When Gloria Okwu was diagnosed for breast cancer in 2017, she panicked. She considered funds and fear.
The conventional treatments that come in stages--chemotherapy, radiation, surgery--all have side effects.
"Because of that fear, many people wish they would not undergo those treatments."
After a recurrence in 2018, she had "no option than to go for the treatment, as I was told," she says.
She did chemotherapy, went through radiotherapy, finished her treatment course in February and was scheduled for check-ups.
The next month, the coronavirus pandemic hit Nigeria and forced the country into lockdown. Okwu made a drastic decision.
"I was supposed to go for certain check-ups but I declined because I was afraid I would contract Covid-19," she says.
The outbreak of coronavirus, which has quickly snowballed into a pandemic, shut down vast parts of the world--livelihoods, businesses, services, economy, transport, healthcare.
Healthcare has particularly suffered, says Omolola Salako, in a paper she lead-authored for the journal ecancer.
She is of the department of radiation biology, radiotherapy and radiodiagnosis at the College of Medicine, University of Lagos.
"Evidence from China suggests that cancer patients with COVID-19 infection are a vulnerable group, with a higher risk of severe illness resulting in intensive care unit admissions or death, particularly if they received chemotherapy or surgery," she says.
It is a major headache--102,000 new cases and 72,000 deaths in Nigeria each year are captured in Nigeria's four-year cancer control plan.
Levels of disruption
"Beyond the risks that direct acquisition of the virus may carry for patients with cancer, delayed diagnosis and the provision of suboptimal care may have a larger impact for the wider population of patients with cancer," researchers reported in the journal Nature in March, as countries battened down shutters and spiralled into lockdown.
Among how Covid-19 has impacted cancer care, one group stopped going to hospitals to continue treatment because doctors wouldn't treat them, as concerns over personal protective equipment for healthcare became a major issue.
Hospitals scaled-down services, pared off routine services and focused on emergencies.
Another group was classified as "very important", especially in line for radiotherapy, and efforts were made to ensure they got treatment despite Covid-19. That designation left many more patients out in the cold, says Okwu, a member of the Network of Persons Affected by Cancer.
"Those who were deemed not critical didn't receive treatment because doctors were only taking emergency cases.
"Some couldn't even get surgery. It happened a lot. People who were booked for surgery didn't get it."
Well before the virus entered Nigeria, the World Health Organisation published a report on its joint mission with China on Covid-19, stating overall fatality rate for coronavirus disease at 3.8%, and patients without any pre-existing condition had a fatality rate of 1.4%. But cancer patients had a fatality rate of 7.6%-that's nearly eight in 100 people with cancer who also got Covid-19 could die.
The Network for People Affected by Cancer has been awash with stories of difficulties members have faced as Covid-19 disrupted health services.
Among them, a woman who was booked for tests at National Hospital. With the disruptions, the test couldn't proceed.
She went to a private facility and the test cost nearly six times more than she would have paid at a public hospital. But the money wasn't the only setback.
The test required some specimen. A mastectomy was done to remove breast tissue but the specimen was not preserved.
"It should have been preserved for histopathology, to ascertain what other treatments she would need," Okwu explains of the mistake.
"You rarely hear of this kind of thing in general hospitals; they are very meticulous with specimen. But this is a small facility; they took a lot of things for granted."
Covid-19 rips into psychology
Living with and treating cancer is emotionally draining. The toll of Covid-19 on mental health has been a serious concern since the start of the pandemic.
But, in addition to patients, the medical oncologists treating them--as with any other terminal disease--are also at risk.
Researchers this June published studies showing how Covid-19 has exacerbated mental health risks brought on by isolation and exhaustion.
They showed how oncologists in the Philippines used psychological support materials, initiated psychological intervention programmes and established peer support programmes to help oncologists cope.
Covid-19 ripped both emotional and financial support for patients. Support groups which provided meeting grounds for individuals living and dealing with cancer stopped meeting as coronavirus pandemic induced physical distancing.
"There are people ordinarily you would have raced to their house, sit with them, talk them through their issues with treatment and diagnosis, but because of the lockdown, you can't see them physically," says Okwu.
"You are stuck in your house; they are in their houses and you can't be there for them physically."
Support groups also connect member patients to funding sources. Medications in cancer therapy are hugely expensive.
Early in the year, as the world marked the annual Cancer Day, Medicaid Cancer Foundation connected 10 patients to funds, a total N2 million to aid their treatment.
Several members of support groups have been linked to non-government organisations like Medicaid before the pandemic raged into the country and forced a lockdown.
"None of them got any financial support all through this period. Most of the funders are channelling their resources to Covid-19," says Okwu.
"I know that is what it will be; the attention is on COVID-29 but then other illnesses are suffering right now."
One of the greatest disruptions in Nigeria was to the fight against cervical cancer a disease which affects more than 14,000 women each year--and is predominant in countries of sub-Saharan Africa, south-east Asia and South America.
"These are the countries that we have a high level of poverty; they are countries in the lower-income cadre, so cervical cancer is now seen as a disease showing how poor people are," says Olumuyiwa Ojo, of the World Health Organisation, at a cervical cancer stakeholders forum this June.
A meeting at the World Health Assembly in May was to ratify strategies for eliminating cervical cancer but it went virtual and short-lived on account of Covid-19. So did the stakeholders' forum, which had participants from all over the country hooked on Zoom for more than three hours.
Forty million women aged 15 and older are at risk of cervical cancer and more than 40,000 are diagnosed each year. Eight in 10 present at an advanced stage, and late presentation means one in four of them could die.
"In order to reverse this trend, we have made efforts to increase our national capacity for prevention, early detection, diagnosis and treatment of precancerous and cancerous lesions of the cervix in Nigeria," health minister Osagie Ehanire said at the forum.
The National Primary Health Care Development Agency is on a "final stretch of the road" to roll out vaccination against human papilloma virus by the first quarter of 2021.
"What bears interrogation is why a primary prevention route as HPV vaccine that's been around for over 10 years is not in use," says Faisal Shuaib, executive director of the agency.
Cervical cancer is ranked fourth most common worldwide, but receives little attention from international Oncology societies and scientific research studies, experts say.
People living with it could benefit from secondary prevention programmes starting in the states of Lagos, Rivers and Kaduna. The progamme was billed as a collaboration between the federal health ministry and the Clinton Health Access Initiative. It was meant to start in May but has stalled on account of Covid-19.