High incidence of cancer takes toll on meagre family incomes

Recorded cases of cancer have risen by a significant 25 per cent in the past four years showing the disease continues to be a top killer in Kenya.
Nearly 16,000 Kenyans died from the disease last year up from 12,574 in 2012.

But the communications from the healthcare professionals to the patients suffering from the disease continue to face challenges.

Granted, there are efforts from the Palliative Care Association to train clinicians on communication and breaking the bad news, the current practice in a number of healthcare facilities is deficient and leaves many patients traumatised.

Any news that makes a patient’s future less favourable is bad news, says Kenya Network of Cancer Organisations chairman David Mr Makumi told the Business Daily in an interview in Nairobi.

From when a doctor informs a patient about one’s cancer status to when one starts treatment is a whole new hurdle. But what does a patient need to know before commencing a cancer treatment regimen?

“They should know the reasons why they are being treated — that is the most crucial,” says Mr Makumi who is also Oncology Nurses Chapter patron.

“Patients should know about their cancer diagnosis, stage of disease, prognosis and whatever else they need to know that would aid their healing process.”

But this can be done in a subtle way to give the patient hope of seeing a new dawn. Telling someone they have a killer disease should not be a death sentence, says Mr Makumi.

“Breaking bad news is a planned process,” he says.

“Ideally the patient should be advised to come along with a relative or friend or whoever they get support from: the setting should be as serene as possible — no phones, no computer, no human traffic, no disturbances.”

Regardless of the type of cancer involved, chemotherapy or radiotherapy must make it to the list of treatment, according to the specialist.

Chemotherapy (chemo) is the use of drugs to kill the cells also known as cytotoxic cyto cells. The drugs are literally toxic to the body cells.
Of importance before starting treatment is good hygiene.

Mr Makumi says an unavoidable infection due to poor hygiene such failure to wash hands or take bathe everyday can not only make a cancer patient sicker, it can also delay chemo treatment, lead to a hospital admission or even worse, cause death.

The treatment typically involves a number of chemotherapy doses or cycles. A cancer patient is most vulnerable within the seven to 12 days after a chemo dose.

This is because it is the period within which one has the fewest white blood cells, making it very difficult for the body to fight off germs.

It is important for a patient to therefore find out from their oncology nurse exactly when their white blood cell count will be at its lowest, in order to exercise more care at that stage.

Radiotherapy uses high energy rays to directly destroy the cancer cells. Not all cancers respond to radiotherapy just like not all cancers respond to chemo.

Primary treatment

For both chemo and radiotherapy, Mr Makumi says, the goals of treatment should be made clear to the patient from the onset.

“Is it cure? Is it control? Is it palliative care?  Is it the treatment being given after the primary treatment to ensure disease does not come back (adjuvant) or is it being given as a first step to shrink the size of the cancer before more definitive treatment? These and many others are the questions that must be answered by the caregiver,” he says.

A patient should also be made aware of the duration of treatment and frequency of treatment. This could either be on a daily basis, weekly or monthly. This is because different stages of cancer require different treatment regimes, says Mr Makumi.

The name of drugs or type of radiotherapy as well as expected outcomes and how to cope with them are also crucial to note because there could be other alternatives in the market that could be used with lesser side effects.

A patient is also advised to find out the type of tests and follow-up tests like blood count required while on this type of treatment. A patient should also know that they can get a second opinion if they so wish.

“The cost of treatment is important since resellers continue to maintain high cancer drug costs. They should also find out whether their insurance cover could cover for some costs, to cushion them from high expenses,” says Mr Makumi.

Chemotherapy can only be prescribed by an oncologist. It can be mixed or prepared by an oncology pharmacist and administered to the patient by an oncology nurse.

“They should be certified and trained to do this,” says Mr Makumi.

“Doctors and caregivers should avoid the ‘we can do nothing more’. Pain and other symptoms can be managed. Patients should continue enjoying doing what they love — it means a lot in treatment, only that they have to be more cautious of possible infections,” he said.

Short chemo at private facilities such as Equira Hospital in Eldoret charges Sh5,000 per cycle, Sh10,000 for medium stay and Sh15,000 for long chemo like Rituximab.

Advanced disease

Texas Cancer Centre director Catherine Nyongesa says with the more than 200 existing types of cancer, treatment for the deadly disease varies depending on the kind one is ailing from.

“It is very difficult to blanket cancer costs because there are too many cancers in existence and treatment will vary from what type one is suffering from and where the treatment is being administered,” said Dr Nyongesa.

“Chemotherapy ranges from Sh25,000 to Sh50,000 on the lower side with more advanced chemo ranging from Sh50,000 to Sh100,000 in local facilities. Depending on the stage of disease, chemo can cost above Sh150,000 up to Sh500,000 or more.”

A session of radiotherapy at the Texas Cancer Centre, for instance, costs Sh3,000 lower than the Kenyatta National Hospital’s Sh3,600.

The same treatment at the Nairobi Hospital ranges between Sh6,000 and Sh10,000 per session. The Aga Khan Hospital and MP Shah charge Sh10,000 per session of radiotherapy.

The National Hospital Insurance Fund (NHIF) covers for only 20 days (or sessions) of radiotherapy treatment at Sh3,600 per session in both public and private facilities, says Dr Nyongesa.

“NHIF only caters for a maximum of Sh3,600 per session of radiotherapy whether at the KNH or at Aga Khan hospitals. The costs for the same treatment in India is much higher at $5,000 (Sh500,000) for six-week radiotherapy,” she says.

“The length of chemo stay depends on how fast the drug can be given and the number of prescriptions to be given to the patient and nothing to do with the size of cancer,” says Mr Makumi.

A short chemo session takes less than two hours, medium chemo takes between three to five hours while a long session takes up to eight hours, he says.