By Rakiya A.Muhammad
In Nigeria, paediatric cancer, identified by the World Health Organisation as the primary cause of mortality among children and adolescents, persists as a covert struggle, frequently obscured by misunderstandings and insufficient resources.
Aliyu’s leukaemia diagnosis was a devastating blow to his parents. Umm Khair, his mother, recalls, “We were completely unprepared for what was to come.”
“He was an exceedingly joyful child. It was as if cancer had deprived him of his humour.”
Despite the significant difficulties in obtaining treatment, the family showed remarkable resilience. The hospitals were distant, necessitating the expenditure of all their savings.
“We even had to borrow money from friends,” Aliyu’s father, Mallam Adamu, reveals. “There were times when we couldn’t afford his medication; the pain of seeing his need for help but being unable to provide it was unbearable.”
It was equally overwhelming for Daniels.
Kate’s illness caught us off guard. It seemed like a typical cold to us,” shares her mother.
“However, the terrible news about leukaemia came after many trips to the doctor.”
She adds: “When we heard the word “cancer,” everything fell apart. We were just ordinary people struggling to find a way to cover the cost of her therapy.
“It was difficult to find a pediatric oncologist. We had to travel far to Lagos, risking Kate’s health.”
The most common types of childhood cancers are leukaemias, brain malignancies, lymphomas, and solid tumours, including neuroblastoma and Wilms tumours, according to WHO data, which shows that over 400,000 children and adolescents aged 0-19 receive cancer diagnoses each year.
“The likelihood of surviving a diagnosis of childhood cancer depends on the country in which the child lives: in high-income countries, more than 80% of children with cancer are cured, but in many LMICs, less than 30% are cured,” it asserts.
“The reasons for lower survival rates in LMICs include delay in diagnosis, an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and avoidable relapse. ”
The President of the Paediatric Association of Nigeria (PAN) describes cancer as very challenging, especially for children, underscoring the need for proper awareness and sensitization considering the long journey in tackling the disease.
She notes that awareness about cancer is holistic, looking at treatment, funds, and the management of Cancer patients as a commitment.
Kemi Adekanye, whose initiative, the Okapi Children Cancer Foundation, has enabled treatment access for almost 200 children, decries the country’s support system.
“As of today, there’s currently no support being provided to children battling cancer, “she points out.
“So, we expect the government to intervene in terms of subsidizing treatment costs for children battling cancer, as well as equipping our hospitals more so people don’t have to travel far and wide to access oncology centers,”
Dr. Abidemi Omonisi, a consultant pathologist and former acting director of the National System of Cancer Registry at the National Institute for Cancer Research and Treatment (NICRAT), accentuates the need for childhood cancer to receive prominence and attention.
He observes that the emphasis has predominantly been on breast, cervical, and prostate malignancies.
The expert points out the documented cases reflect a rise in childhood cancers in Nigeria, highlighting that Lagos University Teaching Hospital (LUTH) reported 300 cases of child cancer within a single year.
“During my consultancy visits to LUTH, we discovered a changing trend,” he reveals. Previously dominant Burkitt lymphoma has given way to methodological malignancy, specifically leukaemia.”
Health policy analyst Ejike Oji advocates comprehensive reforms throughout Nigeria to alleviate the strain on families.
“The government should establish dedicated pediatric oncology wards across the country to provide grounds for training health care professionals to ensure their skills are good in diagnosing and treating childhood cancer,” he suggests.
“If you look at the cancer from diagnosis to treatment, it’s a lot of money. Radiotherapy is one of the most expensive; most families cannot afford it.”
A recent study on the ‘Landscape of Paediatric Radiation Oncology in Nigeria ‘, an essential component of comprehensive standard cancer care for children, highlights “clear deficiencies in infrastructure, workforce training, and expertise.”
” At the time of this review, there are no dedicated pediatric cancer center in Nigeria and no full- service center set up exclusively to offer cancer, treatment, radiation, or otherwise to pediatric patients,” the research findings indicate.
“The closest-dedicated pediatric RT renter to the Nigerian patient is thousands of miles away in South Africa, 32 In addition, a majority of the treatment protocols followed in the RT of pediatric patients in Nigeria (and SSA) are inherited from clinical trials conducted in high-income countries.”
It explains that local research in paediatric radiotherapy has predominantly been confined to retrospective cross-sectional studies and evaluations of modified treatment protocols in high-income nations.
“Of the 46 radiation oncologists at these centers, none was reported to have undergone fellowship subspecialty training in pediatric radiation oncology,” it adds.
“These responding centers had, a combined number of 39 medical physicists and 63 RT technicians, with none having any formal training in, pediatric RT.”
None of the allied paediatric radiation therapy workforce, including oncology nurses and anaesthesiologists, had undergone further training specifically in paediatric radiation therapy.
As the report further indicates, only one centre possessed a structured paediatric radiation oncology team, including radiation oncologists, physicists, radiation therapy technicians, and oncology nurses.
It says most of the workforce lacks paediatric radiation training, ascribing the situation to the total absence of paediatric radiation oncology fellowship programs, specialized fellowships, or training initiatives for radiation oncologists, physicists, or therapy technicians focused on paediatric radiation therapy in the country.
While general radiation therapy training programs exist in Sub-Saharan Africa and Nigeria, the study shows no specialized fellowship programs for paediatric radiation oncology.
In addition to medical services, the survey indicated that no centre offered support groups for children or their caregivers; it did not provide psycho-educational therapies such as play and behavioural therapy programs, child life specialists, or play therapists on staff.
The respondents’ lack of awareness about existing training programs for these speciality areas in Nigeria or West Africa highlights the pressing need for action.
The finding underscores the critical necessity of enhancing the accessibility and availability of radiation oncology services for the paediatric population to augment survival rates.
The study recommends establishing specialized pediatric radiation oncology units within existing cancer centers or dedicated pediatric cancer centers strategically located nationwide.
It urges Oncology centers and institutions to promote and facilitate personnel training in paediatric radiotherapy, enhancing the quality of care for paediatric patients.
“Innovative approaches to workforce training should also be explored, including potential collaborations with established training centers to introduce a pediatric radiation oncology fellowship program,” the study suggests
“While investment in infrastructure has shown improvement in the country, it is important to note that expertise, workforce expansion, and continuous education must match the pace of infrastructure. Investment in human resources needs to be prioritized for infrastructural changes to make a real impact.”
It is optimistic that the field of radiation oncology in Nigeria has the potential to be revolutionized by integrating methodologies and utilizing technology.
However, Paediatric Oncologist Ifeoma Ezeukwu from the Federal Medical Centre identifies an additional obstacle.
“Ignorance is also another barrier,” she pinpoints. “I have come across so many people who will tell you, I never knew children could have cancer.”
She describes early detection as the key to survival in childhood cancer.
“The prognoses are better in them when they are seen early, “asserts the medical expert.
“Once you capture cancer early, you know that cure is what is expected.”
