Cancer care in Nigeria: A deep dive into numbers, cost, closing care gap

…One single dose of injection for prostate cancer costs $20,000 – $25,000

… Radiation therapy for breast cancer costs ranges from 1.5 to 2m

Cancer care is becoming personalised, and limited awareness, accessibility and the insufficiency in common knowledge about early detection, tied with the existing gaps in healthcare infrastructure, resources, economic disparities and economic disparities, has continually created significant barriers in the fight against cancer across Nigeria.

A deep dive into the latest statistics by the World Health Organization (WHO)’s cancer agency, the International Agency for Research on Cancer (IARC), tells the critical need for a focused and united effort to close the care gap of cancer care in Nigeria and the urgency of bridging the existing disparities.

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According to the 2022 data indicting Nigeria’s current situation, 127,763 new cases of cancer were reported, marking a significant health challenge for the nation. This total includes 48,096 cases in males, and 79,667 in females, with both sexes collective.

Over 5 years, the number of prevalent cases reached a concerning 269,109, indicating the persistent impact of cancer on the Nigerian population with a total population of 216,746,933, the age-standardised incidence rate per 100,000 people was 93.9 for males, 133.3 for females, and an average of 113.6 for both sexes collective.

However, the incidence of leading cancers that are more frequent among Nigerians are Prostate, Colorectum, and Liver. Breast and Cervix uteri cancers also featured prominently, collectively contributing to the high incidence rates.

The data further revealed a total of 79,542 lives were lost to cancer in 2022 and the risk of dying from cancer before the age of 75 was outlined as 7.4% for Prostate cancer, 8.7% for Colorectum, and 8.0% for Liver cancer.

These statistics emphasise the urgent need for an all-inclusive and strategic approach to continually improve cancer care in Nigeria.

As the nation commemorates World Cancer Day today, February 4, and embraces the empowering slogan, “Close the care gap,” these numbers serve as a stark reminder of the challenges ahead and the critical importance of concerted efforts to address the growing cancer burden in the country and also fostering raising voices as an individual and collectively in action to bridge gaps in cancer care, more inclusive and supportive environment for those affected.

In the face of a rising cancer crisis in Nigeria, experts are urging a comprehensive approach to tackle the various stages of cancer care.

Francis Durosinmi-Etti, chief clinical oncologist, Nigeria Sovereign Investment Authority, and Lagos University Teaching Hospital, Idi-Araba, Cancer Centre said in closing the care gap, there need to address preemption, prevention, diagnosis and treatment challenges, human resource gap in healthcare, palliative care and terminal care and government initiatives and collaborations.

Addressing the preemption and prevention of cancer, Durosinmi-Etti, emphasizes the need for targeted measures. “For cancers with a familial tendency, such as breast cancer, early testing among first-degree relatives is crucial. Additionally, childhood cancers and cervical cancer can be preempted through measures like HPV vaccination, dispelling misconceptions around its efficacy.

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“To proactively address breast cancer, consideration can be given to familial predispositions, such diagnostic tests can be conducted to assess the likelihood of developing the disease, particularly among first-degree relatives like mothers or aunts. This preempt can identify potential risks in the younger generation before symptoms manifest.

Additionally, certain childhood cancers and cervical cancer can be preempted. For instance, HPV vaccination is an effective measure against cervical cancer, but misconceptions have led to scepticism. It is crucial for the government to educate the public on the importance of vaccination to mitigate the future risk of disease,” he said.

On diagnosis and treatment challenges, chief clinical oncologist said the challenges in cancer diagnosis and treatment persist especially in the case of breast cancer, where some tests cannot be performed locally and are sent to South Africa and other countries.

“Efforts are being made to conduct these tests in Nigeria, narrowing a significant gap. Tests like immunohistochemistry studies (IHC) play a vital role in accurately labeling and identifying the type of cancer, enabling doctors to prescribe specific, effective medications tailored to the individual’s condition. This not only avoids unnecessary expenses on ineffective drugs but also enhances the chances of successful treatment, particularly when the disease is detected early,” he explained.

Durosinmi-Etti said that addressing these gaps in the diagnostic and treatment phases is essential to bring healthcare standards in Nigeria on par with global practices, he added that improving access to advanced tests and fostering public awareness can contribute significantly to narrowing these healthcare disparities.

“Now, turning our attention to cancer treatments, the expenses associated with them are substantial. For instance, individuals requiring radiation therapy for breast cancer may face costs ranging from 1.5 to 2 million. The choice of drugs is contingent upon the results of immunohistochemistry studies, with certain medications priced around 1 million naira. This financial burden creates distress for patients, turning their plight into a form of crowd-funding.

Addressing this issue prompts us to consider the inclusion of cancer in national health insurance. However, only six qualified centers in Nigeria can treat patients, and even in these centers, patients seldom receive more than 1 million. This is insufficient, given that a single injection of some drugs can surpass this amount. Consequently, there is a pressing need to bridge this financial gap.

Moreover, patient follow-up plays a critical role, requiring regular visits over several months or years. Unfortunately, the costs associated with these follow-ups are often beyond the means of most patients.

Accessibility to cancer treatment facilities is also a challenge, as not every part of the country has such facilities, compelling patients to travel long distances. Despite ongoing efforts to establish more centers, the vast population and distances involved remain significant hurdles.

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To close the gaps in cancer care, collaboration between the public and private sectors is commendable, with initiatives such as the partnership between NSIA and LUTH.

For the human resource gap in healthcare, according to him, while the government is making strides in establishing cancer centers, there are critical shortages of healthcare professionals, including doctors, nurses, and pathologists, which poses a significant challenge.

“The importance of improving working conditions and remuneration to attract and retain qualified healthcare workers and fostering collaborations are essential steps in addressing this gap,” Durosinmi-Etti stressed.

Explaining further Durosinmi- Etti said in the unfortunate event of treatment failure and inevitable death, terminal care becomes crucial.

According to him, the increasing incidence of aggressive prostate cancer emphasizes the need for palliative measures.

“However, the costs associated with certain treatments, specialised injections, such as Radium 223 come at an exorbitant cost of $20,000 – $25,000, further exacerbating the financial burden on already distressed patients and making them inaccessible to many.

“Exploring alternative means and prioritizing patient comfort in these challenging times are vital aspects of narrowing the existing gaps.”

“While the challenges in cancer care seem daunting, continuous efforts, aspirations, and dedication are imperative. By persistently striving for improvements, there is hope that, with the grace of God, we can gradually close the existing gaps and provide better care for those in need,” added Durosinmi-Etti.

However, globally, about 1 in 5 people develop cancer in their lifetime, approximately one in nine men and one in 12 women die from the disease. The report shows that the projected cancer burden increase in 2050.

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Over 35 million new cancer cases are predicted in 2050, a 77% increase from the estimated 20 million cases in 2022.

The rapidly growing global cancer burden reflects both population ageing and growth, as well as changes to people’s exposure to risk factors, several of which are associated with socioeconomic development.

Tobacco, alcohol and obesity are key factors behind the increasing incidence of cancer, with air pollution still a key driver of environmental risk factors.