Without coverage of a government-backed insurance, Nigerian parents with a child suffering cancer need a minimum of N2.5 million to manage the deadly disease, while facing a pile of out-of-pocket non-medical expenses in the course of treatment, BusinessDay findings show.
The N2.5-million estimation would cost parents the equivalent of 83 months earnings or 7 years’ worth of salary if they earn Nigeria’s new minimum wage of N30,000 monthly.
In the United States, the average cost of a stay in a hospital for a child with cancer is $40,000, according to the Coalition Against Childhood Cancer (CACC). Taking the average work hours of 8.8 hours per day and a minimum wage of $7.25 per hour, it would cost the American parent 29 months to offset medicals bills without insurance.
Like many diseases, paediatric cancer is blind to people’s economic classes and as such, lays unprecedented burden on many households, several of which in Nigeria already suffer low discretionary income. If everyone had to face the financial burden of childhood cancer, for instance, an SBM Intel study on the consumption pattern of Nigerian households shows less than 37 percent of the population would be up to the task, because the income left after settling basic needs is inconsequential.
Whereas, apart from early detection, the type of cancer and individual factors attributable to each child, the financial strength of parents or guardians determine a lot in getting access to quality care and saving a child from death.
The World Health Organisation (WHO) estimates that up to 30,000 children are diagnosed with cancer yearly, with 80 percent of them living in low- and middle-income countries like Nigeria.
Chemotherapy, a common treatment, requires about N350,000 and a child might need at least six courses of this treatment for a period, which can last up to two years. Diagnosis, drugs and platelets, a blood product that costs N7,500 also infuse unavoidable cost in managing cancer.
In the wake of a downplay on the use of chemotherapy and radiation due to their adverse impact on blood cell production, leading to a depressed immune system and increased chances of contracting deadly infections, blood transfusions are encouraged. This will replenish white and red blood cells damaged during chemotherapy, thus important in the treatment of cancers.
But it comes at a price. A child wrestling with Leukaemia, for instance, could be administered platelets more than five times in a week on a cost running into N37,500, says Korede Akindele, Dorcas Cancer Foundation (DCF) programmes officer. The average cost of a pint of blood hovers around N12,000.
DCF has supported more than 40 children and currently has a waiting list of 15 children whose cases were sieved from a large pool of requests. DCF partners Lagos University Teaching Hospital (LUTH), University College Hospital, (UCH) Ibadan, and National Hospital, Abuja, where there are paediatric centres devoted to cancer.
The work of the foundation is aided by corporate firms, Life Bank, among them. According to the blood distribution company, the inaccessibility of blood in Nigeria further jeopardises the prognosis of children being treated for cancer.
Childhood cancer is not one disease; there are more than 12 major types of paediatric cancers and over 100 subtypes. In Nigeria, the incidence of cancers such as rhabdomyosarcoma – cancer that affects skeletal muscle cell; lymphomas – a cancer attack infection-fighting cells of the immune system; nephroblastoma – an abnormal creation of cells; neuroblastoma, cancer developed from immature nerve cells and leukaemia – over-production of abnormal white blood cells are on the rise.
Since 1980, only three drugs have been approved for use in children: teniposide in 1980 and clofarabine in 2004, which are used in the treatment of all. The third, unituxin was approved in 2015 for use in high-risk neuroblastoma. Fewer than eight total drugs, consisting of the three earlier mentioned and five others approved for use in adults have been developed for use in children with cancer compared with hundreds of drugs that have been developed specifically for adults only.
The United States National Cancer Institute Surveillance, Epidemiology and End Results data show that the survival rates for all of these have been increasing given the right medical attention.
In 2009, the chance of surviving rhabdomyosarcoma grew from 49 percent in 1979 to 64 percent in 2009. Lymphomas shored up from 72 percent in 1979 to 91 percent in 2009 as well.
With the average 5-year survival rate for childhood cancers at 83 percent on the whole, the US boasts of nearly 390,000 childhood cancer survivors, and forecast it will grow to more than 500,000 by 2020.
In Nigeria focus is still largely on adult cancer, underestimating the emerging problems with childhood cancer.
“We are advocating for cancer coverage under insurance. At least, government should be able to wave admission for a child who comes into a hospital with cancer. If the government will start from there, we can then look on to very important things like infrastructure,” Akindele said.
“Cancer centres are not enough. Before a child can get a centre in some states, the family could hours or spend a whole day trying to get to a teaching hospital. There is little or no attention on childhood cancer unlike adult cancer.”
The Nigeria’s Cancer Control Plan for 2018 to 2022, in its implementation framework promises to institute newborn screening for early signs of some common childhood cancers like Retinoblastoma in all health facilities and baby clinics. If the plan does not fall through, chances of cure could be higher as a result of early detection.
A CACC’s insight on childhood cancer indicates it threatens every aspect of a family’s life and the prospects of a child’s future. This has raised the need for psychosocial care to be integrated in treatment plan. The care has been found to yield better management of common disease-related symptoms and adverse effects of treatment such as pain and fatigue.
“Depression and other psychosocial concerns can affect adherence to treatment regimens by impairing cognition, weakening motivation, and decreasing coping abilities,” the coalition states. “For children and families, treating the pain, symptoms, and stress of cancer enhances quality of life and is as important as treating the disease,” CACC states.
