16 February 2013

Zambia: Dealing With Cancer

WITH cancer, time is of essence. Therefore, it goes without say that, just as is the case with other medical conditions, early diagnosis is very critical for the success rate of treatment.

As the world continues to observe the cancer awareness week which began from February 4, and runs through to February 15, medical practitioners cannot over-emphasise the importance of seeking early medical intervention.

Cancer, which is a very complex ailment, is mostly associated with adults, mostly those who are advanced in age.

However, cancer is not exclusively an ailment for the aged, in the recent past, there have been cases of children presenting with symptoms that point towards cancer.

University Teaching Hospital (UTH) senior registrar for hematology and oncology unit Catherine Chunda explained that despite the increased cases of cancer both locally and globally, Zambia still remained ahead of most African countries as regards effective management of childhood cancers.

She said, out of the 12.7 million new cases of cancers globally, about 7.6 million deaths occur, adding that about 200,000 new cases of cancers are recorded in developing countries.

Speaking in Lusaka recently, during a media breakfast to raise awareness of childhood cancer, Dr Chunda noted that the biggest challenge impeding the effective management of cancer was the tendency by most patients to only seek medical intervention as a measure of last resort, when it may be already too late to record any meaningful treatment successes.

"Most patients attended to at health centres, come with already advanced stages of cancers. Most of these are normally in stage four (critical/last stage of cancer), leaving the medical practitioners with very limited options on how to avert the situation," she said.

In Zambia and world over, there are four main cancers that affect children, and these are lymphoma, retinoblastoma, nephroblastoma and kaposi's sarcoma.

According to Dr Chunda, in the case of adults, the most recorded cancers in Zambia were cervical cancer, which is one of the leading causes of mortality in women.

Dr Chunda said advancement of cases (delayed medical intervention) and refusal or lack of adherence to medication, were among the causes of treatment failure in the effective management of cancers in both children and adults.

"In the case of Zambia, we have about 45 per cent treatment abandonment rates, with 45 per cent mortality rate. And in the treatment of cancer, the treatment period ranges from about 6 months to 2 years, and some of the chemotherapy (oral and injectable drugs) is administered every three weeks. This entails adherence to medication, which some patients fail to bear," she said.

Dr Chunda said although causes of cancers varied especially in adults, causes of cancers that affect children were mainly attributed to genetic factors (genetic disorders).

She, however, disclosed that some of the causes of cancer in children were as a result of exposure to carcinogenic factors in the environment.

In Zambia, a local non-governmental organisation, Kayula Childhood Cancer Foundation (KCCF), was established to assist parents and caregivers of childhood cancer survivors, patients and parents whose children lost the battle against cancer to share experiences and work closely with the UTH Paediatric cancer unit, to effectively manage the condition.

KCCF executive director Mumba Sata, who lost her four-year-old daughter (Kayula) to a very rare cancer-Nephroblastoma, is also in agreement that early detection of cancer in both children and adults could help save the many lives that are lost.

Mrs Sata, explained that the motivation behind the establishment of KCCF was because she felt compelled to assist break the silence of cancers affecting children, especially after she realised that early detection could have saved her own daughter's life.

She called for more investment towards the training of more paediatric cancer specialists, adding that the problem has been compounded by inadequate staffing levels and lack of equipment at the paediatric cancer ward.

Mrs Sata disclosed that the survival rate for children with cancer in Zambia currently stands at one out of ten, while in Europe the survival rate was eight out of ten.

Meanwhile, Cancer Diseases Hospital (CDH) executive director Kennedy Lishimpi said the budget line for cancer mediation was still inadequate, because treatment costs were as high as KR1 million per dose.

"We struggle a lot in terms of striking a balance for equal access to medication, and when we are faced with special cases, we always call for assistance for us to meet the treatment costs," he said.

However, these and many other concerns raised by cancer survivors, caregivers and activists, have not fallen on deaf ears, because the Zambian Government, through the Ministry of Health is making frantic efforts to help cushion the effects of cancer in the country.

Ministry of Health Permanent Secretary Peter Mwaba has said Government will continue budgeting for cancer treatment to help in curbing the disease.

Dr Mwaba said about KR10 million was dedicated for the anti-cancer campaign since 2009 and the fund was increasing annually.

Dr Mwaba said Government had also embarked on an ambitious programme to train medical practitioners on how to use the radiographic equipment which would be used for detecting cancer.

He said the privately run Apex Medical School was currently training 15 radiographers who would be able to properly use the equipment.

"We have also procured some machines to detect cancer and so far the machines have been installed in all provincial centres," he said.

Dr Mwaba said the equipment would help in early diagnosis of the disease which would lead to high chances of patients surviving.

He said people should be equipped with knowledge, human resource and equipment to help eliminate the existence of the disease.

He said the upgrading of other equipment was underway in provincial centres like Livingstone, Ndola and Kitwe and the installation of city scanners was scheduled for completion by the end of June this year.

Dr Mwaba said it was important that community initiatives of fighting childhood cancer were brought to light and Government was willing to offer support to the fight against cancer and improve the livelihood of children inflicted with the disease.

Ms Sata is convinced that an effective sensitisation campaign on cancers affecting children, would prevent more children from dying from cancers and other related blood disorders.

KCCF is a non-profit making organisation registered in March 2010, in memory of Kayula Zina Sata.

The foundation's mission is to prevent more children dying from cancer and related blood disorders due to lack of information and awareness.

The statistics from the Paediatric cancer ward at the UTH show that 831 cases of childhood cancers were reported and treated between February 2011 and August 2012, with a death rate of 13.2 per cent (110 deaths). This rate is very alarming in just 18 months.

The KCCF is currently working closely with the UTH Paediatric cancer ward in Lusaka, which is the only location in the country with a Cancer Diseases Hospital.

Patients from all the 10 provinces of Zambia have to travel all the way to Lusaka to seek treatment and sometimes spend more than a year in the city, without any proper accommodation or food, in the case of those from less privileged families.

KCCF has included what they are calling a Parent House or transit home as one of its projects to offer accommodation for parents and care givers during the period that their children are under-going treatment, enable parents and children successfully complete all treatment without having to travel to and from their respective districts, and to assist to decongest the ward in order to create space for more critically ill patients at the cancer ward.

Another reason for the establishment of KCCF was to create a conducive environment for affected children to feel at home while away from home in between their treatment regimes.

"With cancer, time is of essence, if we had diagnosed Kayula earlier, she would have been here with us today," recalled Ms Sata.

It is therefore imperative upon caregivers to work closely with medical practitioners to ensure that cancer is detected early, and that treatment is adhered to.

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