contracting the COVID-19 virus since our immune system has been compromised. The pandemic has actually dealt with us,” she said.

“The pandemic came with a lot of problems on its own and cancer is also a problem on its own, so the problem became double.

“A lot of our members could no longer afford treatment as some donor aids for treatment stopped due to the economic impact of the pandemic.

“Some patients also became scared of contracting the virus and decided not to visit the hospital at all and their cancer disease progressed unlike when they were always accessing treatment,” she explained.

Ms Orji, a breast cancer survivor, said at least seven of their members have died amid the pandemic and many more are in critical conditions.

She said they have held on by encouraging each other to stay strong through their online discussion on Whatsapp and other social media platforms.

World Cancer Day

World Cancer Day is celebrated every year on February 4.

It is a global uniting initiative led by the Union for International Cancer Control (UICC).

Cancer, the second leading cause of death globally, is the uncontrolled growth of a group of cells in the body. It can occur at any age and if not detected at the right time and is not treated, it can increase the risk of death.

The theme for World Cancer Day 2021 is ‘I Am and I Will’.

With disruptions in services caused by COVID-19, cancer advocates believe there is an urgent need to consider cancer treatment as an emergency.

“If we have to put both diseases side by side, the mortality rate of cancer is far higher than that of COVID-19. Nobody is joking about COVID-19; we know what is happening around the world but we are saying that cancer shouldn’t be neglected in the course of trying to stem the effects of the pandemic.

“The key message I have for World Cancer Day is that we should work the talk. We should be more proactive,” Ms Orji said.