Low income countries can tame cancer scourge
Dr Cosmas Mugambi
The cancer burden is rising globally, exerting significant strain on populations and health systems at all income levels. The International Agency for Research on Cancer (IARC) estimated 18.1 million new cases and 9.6 million deaths across the globe in 2018.
This translates to one out of six deaths globally and far exceeding the number of deaths from HIV/Aids, malaria and tuberculosis combined.
Cancers of the breast, colorectum, lung, cervix uterus and thyroid are most prevalent among women while those of the lung, prostate, stomach and liver are top among males.
Notably, the cancer burden is greatest in low and middle-income countries, the sub-Saharan Africa region projected to have more than an 85 per cent increase in cancer cases by 2030.
This sharp increase is being attributed to demographic changes such as ageing and population growth, increased exposure to risk factors such as environmental carcinogens, urbanisation, unsafe food and water, infectious agents and lifestyle changes.
Many cancers can be prevented. Others can be treated and cured when diagnosed early. Even with late stage cancer, the pain can be reduced, the progression of the cancer slowed.
Effective prevention efforts have been shown to reduce new cases while early initiation of treatment has been shown to improve treatment outcome and survival rates.
However, there is a limited public awareness on cancer symptoms. This coupled with geographical inaccessibility of services, cost of treatment, sociocultural factors, poor referral and post referral follow-ups and other social determinants of health delay timely diagnosis.
The consequence is significant physical, financial and emotional strain on cancer patients and their families. Ultimately, prolonged disability and premature mortality have substantial social and economic impact.
In May 2017, world governments made a commitment to further invest in cancer control as a public health priority, passing the World Health Assembly Resolution 70.12 on cancer prevention and control.
However, historically, cancer has received little attention from global policymakers and donors. Thus, low and middle-income countries, are finding it increasingly difficult to respond to the cancer challenge.
At an individual level, one can keep cancer at bay. First, avoid tobacco—using any type of tobacco puts one on a collision course with cancer. Also, a healthy diet can reduce cancer risk—eat plenty of fruits and vegetables; eat lighter and leaner; limit processed foods; and maintain a healthy weight. It helps to be physically active.
In terms of biomedical Intervention, the first step in the event of a diagnosis with cancer would be to find the right doctor followed by designing a treatment plan and creation of a social support system. Treatment aims to cure disease, prolong life, and improve the quality of life after diagnosis with cancer.
The most effective and efficient treatment is linked to early detection programmes and follows evidence-based standards of care. Palliative care meets the needs of all patients requiring relief from symptoms, and the needs of patients and their families for psychosocial and supportive care ultimately improving the quality of life and the ability to cope effectively.
In view of the complex nature of the disease and the fragmented and uncoordinated interventions, taking a systems approach in cancer control plans tailoured to regional and national priorities would address the challenge more holistically.
This underscores the need for cancer registries for informed and evidence-based interventions; integration of cancer control interventions with the prevention of chronic diseases and strengthening regional and sub-regional partnerships for cancer management to improve accessibility.
Moving forward, research on oncology in low and middle-income countries needs to focus on risk reduction and early detection aimed at determining specific genetic, biological, and behavioural risk factors for cancer and evaluating innovative models to improve screening and increase early diagnosis.
It should also focus on survivorship symptom science aimed at reducing treatment-related symptoms The author is an implementation scientist based in Nairobi
