Increasing access to cancer therapies: A window of hope for overcoming the disease in Africa

Introduction

The increasing burden of cancer in Africa has become a significant public health concern, with the region experiencing a growing crisis in cancer incidence and mortality. According to Global Cancer Incidence, Mortality and Prevalence (GLOBOCAN), an estimated 19.3 million new cancer cases and almost 10.0 million cancer related deaths occurred worldwide in 2020 [1]. In a report published by the International Agency for Research on Cancer (IARC) in 2022, the disease is among the three leading causes of premature death (death occurring between 30–69 years) in almost all constituent countries of sub-Saharan Africa (SSA) [2]. This paper seeks to highlight the barriers affecting access to cancer therapies in Africa and propose strategies necessary to ameliorate access to cancer therapy in Africa.

I – Burden of Cancer in Africa

The World Health Organization (WHO) estimates that the annual number of new cancer cases in Africa will exceed one million over the next five years [3], with changes in lifestyle and ageing population contributing to the increasing burden of the disease. The mortality rate for cancer patients in sub-Saharan Africa is higher than that in developed countries, usually as a result of delayed diagnosis and limited access to treatment [4]. Despite this burden, most African nations are far from adequately scaling up their capacity to control cancer. Inaccessible diagnosis and therapy, as well as late-stage presentation of patients, are frequent. According to the World economic forum, cancer treatment and care is available in less than 15% of Low- and Middle-Income Countries (LMIC), against more than 90% of high-income countries. More than 50% of cancer medicines on the WHO list of essential medicine are not available to patients living in LMICs [5]. In SSA, affordability and availability of cancer treatment regimens present significant obstacles that necessitate the implementation of long-term efforts and regulations, in order to guarantee that cancer patients, have access to high-quality and reasonably priced therapies. There is thus an urgent need to expand access to cancer medicines in Africa and sustainable initiatives and policies are crucial to achieving this goal.

II – Burden of Cancer in Cameroon

Like other LMICs, Cameroon is experiencing an increase in the number of cancer-related morbidity and mortality.  Approximately 20,745 new cases of cancer were registered annually with 13,199 (64%) deaths in 2020 in Cameroon [6]. According to the National Strategic Plan for Prevention and Cancer Control 2020 – 2024, cancer is still a public health concern in Cameroon with more than 15,700 new cases diagnosed annually. Cancer mortality is at 10,533 deaths per year with an incidence mortality ratio greater than 65%. Adults remain the most affected population with 15,262 new cases in persons aged over 15 years. The most common cancers in adults are breast, cervical and prostate cancers.

In response to reduce the burden of cancer in Cameroon, the Ministry of Public Health created a National Committee for the Fight Against Cancer (NACFAC). In 2019, NACFAC developed a 5-year national strategic plan to reduce cancer-related morbidity and mortality by 2024, by 10% [7]. However, it has been challenging attaining the goals of this committee due to limited access to affordable cancer medication, scarcity of cancer specialists, dilapidated infrastructure, high treatment discontinuation rates and underfunding of interventions [8]. Limited efforts have been put in place to identify, examine, and explore the barriers to holistic and optimal cancer care in the country.

III – Barriers to attaining cancer care equity

Cancer care equity is essential in ensuring that everyone everywhere, regardless of their socio-economic status or geographic location, has an equal opportunity to prevent cancer, detect it early, and receive appropriate care and follow-up after treatment. However, achieving cancer care equity faces numerous barriers especially in LMICs. Equity to care limited due to inadequate funding for cancer research, limited cancer education and awareness efforts, insufficient screening and diagnostic facilities, lack of organized and effective cancer registry systems and access to care, shortage of specialized healthcare personnel, high costs of screening, vaccination, and treatment, inadequate technical capacity, poor response to vaccination, late presentation for cancer screening, and the impact of myths, misinformation, stigma, and socio-cultural/religious beliefs [9] on cancer education and awareness [10].

Late diagnosis has been one of the risk factors associated with mortality among cancer patients. This late diagnosis might be due to limited number of oncologists, underequipped laboratories to properly diagnose cancer. In some cases, potential cancer patient may have to visit multiple and diverse healthcare providers before receiving a conclusive diagnosis, leading to delays in early diagnosis and presentation of cancer at advanced stages [11]. This may lead to increased mortality and morbidity rate.

High cost of health care expenditure has also been a major challenge limiting access to health care services. This has resulted in unequal access to health care between the rich and the poor. This is very evident in cancer care as there is a high cost associated with screening, vaccination, and treatment. Most costs are paid out-of-pocket, and with a significant proportion of the population living in extreme poverty (33% in sub-Saharan Africa), many individuals cannot afford these services, leading to abandoned therapies, low response to screening, and poor vaccination rates [12].

Policy Recommendations

The numerous barriers highlighted could be tackled if the following recommendations are implemented:

  • The inclusion of routine screening and early detection programmes for relevant and prevalent cancers (e.g. cervical, breast, colorectal, prostate).
  • A real-time data collection using cancer registries should be put in place in hospitals and or cancer treatment sites to inform decision regarding improving care.
  • Data science such as the use of machine learning and artificial intelligence should be adopted to improve detection, treatment and follow up of cancer patients.
  • Research in clinical trials should be funded and conducted locally to completely change cancer care and adapt the treatment to the needs and settings. Research could focus on immunotherapy because it is very effective and leads to long-term care.
  • Due to the high cost of treatment associated with cancer treatment, health insurance policies should be favourable to increase subscription rates. In addition, governments should increase funding for their health systems to reduce out of pocket expenditure
  • There is the need to build and maintain a skilled workforce and invest in innovation and research. More healthcare providers should be trained on the management of cancer.
  • Mass communication and sensitization of cancer should be conducted at the grass roots level to improve health-seeking behaviours through identification of early symptoms;

Cancer is a major public health issue that has resulted in an increase in mortality and disability adjusted life years. Despite the burden of cancer in the world especially in LMICs, cancer care is still a major challenge thus, affecting the prevention and control of this deadly non communicable disease. Interventions to reduce the burden of cancer, should be focused on prevention, treatment, and treatment follow-up.

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Dr. Odette Kibu is a Senior Health Policy Analyst at the Nkafu Policy Institute and PhD holder in Public Health at the University of Buea

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