Any mention of cancer in Kenya today elicits fear and trepidation. It is discussed in hushed tones from church pulpits to Parliament and slums, and villages to presidential events. It has reached catastrophic levels akin to terror attacks at the turn of this decade or the AIDS epidemic of the 1990s. In just one month, earlier this year, the deadly disease claimed the lives of the chief executive officer of one of Africa’s most profitable companies, a sitting governor and a member of Parliament.
The study, Access to financial burden for patients with cancer in Ghana, Kenya, and Nigeria, shows that despite significant strides in detecting, managing and treating breast cancer in this region, it remains the most prevalent cancer, and the leading cause of death in women.
Breast cancer ranks first in new cases, followed by cervical, oesophagus, colorectum and stomach, and is the number three cause of death, according to Globocan 2018, the Global Cancer Observatory under the World Health Organization. And the number of all new cancer cases in Kenya was a whopping 47,888 in 2018, with 32,987 deaths.
The study, commissioned by global biotech company Roche and led by Dr Majid Twahir of the Aga Khan University Hospital and Razaq Oyesegun of National Hospital in Abuja, set out to unearth the specifics of the pain breast cancer patients undergo, by reviewing records of patients treated at one private hospital and a government hospital in each of the three countries.
In Kenya, the centres were the Aga Khan University Hospital and Kenyatta National Hospital. The records were from 862 breast cancer patients – 299 from Ghana, 314 from Kenya and 249 from Nigeria.
Breast cancer patients travelled an average of 56 kilometres to seek treatment in Nairobi, with some coming from as far away as 398 kilometres for such services, according to the study which involved 300 records. This indicates that the capital is still a natural destination for cancer patients in smaller towns and in villages despite the government’s promise to devolve such services. However, Nairobi lacks the capacity to handle the large and ever-rising number of cancer cases from around the country, with many patients who cannot afford the cost of treatment in private hospitals having to book and line up for days or even months to be attended to at Kenyatta National Hospital (KNH).
For instance, KNH, in partnership with Roche, has a programme where patients are supposed to receive free Herceptin treatment, which slows the growth of breast cancer cells, but only a few do.
Such experiences of delays are confirmed by the study, which reveals that patients face significant delays of up to three months in all the three countries before they undergo further tests to determine the appropriate regime of treatment then treated. And when the diagnosis and treatment finally happen, the care is not always of standard.
“The use of common screening methods such as a mammogram or breast ultrasound was less than 45 percent in all the three countries, with the core needle biopsy at 76 percent in Kenya and Nigeria, but only 50 percent in Ghana,” observes the report. A core needle biopsy is used when tests point to one having breast cancer, as it clearly shows the presence of the cells.
In 30 percent of the 300 cases studied in Kenya, the patients paid for diagnosis out of their pockets, compared with 93 percent in Nigeria and Ghana. Similarly, eight to 20 percent of patients studied in Kenya paid for their treatments out of pocket as compared to 89 percent of patients in Nigeria and 79 in Ghana.
The study confirms that indeed patients who have a health cover have better access to treatment and therefore higher chances of survival. Among those patients receiving HER2-targeted therapy, the average number of cycles was five for patients paying out of pocket, against 14 for those with some level of insurance coverage.
“This is a rare kind of cancer affecting about 25 to 30 percent of breast cancers and whose treatment is extremely expensive. Being diagnosed with it can send a patient’s family to poverty, or in a worst-case scenario death and disharmony,” says Dr Stephen Maina, the medical director for East Africa at Roche.