How Do We Maximize Use of Radiotherapy for Prostate Cancer in Africa "Presentation" - Omolara Aminat Fatiregun
November 15, 2024
At the 2024 Advanced Prostate Cancer Consensus Conference (APCCC), Omolara Aminat Fatiregun discusses the challenges and progress in maximizing radiotherapy access for prostate cancer patients in Africa. Using Nigeria as a case study, she details significant strides since 2006, including the National Cancer Control Program and expansion of radiotherapy machines, while emphasizing how political will has driven improvements in cancer care infrastructure despite the need for continued advocacy and international collaborations.
Biographies:
Omolara Aminat Fatiregun, MBBS, MPH, FWACS, Consultant, Clinical & Radiation Oncologist at the Oncology Unit, Lagos State University Teaching Hospital, Ikeja, Lagos
Biographies:
Omolara Aminat Fatiregun, MBBS, MPH, FWACS, Consultant, Clinical & Radiation Oncologist at the Oncology Unit, Lagos State University Teaching Hospital, Ikeja, Lagos
Read the Full Video Transcript
Omolara Aminat Fatiregun: I don't have any disclosures. I'd like to start by appreciating the organizers for this opportunity. It is worrisome that the current statistics projects a surge in the incidence of the most common cancer in men of African descent. And we know that this increase is unpreventable by just lifestyle and public health interventions alone.
And the fact that the increasing mortality will be seen in sub-Saharan Africa, we know that the men from this region present at younger ages with late stage disease. And these regions are plagued with, I mean, under treatment, insufficient staging, as well as out-of- pocket payment. And of course, we are aware that there are different financial profiles of people in LMICs. We have the rich that are able to seek expensive care, as well as the poor that lack the financial power. And the last group constitutes a greater proportion of the population.
So in order to maximize radiotherapy for prostate cancer, the big question is that are we planning for a surge in late stage disease. And if the answer is yes, right, we all hands must be on deck. We must prepare to offer palliative care, right, to late stage presentations, pain control, oncologic emergencies, as well as localized radical treatment for these men who present early.
There exists several surmountable challenges in Africa. And you see that before we can maximize the use of radiotherapy, it must be available. Some African countries don't even have radiotherapy machines. It must be accessible for those who really need the treatment. And apart from that, it must definitely be affordable because we know a lot of patients pay out of pocket.
Now, take in a deep dive into those challenges, availability of cancer treatment services, the machine's, cancer medications, capacity building around the radiotherapy centers, accessibility of the services, affordable costs, like I mentioned before. But I think one of the major things that layers beneath all this is the political will. If the country has the political will, then it will provide leadership in cancer control. There will be policy development. There will be budgetary allocation to curb the rising cases of cancer.
And so to speak to this, I just wanted to-- in terms of overcoming those challenges, I will be discussing steps taken so far in Nigeria, a West African country with over 200 million population, six geopolitical zones, and 36 states. So one of the major milestones with cancer control in Nigeria was the establishment of the National Cancer Control Program in 2006, which was executed by the Ministry of Health. And it focused on five key areas, public health education, cancer prevention, early diagnosis, effective treatment, palliative care with five yearly updates, and involvement of private international organizations with interests in cancer control. The American Cancer Society, the National Cancer Institute, just to mention a few.
Now, this step, right, in establishing-- this was 2006-- has led to the establishment of now the National Institute for Cancer Research and Treatment. That's NICRAT. That was in 2017. And it's supposed to provide leadership. It was established to provide national leadership on cancer research and treatment as well as control in Nigeria.
So why is this a major step? Because now cancer control in Nigeria is handled by an agency set aside with its own budgetary allocation to focus on cancer. It's pulled out of the Ministry of Health with other competing health needs. And you see, they've developed the national cancer control plan for 2023 and up to 2027, which has already been launched by the minister of health.
In terms of availability, so from 2006 upwards, the first radiotherapy machine was installed in 1969. And this paper by Nwankwo et al, which was published in 2010, showed that we had-- at the end of 2010, we had only five radiotherapy machines and two 2D brachytherapy machines in Nigeria.
Fast forward to 2024, all those machines have been decommissioned, and currently we have 25 new radiotherapy machines. And we're still counting. We have the first PET scan machine in West Africa established by private organization. We have a lot of public private partnerships as part of things that were lined up in the National Cancer Control Plan. And you see the former president commissioning the first PPP center in Lagos.
Now, we have other centers in the pipeline, up to 14 of them. When I say pipeline, I'm not saying on paper. They already have the structure. And it's going on and very soon they are private, public and PPP where we have private investors involved in it. That's in terms of availability.
Now, other milestones in terms of access to cancer chemotherapy, we have the N-CAP program, which is in collaboration with the Clinton Access Initiative currently being implemented, also upgrade of oncology centers across the country. But I think one of the major ones is the implementation of the cancer health fund in six federal institutions in each geopolitical zone. I put the color code in the map there.
So we're still at the first phase that is focusing on treating indigent cancer patients that have breast, cervix, and prostate cancer. We also have private and state insurance programs, right, now covering cancer treatment. And you know that this year, in 2024, the budgetary allocation for cancer treatment is about 200 million naira. And in total, over the past four years, Nigeria has invested 1.3 billion naira. That's about $4 million in projects related to cancer treatment.
So the next slide. So because we've had political will and national leadership, it has led to sensitization of other policymakers. State governments are developing their own cancer control programs. And even other organizations have also been established and non-governmentals.
But we know that there's a need for continuous advocacy. Nigeria needs 200 machines. And we need to scale up these programs. We need more public, private partnerships, international collaborations, especially in the space of clinical trials, because we know that men of African descent are underrepresented in most clinical trials globally, and yet we give them the same treatment. And also we must also ensure that the sustainability of these programs, maintenance, evaluation of processes.
So in conclusion, I'd like to say that to prepare for this surge and maximize the use of radiotherapy in Africa, African countries, especially LMICs, must identify their unique challenges and take deliberate, actionable steps towards achieving these goals. Thank you.
Omolara Aminat Fatiregun: I don't have any disclosures. I'd like to start by appreciating the organizers for this opportunity. It is worrisome that the current statistics projects a surge in the incidence of the most common cancer in men of African descent. And we know that this increase is unpreventable by just lifestyle and public health interventions alone.
And the fact that the increasing mortality will be seen in sub-Saharan Africa, we know that the men from this region present at younger ages with late stage disease. And these regions are plagued with, I mean, under treatment, insufficient staging, as well as out-of- pocket payment. And of course, we are aware that there are different financial profiles of people in LMICs. We have the rich that are able to seek expensive care, as well as the poor that lack the financial power. And the last group constitutes a greater proportion of the population.
So in order to maximize radiotherapy for prostate cancer, the big question is that are we planning for a surge in late stage disease. And if the answer is yes, right, we all hands must be on deck. We must prepare to offer palliative care, right, to late stage presentations, pain control, oncologic emergencies, as well as localized radical treatment for these men who present early.
There exists several surmountable challenges in Africa. And you see that before we can maximize the use of radiotherapy, it must be available. Some African countries don't even have radiotherapy machines. It must be accessible for those who really need the treatment. And apart from that, it must definitely be affordable because we know a lot of patients pay out of pocket.
Now, take in a deep dive into those challenges, availability of cancer treatment services, the machine's, cancer medications, capacity building around the radiotherapy centers, accessibility of the services, affordable costs, like I mentioned before. But I think one of the major things that layers beneath all this is the political will. If the country has the political will, then it will provide leadership in cancer control. There will be policy development. There will be budgetary allocation to curb the rising cases of cancer.
And so to speak to this, I just wanted to-- in terms of overcoming those challenges, I will be discussing steps taken so far in Nigeria, a West African country with over 200 million population, six geopolitical zones, and 36 states. So one of the major milestones with cancer control in Nigeria was the establishment of the National Cancer Control Program in 2006, which was executed by the Ministry of Health. And it focused on five key areas, public health education, cancer prevention, early diagnosis, effective treatment, palliative care with five yearly updates, and involvement of private international organizations with interests in cancer control. The American Cancer Society, the National Cancer Institute, just to mention a few.
Now, this step, right, in establishing-- this was 2006-- has led to the establishment of now the National Institute for Cancer Research and Treatment. That's NICRAT. That was in 2017. And it's supposed to provide leadership. It was established to provide national leadership on cancer research and treatment as well as control in Nigeria.
So why is this a major step? Because now cancer control in Nigeria is handled by an agency set aside with its own budgetary allocation to focus on cancer. It's pulled out of the Ministry of Health with other competing health needs. And you see, they've developed the national cancer control plan for 2023 and up to 2027, which has already been launched by the minister of health.
In terms of availability, so from 2006 upwards, the first radiotherapy machine was installed in 1969. And this paper by Nwankwo et al, which was published in 2010, showed that we had-- at the end of 2010, we had only five radiotherapy machines and two 2D brachytherapy machines in Nigeria.
Fast forward to 2024, all those machines have been decommissioned, and currently we have 25 new radiotherapy machines. And we're still counting. We have the first PET scan machine in West Africa established by private organization. We have a lot of public private partnerships as part of things that were lined up in the National Cancer Control Plan. And you see the former president commissioning the first PPP center in Lagos.
Now, we have other centers in the pipeline, up to 14 of them. When I say pipeline, I'm not saying on paper. They already have the structure. And it's going on and very soon they are private, public and PPP where we have private investors involved in it. That's in terms of availability.
Now, other milestones in terms of access to cancer chemotherapy, we have the N-CAP program, which is in collaboration with the Clinton Access Initiative currently being implemented, also upgrade of oncology centers across the country. But I think one of the major ones is the implementation of the cancer health fund in six federal institutions in each geopolitical zone. I put the color code in the map there.
So we're still at the first phase that is focusing on treating indigent cancer patients that have breast, cervix, and prostate cancer. We also have private and state insurance programs, right, now covering cancer treatment. And you know that this year, in 2024, the budgetary allocation for cancer treatment is about 200 million naira. And in total, over the past four years, Nigeria has invested 1.3 billion naira. That's about $4 million in projects related to cancer treatment.
So the next slide. So because we've had political will and national leadership, it has led to sensitization of other policymakers. State governments are developing their own cancer control programs. And even other organizations have also been established and non-governmentals.
But we know that there's a need for continuous advocacy. Nigeria needs 200 machines. And we need to scale up these programs. We need more public, private partnerships, international collaborations, especially in the space of clinical trials, because we know that men of African descent are underrepresented in most clinical trials globally, and yet we give them the same treatment. And also we must also ensure that the sustainability of these programs, maintenance, evaluation of processes.
So in conclusion, I'd like to say that to prepare for this surge and maximize the use of radiotherapy in Africa, African countries, especially LMICs, must identify their unique challenges and take deliberate, actionable steps towards achieving these goals. Thank you.