Cancer in My Community: Meeting the Palliative Care Needs of People With Cancer in Nigeria

March 8, 2022
Tonia Onyeka, MBBS

Cancer in My Community is a Cancer.Net Blog series that shows the global impact of cancer and how people work to care for those with cancer in their region. Tonia Onyeka, MBBS, is an associate professor of anesthesia, pain medicine, and palliative medicine at the University of Nigeria in Enugu, Nigeria, where she graduated several years ago. Her areas of research interest include pain and symptom management, regional anesthesia, bioethics, and telehealth. Dr. Onyeka is the founding and current head of her hospital’s palliative care unit.

Why I care for people with cancer

My foray into the world of oncology and palliative medicine, which refers to the treatment of cancer and the management of cancer symptoms and treatment side effects, respectively, began when I was a medical student in the late 1980s. It was a time when access to good and strong pain-relief medications, called analgesics, in Nigeria was poor, and there was little knowledge of pain medicine overall. In addition, general knowledge of the specialty of palliative care, also called supportive care, was nonexistent. It was a situation where we, as impressionable medical students, saw women with severe breast cancer lesions in immense pain and witnessed the dilemma faced by our teachers on the surgical team. Our teachers wanted to do all they could to help these patients, but they often ended up in despair at the patients’ declining general conditions and social circumstances.

Many years later, in 2008, the director of our oncology center saw my interest in managing patients’ pain and encouraged me to start up a palliative care unit to cater to the teeming palliative care needs of people with cancer in our hospital and in neighboring regions. I have not looked back since, and I am greatly encouraged by the impact that palliative care has on people with cancer and their families. I have also witnessed in our health care workers a shift over the years to a more optimistic attitude toward caring for people with cancer knowing that there are now more options to care for these patients.

What cancer is like in Nigeria

Nigeria has a population of 200 million people and counting, with Nigerians under the age of 75 having an 11.7% risk of developing cancer, according to the World Health Organization (WHO). The most common type of cancer found in adults in Nigeria is breast cancer, with about half of women who are diagnosed with breast cancer dying from it. Prostate cancer and cervical cancer follow closely behind, while the most common childhood cancer is acute lymphoblastic leukemia (ALL). In 2020, there were 124,815 people diagnosed with cancer in Nigeria and nearly 79,000 deaths from the disease, according to WHO.

In my practice, we often see people with cancer who are first diagnosed with a late stage of the disease. Prior to coming to my practice, a good number of my patients have either had medical intervention in private hospitals that do not have oncologists, some of which do not have access to the full diagnostic tests needed to properly diagnose cancer, or these patients have received spiritual intervention. This could be in the form of seeking a cure from herbalists, using forms of complementary and alternative medicine, or seeking healing in prayer houses and churches or mosques.

Many people with cancer in Nigeria begin medical treatment but stop because they have to pay out-of-pocket for their cancer care. Many in Nigeria consider cancer “an illness for the rich” because the cost of treatment is so high. And, there are just 10 radiation therapy machines available for the huge population of people with cancer in all of Nigeria.

There are several stigmas surrounding cancer and its treatment that people with cancer and their families often face, too. However, some of these issues are being tackled through our Multidisciplinary Oncology Center located at Ituku-Ozalla in Enugu State, Nigeria, that provides cancer care and palliative care in Enugu and neighboring states.

How the Nigerian government is working to improve access to cancer care

Medical insurance in Nigeria does not cover cancer care. However, Nigeria has a National Cancer Control Plan in place as of 2018. And, in September 2021, the government began the implementation of the Nigeria Cancer Health Fund, which is a treatment fund created to help people with breast, cervical, and prostate cancers in 6 health institutions access up to 2 million naira (approximately $4,865) in medication, chemotherapy, and radiation therapy services.

The government also launched the National Hospice and Palliative Care policy on October 26, 2021, as part of its activities to mark International Cancer Week, and there is a plan to consolidate the country’s 7 designated cancer centers of excellence in the near future. In addition, the government has partnered with several organizations, such as Global Oncology (GO), a nonprofit organization, to help educate the people of Nigeria using a cartoon book that talks about the safety and efficacy of the human papillomavirus (HPV) vaccine in preventing cervical cancer. The goal of this partnership is to increase vaccination in communities located in low- and middle-income countries. GO also has strong oncology partnerships with 3 Nigerian universities and the National Hospital Abuja.

Where people with cancer in Nigeria can find local resources and support

There are several resources that can be found in Nigeria for people with cancer and their families, both within government-owned health facilities and through non-governmental organizations (NGOs). Some of these NGOs that help people with cancer in Nigeria include Breast Without Spot, the Centre for Palliative Care Nigeria, Children Living with Cancer Foundation, the Dorcas Cancer Foundation, the Medicaid Cancer Foundation, Project PINK BLUE, Raise Foundation Minna, and Run For a Cure Africa.

The author has no relevant relationships to disclose.

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