Attacking cancer through mobile centres

WORLD Cancer Day (February 4 every year) is set aside by the United Nations/World Health Organisation to raise awareness about cancer and to encourage its prevention, detection, and treatment. World Cancer Day is an opportunity for nations to collectively examine cancer control strategies and to identify winning formulas that will accelerate progress. The goal for all of us is to ensure that fewer people develop cancer, more people are successfully treated and that there is a better quality of life for people during treatment and beyond.

Taking place under the tagline ‘We can. I can.’, World Cancer Day 2016-2018 explores how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer. Just as cancer affects everyone in different ways, all people have the power to take various actions to reduce the impact that cancer has on individuals, families and communities.

Sadly, WHO latest data shows that worldwide, there were about 14 million new cases and 8.2 million deaths from cancer in 2014, of which half died prematurely (aged 30-69 years). About 70 per cent of these deaths occurred in developing nations like Nigeria. To put this into perspective, 1.1 million people died of Tuberculosis, HIV/AIDS killed 1.2 million people and malaria killed less than 500,000 people globally, during the same period. This means that cancer kills about thrice the number of people who die of tuberculosis, HIV and malaria combined.

According to W.H.O. Nigeria has had a significant increase in the incidence of deaths from the common cancers within four years. In 2008 breast cancer killed 30 Nigerian women daily; by 2012 this had risen to 40 women daily. In 2008 prostate cancer killed 14 Nigerian men daily; by 2012 this had risen to 26 men daily. In 2008 liver cancer killed 24 Nigerians daily; by 2012 this had risen to 32 daily.

Over 100,000 Nigerians are diagnosed with cancer annually, and about 80,000 die (10 deaths every hour!) with a dismal survival rate of 1: 5. The situation is worse for some specific cancers. For example, the survival rate for certain blood cancers in Nigeria is 1:20 whilst at the Tata Cancer Centre in the Indian city of Mumbai; survivorship is 99:100 for the same condition. This poor survival rate in Nigeria is mainly due to inadequate infrastructure for cancer care and lack of well-organized system of prevention.

To address this problem, the Committee Encouraging Corporate Philanthropy (CECP-Nigeria) has adopted the Big War Against Cancer as its current focal cause. The big war against cancer is designed to establish the infrastructure for efficient and effective cancer prevention and treatment in Nigeria. The short-term goal of the big war is to acquire and deploy 37 Mobile Cancer Centres, one for each state and FCT Abuja. As a longer-term goal, the CECP is committed to spearheading the establishment of one Comprehensive Cancer Centre in each of Nigeria’s geopolitical zones.

A Mobile Cancer Centre is NOT the same as a Mobile Mammogram. Rather, it is a clinic on wheels with state of the art facilities for screening, follow-up and treatment including surgeries for pre-cancer and early cancer cases. It also contains facilities for screening against ten cancer-related killer diseases, including hepatitis, diabetes, malaria, HIV/AIDs and others. Thus the Mobile Cancer Centres would tackle the double burden of disease, i.e. Communicable & Non-Communicable.

On the other hand, a Comprehensive Cancer Centre is a tertiary health institution that is focused exclusively on cancer care in all its departments. A Comprehensive Cancer Centre costs about $63 million, while a Mobile Cancer Centre costs about $600,000. Nigeria has no Mobile Cancer Centres (MCC); therefore, most Nigerians have no access to basic cancer screening. Likewise, Nigeria has no single Comprehensive Cancer Centre (CCC); therefore, most Nigerians have no access to optimal cancer treatment.

Radiotherapy which is one of the essential equipment needed to manage cases of cancer is unavailable in most tertiary hospitals in Nigeria. Only six public hospitals and one private hospital have such facilities in Nigeria. In Nigeria, some patients travel a distance of more than 600 km to access the nearest radiotherapy service. According to international best practice, radiation treatment facility within a 100 km distance is deemed appropriate. This contributes to the delay in treatment, increases waiting times for patients, resulting in progression in growth of cancer cells as well as spread to other organs.

Nigerians spend $200 million annually on cancer treatment abroad. Incidentally, $200 million is the approximate amount needed to establish three Comprehensive Cancer Centres or to acquire 300 Mobile Cancer Centres. Unfortunately, the outcome for Nigerians who embark on cancer-related medical tourism is often poor, because of late detection. Cancer constitutes a preventable major drain on our human and financial resources. Nigeria has thus, lost so many precious, gifted and talented people from all works of life.

According to WHO one – third of cancer is preventable, another one- third is curable and the last third can have good quality of life with appropriate care. The story of what led to the reduction in deaths from cervical cancer in Nigeria underscores the fact that with concerted and sustained effort we can also win the BIG WAR against cancer.

CECP’s operational partner in the BIG WAR is the National Cancer Prevention Programme (NCPP), a non-governmental initiative, which pioneered community-based mass cervical cancer screening campaign in Nigeria, a project known as the National Cervical Cancer Prevention Programme (NCCPP). This initiative was later renamed the National Cancer Prevention Programme, following the incorporation of screening for other cancers. Since its establishment in 2007, over 100,000 Nigerians have been directly screened and treated and through the awareness created, the NCPP is helping to protect millions of Nigerians from cancer.

This sacrificial effort was made in spite of its limited resources. It contributed to a 15 per cent reduction of cervical cancer deaths in Nigeria, from 26 women dying daily to 22 daily, between 2008 and 2012 (WHO. data). The significance of this modest improvement is underlined by the fact that the WHO had projected a 25 per cent increase in cervical cancer deaths within ten years, in the absence of widespread intervention.

However, we can do much better than that! The improvement in cervical cancer survivorship in Nigeria is proof positive that we can win the big war if we could scale up the effort. The Mobile Cancer Centres will take cancer prevention and early treatment to the grassroots, by energizing the impact of NCPP.

According to the USA Network of Mobile Clinics, “The mobile clinic sector is an untapped resource for helping the nation reduce health disparities while improving care and saving healthcare costs.” A study by the Harvard Medical School found that for every dollar invested in the operation of the mobile clinic, $20 was saved in terms of management of chronic illnesses, avoided hospital visits, and prevention of diseases.

A single Mobile Cancer Centre in a state of Nigeria could make a huge positive difference. That state would be divided into smaller units such that every community would be reached by the Mobile Cancer Centre at least once a year.

We cannot achieve this unless we ACT! (Attack Cancer Together!). This year’s WCD calls on us to ACT! Let’s support the CECP-Nigeria through advocacy and donation towards the Mobile Cancer Centres. Together we can! You can! I can!
Dr. Nzelu is executive secretary, CECP-Nigeria