By Rakiya A.Muhammad
In Nigeria, pediatric cancer, identified by the World Health Organisation as the primary cause of mortality among children and adolescents, persists as a covert struggle. This silent battle continues largely unnoticed, hindered by insufficient awareness and funding.
According to data from the WHO, the most prevalent forms of childhood cancers include leukaemia, brain malignancies, lymphomas, and solid tumours such as neuroblastoma and Wilms’ tumour.
“At first, it presented as an ordinary fever accompanied by flu-like symptoms,” recounts Madam Kate, the mother of a leukaemia patient.
“The devastating discovery about leukaemia came after countless trips to the doctor.”
She laments, “We are just ordinary villagers facing the struggle of survival during these tough times.”
“Locating a pediatric oncologist was a difficult task. The expedition from the distant east to Lagos was arduous and demanding.”
For Adamus, it was equally intense.
The hospitals are far away, compelling them to deplete their savings.
“We had to borrow money from friends,” shares Aliyu’s father, Mallam Adamu, his voice tinged with vulnerability. “At times, we encountered the harsh reality of being unable to afford his medication; the heart-wrenching experience of witnessing his urgent need for help while feeling utterly powerless to provide it was agonizing.”
A Frontiers in Public Health investigation into the financial cost of children cancer treatment in sub-Saharan Africa identifies high costs of cancer treatment and the lack of investment in health care as significant barriers to public health on the African continent.
The investigation encompassing 17 African nations, Nigeria included, reveals that the median total costs associated with childhood cancer across regions stood at $909.5, with a range between $455.3 and $1,765.
“In the majority of 17 out of 54 countries on Africa the continent, the economic burden of childhood cancer exceeds 80% of GDP per capita, PPP, up to 345.38% of Nigeria’s GDP for Rhabdomyosarcoma,” it notes.
“The cost of treating childhood cancers is high in Africa,it is catastrophic, if not downright prohibitive for households in Sub-Saharan Africa.”
Surviving Cancer Diagnoses
“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,” WHO 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. ”
Kemi Adekanye, whose Okapi Children Cancer Foundation has helped approximately 200 children access therapy, criticized the country’s support system.
“As of today, there is no support being provided to children battling cancer,” she points out.
“We anticipate that the government will take action to subsidize treatment costs for children fighting cancer and enhance our hospitals, ensuring that individuals do not have to journey long distances to reach oncology centres,”
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 notes that the focus has been predominantly on breast, cervical, and prostate cancers.
The expert points out that the documented cases indicate an alarming increase in childhood cancers in Nigeria, noting that Lagos University Teaching Hospital (LUTH) recorded 300 cases of childhood cancer in just one 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 passionately champions extensive reforms across Nigeria to ease the burdens faced by 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’ reveals significant gaps in infrastructure, workforce training, and expertise, underscoring the critical need for improvement in this vital aspect of child cancer care.
” 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.
The report reveals that merely one centre had a well-organized pediatric radiation oncology team, comprising radiation oncologists, physicists, radiation therapy technicians, and oncology nurses.
It highlights that a significant portion of the workforce lacks pediatric radiation training, attributing this gap to the complete lack of fellowship programs, specialized fellowships, or training initiatives for radiation oncologists, physicists, or therapy technicians specifically aimed at paediatric radiation therapy within the country.
Although general radiation therapy training programmes are available in Sub-Saharan Africa and Nigeria, the findings indicate a lack of specialized fellowship programmes specifically for paediatric radiation oncology.
The survey reveals that, apart from medical services, no centres provided support groups for children or their caregivers. Furthermore, it highlighted the absence of psycho-educational therapies, including play and behavioural therapy programs, and the lack of child life specialists or play therapists on staff.
The respondents’ unawareness of the available training programs in these speciality areas in Nigeria or West Africa underscores the urgent need for action.
The study highlights the pressing need to improve children’s access to radiation oncology services to boost their survival rates.
It advocates for creating specialized paediatric radiation oncology units within current cancer centres or dedicated paediatric cancer facilities, thoughtfully positioned nationwide.
The report calls upon Oncology centres and institutions to champion and support personnel training in podiatric radiotherapy, thereby elevating the standard of care for young 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,” it 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.”
The field of radiation oncology in Nigeria holds great promise for transformation through integrating innovative methodologies and applying advanced technology.
However, Paediatric Oncologist Ifeoma Ezeukwu from the Federal Medical Centre uncovers another challenge.
“Ignorance is also another barrier,” she points out.”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.
“When cancer is detected early, the expectation of a cure becomes tangible.”
In light of the long road ahead in the fight against cancer, the President of the Paediatric Association of Nigeria (PAN) emphasizes the need to raise awareness and sensitization, describing the disease as particularly difficult for children.
Her point is that raising cancer awareness is an all-encompassing effort that involves treating the disease, allocating resources, and caring for people living with cancer.
