Rising throat cancer cases overrun local hospitals
Local hospitals are getting increasingly overwhelmed by rapid surge in cancer cases that continue to eat into resources and cripple prevention and curative services.
Oesophagus cancer is fast becoming one of the region’s leading killers only second to breast and prostate cancers.
A crippling corruption culture is frustrating provision of efficient medical and other prevention services in public hospitals.
Prof Nicholas Abinya of Kenyatta National Hospital Cancer Unit says out of the 4,380 people diagnosed with the disease at the hospital every year, only an average 29 survive.
He says there are three types of cancer treatments; surgery, radiotherapy and chemotherapy, with the latter being the most complicated. “But if surgery and chemotherapy are administered to the wrong patient, they die,” Prof Abinya warns.
Since Kenya has the best medical facilities and personnel in the Horn of Africa, the high number of local oesophagus cancer patients and others from neighbouring countries has inevitably condemned thousands of patients to untold suffering and early death.
A substantial number of patients die before they see the few available doctors. More than 60 cancer patients were on March 22, 2021 ordered to return home after KNH suspended radiotherapy treatment.
A month later, there has been no communication from the referral facility on when the services will resume.
Patients were due to start radiotherapy but Oncology Unit workers insist treatment for first-timers remain indefinitely suspended.
Long waiting time
Doctors claim due to the overwhelming numbers, the hospital will only continue serving existing patients “after which plans on how to ration life-saving therapy will be communicated.”
Lead Head and Neck Cancer surgeon Dr Joyce Aswani says efforts by medical personnel in Africa to manage cancer of larynx have been hampered by lengthy waiting time for theatre space.
Other challenges include long waiting queues for reporting of biopsy, radiotherapy and lack of funds for patients to look for treatment.
The latest World Health Organisation Globocan 2020 report shows out of a population of 53,771,300, Kenya reported 42,116 fresh cancer cases, with more than 27,092 patients losing the battle in a year.
During the period, there were 1,362 fresh oesophagus cases, representing a 8.7 per cent infection jump over the 2019 figures.
Kenya has about 100 Ear, Nose and Throat (ENT) doctors, but majority are based in Nairobi because, Dr Aswani says, “peripheral hospitals lack facilities for satisfactory ENT practice.”
Deep financial strain
There are about an equal number of clinical officers with ENT training. Majority of Level I-IV hospitals lack equipment to adequately examine the larynx.
Patients with hoarseness are, therefore, provided with less than minimal examination and will routinely receive wrong treatment for the problem.
Medical experts predict the WHO figures on the disease are only a fraction of the real cancer numbers in Kenya and thousands more may be unaccounted for. Doctors believe many patients die or may be languishing in rural areas.
KNH charges Sh4,000 for single bed, single room Sh6,150 per day, private room Sh8,150 and Sh20,000 a day for VIP rooms. However the prices are high for poor patients, most of whom are unable to raise bus fare to the hospital.
Patients at Nairobi Hospital pay an average of Sh147,071 for a single chemotherapy session, while those who undergo surgery pay an average Sh136,545, and those on radiotherapy Sh126,781.
A local publication recently reported a survey of treatment costs for throat cancer at three major hospitals; Nairobi Hospital, KNH and Aga Khan that exposed “deep financial strain” for households with patients suffering from four main strains of the disease —cervical, breast, esophageal and prostate.
The results exposed deep financial strains for average households with patients suffering from the four main strains of the disease.
Besides lack of adequate clinical staff, thousands of patients are unable to raise money for diagnosis, tests and drugs.
KNH adjusted charges in 2018 to raise funds to upgrade equipment in the facility.
Kenya has only two public cancer data registries at Kenyatta National Hospital in Nairobi and Moi Teaching and Referral Hospital in Eldoret.
If a cancer patient is lucky to eventually see a qualified doctor, they will be tied to weekly or monthly clinics in major hospitals in Nairobi, Mombasa, Kisumu or Eldoret.
Majority of Level I-IV health facilities in the country are mainly run by technicians who lack standard equipment to effectively examine patients for various types of cancer.
Management of cancer of larynx ideally starts with taking appropriate x-rays to determine extent and spread of the disease and specimen (biopsy) to confirm cancer and other specific information related to the patient and the disease.
Cancer diagnosed late requires a combination of surgery, and where the situation allows chemotherapy and radiotherapy, Dr Aswani says. Some patients may receive all three modes of treatment.
Early diagnosis of cancer of larynx has up to 90 per cent cure rate but stage 4 laryngeal cancers have at least 50 per cent cure rate “if it has not spread beyond the neck.”
Dr Catherine Nyongesa, head of Cancer Unit at Kenyatta National Hospital says occurrence of tumour is closely associated with smoking cigarettes. She says head and neck tumours occur six times more often among smokers than among non-smokers.
Nyongesa, who is the founder of Texas Cancer Centre in Nairobi says there are correlations between site of lesion and social habit among patients, with regular cigarette smoking and alcohol consumption presenting more glottis tumours.
This could be due to synergistic effects of cigarette smoking and alcohol on head and neck tumours.
Many patients travel hundreds of miles from disease-prevalent regions of Kisumu, Kakamega, Nyeri, Nakuru, Bomet and Eldoret counties to attend clinics at KNH.
One such patient is Mary Akinyi, 45. Frail and exhausted, she is often forced to wait for hours to be attended to because of the high number of patients seeking treatment.
“Every month I travel several times to Nairobi to seek radiotherapy services.
Every time, I am told either the machines are not working, the doctor is away attending emergency cases or sometimes I don’t have money to pay for the treatment,” she says.
Mary, a single mother of four, says she has stage four throat cancer but has exhausted her savings on transport and treatment.
She may, therefore, be forced to discontinue radiotherapy session for lack of money. “How will I pay for remaining cycles of chemotherapy and radiotherapy that I desperately need?
Who will I turn to for support on managing side-effects? How will I be able to make the eight-hour bus trip from Kisumu to Nairobi every few weeks to receive treatment?” she asks.
Dr David Muturi of Aga Khan Hospital Nairobi says many head and neck cancer survivors recover physically and emotionally and may return to normal life.
But others adopt a “new normal” and settle into altered lifestyles with some experiencing problems swallowing during the treatment period caused by location of tumour, nausea and/or vomiting.
These are side effects associated with chemoradiation therapy and changes in perception of taste or smell.
Others are low appetite, changes in salivation, diarrhoea and inflammation of membranes in mouth mucositis, severe mucositis that causes pain and affects a patient’s ability and desire to eat.
Patients also experience fatigue, changes in speech, pain, changes in hearing, decreased salivation and problems swallowing.
He says patients rank fatigue as having the strongest impact on their quality of life. Others complain of weight loss but doctors recommend nutritionists to assess individual needs and provide strategies for treatment of associated side effects.
Dr Alfred Kiragu, the director of National Cancer Institute says unlike other cancers, majority of oesophageal cancer patients are normally diagnosed at advanced stages, leading to poor treatment outcomes.
The disease risk factors he says include dental fluorosis characterised by brown teeth caused by exposure to high fluoride levels during childhood.
Studies conducted in Eldoret area of Rift Valley region reveal a nine-fold risk of developing oesophageal cancer among individuals with moderate or severe dental fluorosis.
The condition is common in Rift Valley and parts of Western Kenya which have rivers, and other water sources containing high fluoride levels such as Lakes Nakuru, Naivasha and Baringo.
The studies, which have been published in the International Journal of Cancer, also reveal oesophageal cancer risk increases with poor oral hygiene, including use of Mswaki stick (African brush) cut from wild trees and widely used by residents for cleaning teeth.