Onyinyechi Okafor, an intelligent and healthy 14-year-old girl, never had previous history of head injury or trauma before she was diagnosed with a rare and aggressive form of brain tumour known as Brain Stem Glioma in January this year. The entire left side of her body is paralysed and she is seeking assistance to raise N5 million to undergo an urgent life-saving brain surgery in an Indian hospital. The case of 25-year-old Linda Godwin is not entirely different from Onyinyechi’s.
Following a diagnosis of invasive ductal carcinoma, SBR Grade III, synchronous bilateral breast cancer, Linda, who has lost her right breast and is undergoing chemotherapy to mange her very critical state of health, is languishing at the Lagos University Teaching Hospital (LUTH), in search of about N500,000 every three weeks to stay alive. These two cases only represent the tip of the iceberg of the cost of cancer care and management in Nigeria. Financial constraint is the bane of most cancer patients seeking treatment.
More than two million Nigerians are known to have some form of invasive cancer, an estimated 100,000 are diagnosed annually, of which at least 80,000 die, making cancer one of the nation’s highest causes of death. Although most cancer patients are not “catastrophic” overall, cancer is one of the most expensive disorders to treat and manage.
The total life time cost of handling cancer in Nigeria iscolossal, perhaps unquantifiable. For the rich, only palliative care is available in most cases of late presentation, while for the poor, there is little or no hope for survival. Everything about cancer is expensive. Cost of treatment of cervical cancer, colon cancer, breast cancer, lung cancer, prostate cancer and any kind of cancer for that matter is mind boggling. Even the routine cancer therapy is no more affordable in Nigeria, than elsewhere. It is an expensive and impoverishing disease. “The poor cannot survive cancer and even the rich do not always survive,” said Professor Remi Ajekigbe, Head,
Oncology/Radiotherapy Department LUTH. “The reason is because treatment is either unavailable or where available, it is extremely expensive. The cost involved in treatment, coupled with the impact of disability and loss of life, is significant. From the drugs, radiotherapy, and chemotherapy, the cost is prohibitive.”
The rich, the poor die
Currently, Nigeria has no comprehensive cancer centre, and lacks adequate treatment facilities hence Nigerians are compelled to spend over $200 million annually on treatment abroad, often in India which has over 120 cancer centres, mostly established through non-governmental effort, with private sector support. Thousands of patients usually travel abroad for treatment at the end stage.
Even for the rich who have the option of going abroad, they travel and still die. An average cancer patient, on regular screening, clinical assessment and chemotherapy, over the course of a year, may accumulate N5 million to N20 million or more in medical bills depending on the type of cancer, the type of treatment and where the treatment is being accessed.
Certainly many patients cannot afford costs like these. They—and their families—too often go broke, and die trying to pay for this and other treatments. The result is that average Nigerian cancer patient is less likely to get regular screening tests, such as pap tests and colonoscopies, which catch the disease in its early, more curable stages. That person is less likely to be in good health generally in the first place and thus unable to fight cancer if it occurs.
He is less likely to be on a health plan that will enable him to get to the doctor sooner when cancer symptoms first appear. Among most people without health insurance, the prognosis is worse as the cancer is more likely to have spread by the time they see a doctor. The person is less likely to get high-quality cancer treatments and benefit from state-of-the-art technology. Such “high cost patients” are those who become really sick.
Cancer patients with no access to chemotherapy, radiotherapy or surgery constitute the bulk of those who inevitably die. Unconfirmed sources say this would apply to over 80 percent of total cancer patients. However, cancer patients who receive chemotherapy, radiotherapy and cosmetic surgery may spend N10 million – N20 million on the average.
Sunday Vanguard investigations showed that three years ago, cancer was one of the world’s top 10 most expensive disorders. Today, it is among the top three. As if it’s not bad enough to get diagnosed with cancer, virtually every patient has to contend with paying for treatment, including somehow managing the high cost of drugs (chemotherapy). Most cancer drugs are available in Nigeria, but the costs are prohibitive, distribution is inefficient, and efficacy is uncertain.
Drug prices are so high in the first place due to the cost of researching the drugs. The average cancer drug costs an estimated N10 million to research. Worse still, there is no subsidy for cancer care, such as radiotherapy or chemotherapy. Poor infrastructural development in the healthcare worsens the picture. Overall, cancer drug prices are skyrocketing.
A decade ago, the typical new cancer drug coming on the market cost about N600,000 per month but over the last three years, the average cost has been around N1.6 million. In 2012, of the 12 drugs approved by the Food and Drug Administration for various cancer conditions, 11 were priced above N16 million for a year of treatment.
Several physicians—all of who specialize in managing cancer or its complications – confirmed that cancer drug costs are “too high, unsustainable, and may compromise access of needy patients to highly
effective therapy”. It’s hardly surprising that in several countries, cancer is now ranked as the world’s most expensive and deadliest disorder. Every year, over the last five years, the economic toll of cancer has cost an estimated $1,000 billion – about 1.5 percent of the world’s annual Gross Domestic Product. Cancer is the most expensive disorder to treat on the short-term.
It is also the most expensive long-term sickness, according to a report by the American Cancer Society. Cancer costs more in productivity and lost life than AIDS, malaria, the flu and other diseases transmitted from person-to-person, the report noted. Although the key message remains: “Early detection is your best protection,” while early detection is valuable, detecting and preventing cancer in the first place are two different things.
Prevention consists of finding out what causes cancer and minimising those risks. In practice, this is easier said than done. In Nigeria, cancer is not covered by insurance; although some of the higher and comprehensive plans may offer limited coverage, no insurance company is ready to pay out the huge sums for the treatment and disability payments of cancer management every year.
Findings by Sunday Vanguard reveal that uninsured cancer patients were more than twice as likely to die within five years compared to insured patients. Professor Clement Adebamowo, of the Department of Epidemiology and Preventive Medicine, School of Medicine & Institute of Human Virology at the University of Maryland, describes cancer as the most important risk factor for poverty and loss of social status among the middle class in Nigeria. “The implication is that most people do notice the early signs of cancer and just wish it would go away.”
When cancer strikes
Adebamowo, who is Director of the Office of Strategic Information and Research Institute of Human Virology in Nigeria, laments that Nigerians cannot afford the cost of cancer care. “When cancer strikes, even the rich become beggars, because, the affected persons exhaust savings as they are forced to sell their property, and seek public assistance”, he points out.
Dr. Samuel Eyesan, an Associate Professor of Orthopaedic Surgery and sub-specialist in Orthopaedic Oncology (bone cancer management), says the only way to bring down the currently prohibitive cost of cancer treatment, is for government at the top to acquire a central coordinating role.
Next week: A cancer survivor tells her pathetic story.
Eyesan, one of the three orthopaedic oncologists in Nigeria, and currently lecturer/medical care personnel trainer at Bowen University, Osun State, argues that cancer management must be a team work and government must make such policy possible. “Cancer control must be centrally coordinated and the Federal Ministry of Health must take up that role. Every patient has to be seen by a group, not just the doctor, but the radiologist, phototherapist, chemotherapist, and rehabilitation specialist. Everybody will have to contribute and decide the best way for the patient, not just the surgeon.”
Next week: A cancer survivor tells her pathetic story.