Transcript current situation on the treatment of cancer in ghana

Dr Hannah N.G.Ayettey Anie
Introduction
 The Burden of Cancer amounts daily worldwide. It is
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alarming!
An estimated 12.7 million new cancer cases were diagnosed
worldwide in 2008
Lung, female Breast, Colorectal and Stomach cancers were
most commonly diagnosed. 40% of all cases
Worldwide, an estimated 7.6 million deaths from cancer
occurred in 2008
Cancer is now the third leading cause of death worldwide
In Africa, cancer is emerging as a major public health
threat
 With improvement in our lifestyle and environmental
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changes, cancer has become an increasing problem in
Africa
The 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 track
This 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
Africa
 The cancer incidence in Africa has been increasing
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dramatically
Especially after the onset of AIDS epidemic
Most of the efforts and helps provided by the Western
countries to Africa are spent to prevent and cure
Infectious diseases and Malnutrition
This 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 Healers”
 The 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 population
Cancer Registries in Africa
 The African cancer registry network(AFCRN) was formally
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inaugurated on 1st March 2012
Succeeded and expanded the East African Cancer Registry(Jan
2011)
To improve the effectiveness of Cancer surveillance in Sub
Saharan Africa
This is the basis for any Rational programme for Cancer control
Population-based cancer registration is developing fairly rapidly
in some areas of Africa
There are now at least 30 registries in the continent
Algeria, Zimbabwe, Guinea, Uganda, Rwanda, Gabon, Malawi,
South Africa, Ivory Coast, Niger, Nigeria, Tanzania, Ethiopia,
Burkina Faso, Botswana and Kenya
Ghana
 No Cancer Registry as yet
 Hospital based Registry
 Korle Bu Registry – Any case of cancer that comes to
the hospital. Whether through the clinics or the
pathology department
 Komfo Anokye hospital registry
 National Policy on Cancer- A cancer strategic plan
which is yet to be fully established
Korle Bu Teaching Hospital
Korle Bu Registry
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As at 2012
Report of 830 out of 1136 patients
Breast- 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 Medicine
 The National centre for Radiotherapy and Nuclear
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Medicine was established in 1997
By Flight Lieutenant Jerry John Rawlings
It is located in the Korle Bu teaching Hospital on
Guggisberg Avenue
A semi- Autonomous Centre
A tertiary referral centre
National Centre for Radiotherapy
and Nuclear Medicine
Staffing at Radiotherapy
Department
 Doctors - 2 Consultants, 3 Specialists, 4 Residents in
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training
Nurses – 13 trained Nurses and 6 Health Care
Assistants
Pharmacists- 2
Radiotherapists - 14
Physicists- 6
Radiation Protection Officer – 1
 Engineers - 4
 Secretaries ( Including Bilingual secretaries) -5
 Records/Statisticians – 3
 Orderlies- 3
 Security men – 4
 Driver - 1
Equipment
 A Cobalt Teletherapy machine (Uses gamma rays)
 Two Low Dose Brachytherapy machines (Cesium 137)
 A Conventional Simulator
 3 Consulting Rooms
 A Waiting Area for patients
 A Nurses room
 1 Chemotherapy Suite for patients
Other oncology centres
 Public- Oncology Department, Komfo Anokye
teaching Hospital
 Private- Swedish Ghana Medical Centre
Referrals
 Referrals from within the country
 Korle Bu teaching hospital
 37 Military hospital
 Police Hospital
 Ridge Hospital
 SSNIT Trust hospital
 Other private hospitals
 Regional hospitals including- Koforidua, Central,
Volta, Tamale, Effia Nkwanta etc
 Referrals from Neighbouring countries:- 5% of
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Patients
Cote D’Ivoire
Togo
Benin
Burkina Faso
Sierra Leone
Liberia
Referrals from Overseas:- UK, USA, South Africa
Common Cancers
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Breast Cancer(Monday) 26%
Cervical Cancer(Tuesday) 18%
Ovarian Cancer 2%
Endometrial cancer
Prostate Cancer(Thursday) 9%
Colorectal Cancer 4%
Head and Neck cancers- Nasopharyngeal cancer, Laryngeal
cancer(Wednesday) 13%
 Stomach cancer
 Lung cancer
 Hepatocellular Cancer
Cases/Years
2008
2009
2010
2011
Breast
266
288
302
281
307
1444
Cervix
171
207
184
195
221
1199
Head & neck
127
165
146
173
151
762
Prostate
86
117
100
131
110
544
Colorectal
43
35
42
50
61
231
Sarcomas
36
43
35
35
38
187
Ovary
23
42
33
40
33
171
Endometrium
15
16
17
18
66
18
22
15
55
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4
4
16
14
14
Lung
Wilms tumor
Bladder
Lymphoma
2012 Total
12
12
Multiple Myeloma
12
Anus
Liver
Oesophagus
Cases/Years
2008
2009
2010
2011
2012 Total
12
350
300
250
200
2008
2009
150
2010
2011
100
50
0
2012
 Patients commonly present with advanced stage
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disease across board(60-80%)
However some people present early
Investigations- Blood tests, Chest Xray, Xrays of
vertebrae, Abdominal ultrasound, CT Scan, MRI ,
Bone Scan
Treatment- Surgery, Chemotherapy, Radiotherapy,
Hormonal therapy
Prognosis- This depends on the Type of tumor, Grade
and Stage at presentation
 Awareness of Cancer is gradually increasing
 Over the years patient numbers have been increasing
 Many more doctors are referring patients
 Patients are turning up for screening
 Cancer screening for some diseases like breast cancer
and Cervical cancer is gradually improving
 Talk shows with topics on Cancer
Necessary Interventions
.Improvement on Public awareness (Advantages of early
presentation, Curative and Palliative treatment)
 Support from Physicians, Media, NGOs, Patient
interviews, Support groups
 Training of health personnel
 Improvement of Palliative care in Ghana
 Hospices to assist in management of terminally ill
patients
Patient Challenges
 Cost of Treatment
 Very few drugs on NHIS, hence a lot of financial
burden on patients who are already battling with the
disease
 Need to establish more Support groups to encourage
patients
 Elimination of Societal Stigma of cancer
(Demystification)
 Establishment of a Cancer Foundation
Departmental needs/
Requirements to improve patient
care
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Wheel Chairs
Patient Trolleys/ Stretchers
View Boxes for Xrays
Linen
Water dispensers
Soap and Tissue dispensers
Hand sanitizer dispensers
Refurbishing of patient toilet facilities
Hematology and Chemistry analyzer machines
Breast Prosthesis for mastectomy patients
Conclusion
 The 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 strategies
Thank you