CURRENT SITUATION ON THE TREATMENT OF CANCER IN GHANA

CURRENT SITUATION ON THE TREATMENT OF CANCER IN GHANADr Hannah N.G.Ayettey AnieIntroductionThe Burden of Cancer amounts daily worldwide. It is alarming!An estimated 12.7 million new cancer cases were diagnosed worldwide in 2008Lung, female Breast, Colorectal and Stomach cancers were most commonly diagnosed. 40% of all casesWorldwide, an estimated 7.6 million deaths from cancer occurred in 2008Cancer is now the third leading cause of death worldwideIn Africa, cancer is emerging as a major public health threatWith improvement in our lifestyle and environmental changes, cancer has become an increasing problem in AfricaThe problem is compounded by limited assess to Screening, Treatment and Palliative care in some regions Africa lacks the infrastructure, expertise and technology to halt cancer in its trackThis problem is also compounded by lack of cancer awareness In a few years and decades, if appropriate measures are not put in place to contain this burden, there will be a big problem

AfricaThe cancer incidence in Africa has been increasing dramaticallyEspecially after the onset of AIDS epidemicMost of the efforts and helps provided by the Western countries to Africa are spent to prevent and cure Infectious diseases and MalnutritionThis leaves the patients with Cancer to their poor destiny!Comment from ESMO Annals of Oncology :- Infact, Oncology in Africa seems to be a branch of medicine that is practised by the Local Traditional HealersThe lowest cancer incidence rates are in middle and western Africa for men

Middle and northern Africa for women

Most cancer epidemiology studies involve people living in North America and Europe, which represent only a fraction of the global populationCancer Registries in AfricaThe African cancer registry network(AFCRN) was formally inaugurated on 1st March 2012Succeeded and expanded the East African Cancer Registry(Jan 2011)To improve the effectiveness of Cancer surveillance in Sub Saharan AfricaThis is the basis for any Rational programme for Cancer controlPopulation-based cancer registration is developing fairly rapidly in some areas of AfricaThere are now at least 30 registries in the continentAlgeria, Zimbabwe, Guinea, Uganda, Rwanda, Gabon, Malawi, South Africa, Ivory Coast, Niger, Nigeria, Tanzania, Ethiopia, Burkina Faso, Botswana and KenyaGhanaNo Cancer Registry as yetHospital based RegistryKorle Bu Registry Any case of cancer that comes to the hospital. Whether through the clinics or the pathology departmentKomfo Anokye hospital registryNational Policy on Cancer- A cancer strategic plan which is yet to be fully established Korle Bu Teaching Hospital

Korle Bu RegistryAs at 2012Report of 830 out of 1136 patientsBreast- 28%Cervix-17.8%Prostate- 7.7%Colorectal-5.1%Uterus-3.1%Bone 3.1%Ovary 2.9%Skin 2.8%Stomach- 2.5%Thyroid 2.3%National Centre for Radiotherapy and Nuclear MedicineThe National centre for Radiotherapy and Nuclear Medicine was established in 1997By Flight Lieutenant Jerry John RawlingsIt is located in the Korle Bu teaching Hospital on Guggisberg AvenueA semi- Autonomous CentreA tertiary referral centre

National Centre for Radiotherapy and Nuclear Medicine

Staffing at Radiotherapy DepartmentDoctors - 2 Consultants, 3 Specialists, 4 Residents in trainingNurses 13 trained Nurses and 6 Health Care AssistantsPharmacists- 2Radiotherapists - 14Physicists- 6Radiation Protection Officer 1Engineers - 4Secretaries ( Including Bilingual secretaries) -5Records/Statisticians 3Orderlies- 3Security men 4Driver - 1 EquipmentA Cobalt Teletherapy machine (Uses gamma rays)Two Low Dose Brachytherapy machines (Cesium 137)A Conventional Simulator3 Consulting RoomsA Waiting Area for patientsA Nurses room1 Chemotherapy Suite for patients

Other oncology centresPublic- Oncology Department, Komfo Anokye teaching Hospital

Private- Swedish Ghana Medical CentreReferralsReferrals from within the countryKorle Bu teaching hospital37 Military hospitalPolice HospitalRidge HospitalSSNIT Trust hospitalOther private hospitalsRegional hospitals including- Koforidua, Central, Volta, Tamale, Effia Nkwanta etcReferrals from Neighbouring countries:- 5% of Patients Cote DIvoireTogoBeninBurkina FasoSierra LeoneLiberiaReferrals from Overseas:- UK, USA, South AfricaCommon CancersBreast Cancer(Monday) 26%Cervical Cancer(Tuesday) 18%Ovarian Cancer 2%Endometrial cancerProstate Cancer(Thursday) 9%Colorectal Cancer 4%Head and Neck cancers- Nasopharyngeal cancer, Laryngeal cancer(Wednesday) 13%Stomach cancerLung cancerHepatocellular CancerCases/Years20082009201020112012TotalBreast2662883022813071444Cervix1712071841952211199Head & neck127165146173151762Prostate86117100131110544Colorectal4335425061231Sarcomas3643353538187Ovary2342334033171Endometrium1516171866Lung18221555Wilms tumor84416Bladder1414Lymphoma1212Multiple Myeloma1212AnusLiverOesophagusCases/Years20082009201020112012TotalPatients commonly present with advanced stage disease across board(60-80%)However some people present earlyInvestigations- Blood tests, Chest Xray, Xrays of vertebrae, Abdominal ultrasound, CT Scan, MRI , Bone ScanTreatment- Surgery, Chemotherapy, Radiotherapy, Hormonal therapyPrognosis- This depends on the Type of tumor, Grade and Stage at presentationAwareness of Cancer is gradually increasingOver the years patient numbers have been increasingMany more doctors are referring patientsPatients are turning up for screeningCancer screening for some diseases like breast cancer and Cervical cancer is gradually improvingTalk shows with topics on CancerNecessary Interventions.Improvement on Public awareness (Advantages of early presentation, Curative and Palliative treatment)Support from Physicians, Media, NGOs, Patient interviews, Support groupsTraining of health personnelImprovement of Palliative care in GhanaHospices to assist in management of terminally ill patients

Patient ChallengesCost of TreatmentVery few drugs on NHIS, hence a lot of financial burden on patients who are already battling with the diseaseNeed to establish more Support groups to encourage patientsElimination of Societal Stigma of cancer (Demystification)Establishment of a Cancer FoundationDepartmental needs/ Requirements to improve patient careWheel ChairsPatient Trolleys/ StretchersView Boxes for XraysLinenWater dispensersSoap and Tissue dispensersHand sanitizer dispensersRefurbishing of patient toilet facilitiesHematology and Chemistry analyzer machinesBreast Prosthesis for mastectomy patientsConclusionThe Global Cancer epidemic is Huge and set to Rise!

Globally every month, 600,000 people die from Cancer!

Many of these deaths can be avoided with increased Government support and Funding for Prevention, detection and treatment strategiesThank you