31 January 2019

Nigeria: Data As Key to Better Cancer Care in Nigeria - MedicAid Cancer Foundation 2nd Annual Summit

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Cancer is the second most common cause of death in developed countries and among the top three leading causes of death in developing countries. The World Health Organisation (WHO) reports that about 24.6 million people live with cancer globally, with an alarming 12.5% of all deaths worldwide attributable to cancer. If this trend continues, it is estimated that by 2020, 16 million new cases will be diagnosed annually, out of which 70% will be from developing countries.

Access to relevant information, networks and expertise is critical in the fight against cancer. The Medicaid Cancer Foundation (MCF) is one amongst many organisations working to raise awareness about cancer in Nigeria. MCF works to bridge the information gap in cancer care by empowering stakeholders with information on trends and fostering platforms to discuss how to inform and protect Nigerians. The foundation seeks to support cancer patients, promote cancer awareness and drive community cancer campaigns for underserved Nigerians. It also brings together researchers, policy makers and other stakeholders to drive for better cancer care in Nigeria.

MCF’s 2nd annual cancer summit which took place in December 2018, was an important gathering of pathologists, medical record officers, cancer registrars and scientists from across the globe. The summit focused on the surveillance of cancer survival in low resource settings. Discussions revolved around cancer prevention and treatment, adequate patient care, strengthening existing cancer registries and establishing new ones, training, providing mentorship, leveraging on technology for cancer data management.

The summit touched on the three main characteristics of modern cancer care;

  • state-of-the-art clinical medicine
  • an approach to care that is attentive to the spectrum of patient's needs
  • the use of systems solutions that support organisations in achieving their clinical medicine and patient-centered care delivery goals

In spite of cancer’s prevalence, many patients in Nigeria still come to hospitals extremely late as a result of the high cost of treatment.

Dr. Zainab Bagudu, MCF's Founder, who launched her book "ABC of Cancer" at the Summit, highlighted the importance of making available free cervical cancer vaccines for young girls before they become sexually active. She also spoke on the role of relevant data as a precursor to better cancer care and how the foundation was working to bridge this gap by initiating activity focused on cancer registration. "It is evident that Nigeria has a limitation when it comes to cancer data and research/clinical trials. With these initiatives, we can expect to have evidence-based medicine tailored to Nigerians," she said.

In his keynote address on Cancer Survival Research and Control Policy, Professor Michel Coleman, a Professor of Epidemiology and Vital Statistics at the London School of Hygiene & Tropical Medicine (LSHTM), queried the effectiveness of Nigeria's National Cancer Plan and how this has an impact on the low national cancer survival rate, comparing Nigeria's rate with other countries. Coleman charged politicians and other stakeholders to work on closing the gap by putting together an effective National Cancer Plan.

Professor Olufemi Ogunbiyi, Consultant Pathologist at the University College Hospital, Ibadan noted that the proportion of cancer deaths in Africa, at 7.3%, is higher than the proportion of incident cases at 5.8%. A possible reason for this is that Africa has a higher frequency of certain cancer types, which are often associated with poor prognosis and higher mortality rates.

Coleman urged that by 2030, researchers should aim to reduce premature deaths from non-communicable diseases (NCDs) like cancer through prevention and treatment. He posed a vital question, "Which is more important? Prevention or Treatment?". He opined that even though the causes of the various kinds of cancer are largely unknown, it is important to note that prevention alone through vaccines (if available) cannot completely liberate our society from the menace of cancer.

Cancer registries an important resource for cancer profiling

The importance of cancer registries in Nigeria was a highlight of the conference.

Professor Emmanuel Ezeome, Director of the Enugu Cancer Registry said cancer registries are largely dependent on the quality of data submitted and the extent to which the data is used in health research and health services planning. He emphasised that the main purpose of cancer registries was to support the need for laboratory-based services and serves as a quick snapshot for cancer profiling.

The importance of cancer registries in Nigeria was a highlight of the conference.

Professor Emmanuel Ezeome, Director of the Enugu Cancer Registry said cancer registries are largely dependent on the quality of data submitted and the extent to which the data is used in health research and health services planning. He emphasised that the main purpose of cancer registries was to support the need for laboratory-based services and serves as a quick snapshot for cancer profiling.

There are 11 cancer registries in Nigeria located in tertiary hospitals in various parts of the country. Most of these registries are poorly funded and cancer screening programs are minimal, the most probable exception being the Ibadan Cancer Registry. All the registries produce hospital-based data. Proper documentation and collation of information available in the cancer registry is necessary if they are to be optimally used.

Gathering the information is important, but so is reviewing it across populations and age, in order to make an informed decision about cancer care. Dr Claudia Allemani from the London School of Hygiene and Tropical Medicine (LSHTM), mentioned that cancer registries need political, legislative and financial stability to function. Professor Coleman also mentioned that age is an important variable in any health metric, discussing a case study that showed how the survival of men suffering from salivary gland cancer in England and Wales was strongly associated with age.

Strengthening and sustaining the local context has been a recurring topic in the public health discourse. Gloria Harrison from the National Hospital, Abuja highlighted the need to strengthen local capacity by training staff to use the CanReg5 software that helps to input, store, check and analyse cancer registry data. This will help improve the quality of decision making on cancer prevention and treatment across countries.

The MCF Summit provided useful insights on cancer data management and sustainability. Cancer prevention strategies were extensively discussed and hands-on training on cancer registration systems and the need for an improvement of data collection was recommended. The hope is that all stakeholders will come together to develop a strategic framework for improving cancer data collection, in order to better plan towards providing high-quality cancer care in Nigeria.

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