Patients agonise as the State dithers over action on cancer

cancerOriginally Published: August 2, 2008 exclusively for Sunday Nation

The campaign against cigarette smoking has lately gone a notch higher with the primary goal of reducing the number of tobacco-related ailments including lung cancer.

But an investigation by the Sunday Nation into the available research and data on cancer prevalence in Kenya concludes that lung cancer is not the one that Kenyans should be most wary of.

More alarming is the finding that little is being done in the management one of the country’s top killers – cancer of the cervix.

Government officials acknowledge this lack of data creates potentially deadly barriers to the formation of effective public health strategies targeting urgent health problems.

But in countries like the United States of America, those policies are often based on decades of research, involving numerous clinical studies, and both public and privately-funded research.

Data on prevalence of cancer in Kenya is scarce. The official National Cancer Registry at the Kenya Medical Research Institute (Kemri) collects the bulk of its data from Nairobi and its environs.

Kemri’s most recent publication is a six-year-old report containing data from 2000-2002.

The only other substantive cancer data comes from the Nairobi Hospice, which was founded in 1988. It handles more than thirty thousand patients each year (both ongoing and new).

Dr K.J. Weru, a senior medical officer at the Nairobi Hospice, said that last year alone, the facility received more than 900 new cases of cancer. More than 50 per cent of these patients suffered from cervical cancer.

He says that many “life-limiting diseases” like cancer of the cervix are on their way to being forgotten, and people who get them are dying much sooner than they ought to.

Dr Weru says the primary reason is lack of reliable data on cancer prevalence and related deaths.

Information obtained from Nairobi Hospice rank cervical cancer as the top most killer among the cancer types. It is followed by cancer of the breast, prostate, oesophagus and lung in that order. Down in the list are cancers of the stomach, colon, mouth and liver.

The ministry of health’s division of non- communicable diseases houses the National Cancer Registry, founded in 2000 to keep records on the trends, prevalence rates, and most common cancers and carry out molecular research on the disease.

Driven by donors

“We do not even have enough funds to carry out basic data collection activities. We cannot fund a countrywide data collection campaign.

“I even doubt if the whole division of non- communicable diseases has a budget to work with,” said Dr Alice Musibi, an oncologist and a research officer of the Nairobi Cancer Registry at Kemri.

Compounding the problem, Musibi says the registry’s activities are driven by donors, who more often than not dictate the direction to be taken by the research.

“ As a result, studies are rarely dedicated to cancers that are most common locally, but rather to those prevalent in the donor countries,” Dr Musibi said.

Echoing Nairobi Hospice data, the Cancer Registry lists cervical cancer as the number one killer for women, followed closely by breast cancer.

For men, the leading cancers are prostate and oesophageal. Of all cases reported at the Nairobi Cancer Registry during the period between 2000 and 2002, 43.3 per cent were either breast or cervical cancer.

Another Cancer Registry publication, covering the years 2003 and 2004, has not been published due to lack of funds.

Since cancer data is not collected country-wide, it is likely that case numbers are significantly higher, since reports from rural areas rarely reach the registry.

Kenya’s scarcity of cancer data highlights a larger problem, officials admit.

According to Dr Nicholas Muraguri, the director of Division of Health Promotion at the Ministry of Health, the ministry is not only unable to fund the cancer registry. Other departments dealing with non-communicable diseases aren’t sufficiently funded.

Dr Muraguri says that in the 2008/2009 national budget, the total allocation to the Ministry of Health was Sh8.4 billion, from which almost Sh5 billion went to HIV/Aids, tuberculosis and malaria.

“It is a matter of choice, and a very difficult one at that,” Dr Muraguri said.

“We are faced with the challenge of providing immediate care for a host of other diseases that are killing women, from HIV/Aids, Malaria and pregnancy-related deaths. Trying to avail funds for (other) projects might mean freezing out more immediate needs,” he said.

Underage sex

But researchers believe such an approach makes cancer a time bomb. Specifically, data from the Nairobi Hospice indicate that younger women are increasingly getting cervical cancer.

Girls as young as twelve years old are being diagnosed with cervical cancer due to an increase in underage sex and HIV/Aids.

“If we do not do anything about it, the numbers will be too large to handle in the future,” said hospice official Dr Weru.

For Dr Musibi of the National Cancer Registry, the first step should be to increase awareness of cervical cancer in women, and of prostate and oesophageal cancer for men.

She says an aggressive early detection public service campaign would save many lives. However, Dr Muraguri of the Department of Health Promotion says that presently, government cannot a vigorous campaign to encourage more women and men to go for screening.

Ironically, the very type of research the government cannot afford has yielded a potential weapon against the leading cancer for Kenyan women.

A vaccine for the human papilloma virus, which causes cervical cancer, is available in local hospitals for Sh5,000. The vaccine can be administered to girls as young as 12 years old.

But Dr Muraguri says that the Ministry of Health is hesitant to publicise it, because officials fear the resultant demand would outstrip the supply.

He says that demand may only be met by a global response from agencies like the Global Alliance for Vaccine And Immunisation (Gavi), which provides vaccines for third world countries.

Gavi is a partnership of public and private sector organisations from around the world aimed at improving health care in the poorest countries.

Rural dwellers

With little research and lack of awareness campaigns, the road to treatment for cervical cancer patients may be long. In fact, that wait applies to all Kenyans who develop any type of cancer.

For example, at present, any Kenyan diagnosed with cancer and who needs radiotherapy may be forced to wait for long periods at Kenyatta National Hospital, which is the only public hospital offering the service.

The issue is more urgent for rural dwellers. Data obtained by Kemri from private clinics nationwide suggest that more cancer cases are reported in rural versus urban areas.

Unfortunately, officials say the rural population receives far less cancer care and treatment. For that group, services are either too expensive or too far away.

If they are able to get a referral to KNH, it is often too late because their cancers are at advanced stages.

Dr Weru says that this happens because many doctors don’t refer patients, even when there’s nothing more they can do, because they want to keep charging them for pointless “treatment.”

There is one more critical barrier. According to Kemri, there are only seven trained medical and radiation oncologists in Kenya. They shuttle between public and private hospitals administering both chemotherapy and radiotherapy.

Ultimately, experts believe that until more resources are tapped to equip the National Cancer Registry and our national hospitals with vital manpower and equipment, and to mount aggressive screening campaigns, the spread of cancer may go unchecked.

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