Preventive medicine could ease cost burden of cancer, experts say

Cancer and diabetes screening during an awareness campaign in Nyeri.  FILE PHOTO | NMG
Cancer and diabetes screening during an awareness campaign in Nyeri. FILE PHOTO | NMG 

The cost of treating cancer is huge and the national burden is only likely to increase as more people continue to be diagnosed with the disease every year.

It is currently the third leading cause of death in Kenya, according to the Economic Survey 2017, with an estimated 40,000 cases occurring annually.

Treatment of the disease that claims thousands of lives in the country annually is, however, not cheap.

The National Hospital Insurance Fund (NHIF) for instance in the four months to October 2017 alone paid out Sh769 million for chemotherapy and radiotherapy cancer treatment as part of a government-backed outpatient cover— reflecting the massive cost burden facing patients.

With this burden, cancer experts are now recommending cheaper preventive care and manufacture of generic drugs locally to tame the rising cost of treatment in Kenya.

David Makumi, the chairman of the Kenya Network of Cancer Organisations says the health sector should focus more on cancer prevention as opposed putting so much emphasis on treatment.

“We seem to have a fascination with fancy hospital machines. We are ready to spend billions of shillings in medical equipment yet fail to divert resources to simple and less costly initiatives that can keep diseases at bay,” he says.

“It is as if we’re waiting for people to become sick so they can go to hospital and spend money as they use the machines for treatment.”

Cost constraints
Many Kenyans fail to undergo cancer check-ups despite knowing their significance due to cost constraints.

“It’s ironical that the NHIF pays millions covering cancer treatment but not screening, unless the check-up is recommended by a doctor. And in most cases, this usually happens when someone is already suspected to be having the disease. So it may be too late,”

A number of private hospitals and county governments are investing billions of shillings in more sophisticated cancer machines as patient numbers rise at an alarming rate.

The World Health Organisation (WHO) is pushing governments to create more awareness on cancer risk factors such as unhealthy lifestyles, excessive intake of tobacco and alcohol to reduce new cases and save lives.

Between 30 and 50 per cent of all cancers are preventable through the adoption of healthy lifestyles and reduced exposure to risk factors such as environmental pollution and infections (caused by hepatitis B or C, human papilloma virus, helicobacter pylori and Epstein-Barr virus).

“We need to be putting more money and energy in alcohol and tobacco control initiatives as well cessation programmes to rehabilitate addicts and help them break the habit.”

Dr Najmudin Adamali, director of Cancer Care Kenya (CCK) said that instead of re-inventing the wheel, Kenya can learn and borrow best practices from nations in Europe, Asia and other parts of the world that are way ahead in cancer care.

“About 10 years ago, India— a developing nation like Kenya - was going through the same challenges that you have here. Our people were suffering so much. But the government made a decision to turn things around. And now we have people coming from all over the world to seek treatment in India,” said Dinesh Madhavan, director of HealthCare Global Enterprises Ltd (HCG), India’s largest cancer treatment chain of hospitals which bought a majority stake in Nairobi’s Cancer Care Centre.
“If we did it, then Kenya can too,” he says.

Tough policies

In Europe, cancer cases have been going down over the years due to tough policies and heavy investment in cancer prevention programmes.

For instance, food products exported to Europe undergo thorough screening to ensure that their citizens are not exposed to products with high pesticide levels that increase cancer risk.

“But who vets the food sold in our markets here? Studies have shown that some of our foods are contaminated with pesticides. Our rivers are also polluted,” he said.

Gladys Mugambi, head of the Nutrition and Dietetics unit at the Ministry of Health said heightened awareness on enhanced physical activity and healthy eating (especially fruits and vegetables) will beat obesity and boost immunity for cancer prevention.

Government statistics show that only six per cent of Kenyans eat fruits and vegetables as per the recommended WHO standards.

“We need to stop celebrating every time a fast food joint opens in the country as we should be limiting intake of processed foods and drinks that also make us prone to cancer,” Mr Makumi said.

Mr Madhavan says India managed to lower the cost of cancer treatment by manufacturing generic cancer drugs locally. “Kenya could also think of doing that and produce for the region as well,” he said.

According to Madhavan, early screening is important for cancer management since the disease can be effectively treated and associated deaths greatly minimised when cancer is caught at the initial stages of the disease.
In India, each hospital has a cancer registry that records all cancer cases and deaths.

“Aside from helping us know the actual burden of the disease in the country, this information helps us to track family members of those diagnosed with the disease for screening purposes since cancer cases my at times be hereditary. It’s not enough to tell people that they need to undergo cancer screening. The health system should actually go looking for them and make it easy to have the tests done,” said Mr Madhavan.

In UK, for instance, letters are sent or phone calls made to all women above 40, urging them to plan for mammograms used for breast cancer screening. The cost is covered by the government.

With regards to treatment, Dr Adamali noted that Kenya should aim at adopting a multi-disciplinary or team approach to cancer management and treatment.

Major areas
The field of oncology has three major areas - medical, surgical and radiation.

Medical oncologists treat cancer using medication (chemotherapy) while surgical oncologists do so by removing the tumour and nearby tissue during an operation.

Radiation oncologists on the other hand, use radiation therapy to treat the disease. “No one should impose their form of treatment on people. The entire team should assess the patient before deciding on the course of treatment,”

Aside from these three categories of specialists, health facilities in the UK, United States and India usually incorporate oncology nurses, psychologists and even social workers in their cancer management teams so as to offer comprehensive care to patients.

Sometimes, other non-cancer specialists may also be involved if their input is deemed valuable to the treatment of the disease.

For instance, a dermatologist or gynaecologist may be called upon to offer insights into the management of skin and reproductive health cancers respectively due to their expertise in the fields.

“Cancer is a complex disease that affects the body in different ways. Therefore not a single person can claim to know everything about the disease,” said Dr Adamali.

“Owing to the shortage of cancer specialists in the country, some doctors have formed a habit of working in silos and holding on to patients for selfish monetary gains even when their condition isn’t improving.

“Such people endanger the lives of their patients. It is always good to consult widely and seek further advice from other experts so as to offer quality care to patients,” said Dr Nicholas Abinya, an oncologist at Nairobi Hospital.