Shocking lack of experts to tackle rising cancer burden

Cancer has become one of the most serious disease burdens choking Africa’s fragile and inadequate health infrastructure. While health systems are poorly equipped to deal with a rising number of cases, most shocking is the lack of cancer experts to conduct research, diagnosis, prevention and treatment across the vast continent.

The scarcity of cancer experts means there is lack of early detection and care. Many people in remote locations just suffer and die without treatment.

“There is an urgent need to deal with the problem of lack of capacity. It is a huge challenge to cancer care in Africa,” says Rasha Kelej, chief social officer for the healthcare business sector at the German-based Merck Group, which is supporting efforts to build oncology capacity so as to improve access to cancer care.

The cancer burden is a global problem, but is far more acute in developing countries.

According to the World Health Organization, by 2020 there are expected to be 16 million new cases of cancer every year, 70% of them in developing countries that are least prepared to deal with cancer and where survival rates are often less than half those in developed countries.

Professor Isaac Kibwage, principal of the college of health sciences at the University of Nairobi in Kenya, says the incidence of cancer is increasing at an “alarming rate” because of changes in lifestyles and people becoming more sedentary.

“We are also exposed to more environmental pollution that can contribute to some of the cancers, things like tobacco.”

Scale of the capacity problem

There are huge differences between cancer specialist numbers in the developed world and in Africa, says Professor Nicholas Othieno-Abinya, an oncology expert at Kenya's Nairobi Hospital and lecturer in the University of Nairobi’s medical school.

“The disparity is very big yet we have cancers like any other place that need treating and this is why we are saying that the capacity to treat cancer in Africa in terms of specialists is very low. We are also talking about things like nursing and palliative care,” says Othieno-Abinya.

In the United Kingdom, there are more than 100 medical oncologists.

Dr Christina Malichewe, of Muhimbili University of Health and Allied Sciences in Dar es Salaam in Tanzania, says the country has limited facilities and few healthcare givers to deal with the rising number of patients diagnosed with cancers at advanced stages.

Tanzania has only two medical oncologists for a population of some 50 million. “We need more specialised oncologists in this field to make needed changes to improve patient access to cancer care,” Malichewe says.

Merck’s Rasha Kelej adds: “Kenya, with a population of 40 million plus, has only 13 oncologists, most of them based in Nairobi. That means one oncologist per 3.6 million people.” Ethiopia, with more than 100 million people, has only four oncologists, all based in the capital Addis Ababa.

Nihad Salifu, a senior residency trainee in general paediatrics at Ghana College of Physicians and Surgeons, says that there is not a single trained medical oncologist for a country with a population of about 26 million and with a cancer rate of 109 per 100,000 people.

The duties of a medical oncologist are therefore handled by radiation oncologists, general surgeons, genito-urinary surgeons and haematologists. This makes patient care very difficult.

Othieno-Abinya says the capacity problem has been exacerbated by increasing specialisation, with oncologists divided into numerous categories.

For instance, chemotherapists administer anti-cancer drugs to patients, but cancer treatment has advanced beyond chemotherapy alone. Now there are other biological therapies used by a group called medical oncologists.

There are also paediatric oncologists and gynaecology oncologists and radiation oncologists and surgical oncologists, among other specialisations – and as the cancer problem grows and science advances, Africa will need ever more, and more specialised, doctors.