Status of Government-Funded Radiotherapy Services in Nigeria.

PURPOSE: Access to radiotherapy (RT) is now one of the stark examples of global cancer inequities. More than 800,000 new cancer cases require potentially curative or palliative RT services in Africa, arguably <15% of these patients currently have access to this important service. For a population of more than 206 million, Nigeria requires a minimum of 280 RT machines for the increasing number of cancer cases. Painfully, the country has only eight Government-funded RT machines. This study aimed to evaluate the status of the eight Government-funded RT services in Nigeria and their ability to deliver effective RT to their patients. METHODS: A survey addressing 10 critical areas was used to assess the eight Government-funded RT services in Nigeria. RESULTS: Unfortunately, six of the eight centers (75%) surveyed have not treated patients with RT because they do not have functioning teletherapy machines in 2021. Only two RT centers have the capability of treating patients using advanced RT techniques. There is no positron emission tomography-computed tomography scan in any of the Government-funded RT centers. The workforce capacity and infrastructure across the eight centers are limited. All of the centers lack residency training programs for medical physicists and radiation therapy technologists resulting in very few well-trained staff. CONCLUSION: As the Nigerian Government plans for the new National Cancer Control Plan, there is an urgent need to scale up access to RT by upgrading the RT equipment, workforce, and infrastructure to meet the current needs of Nigerian patients with cancer. Although the shortfall is apparent from a variety of RT-capacity databases, this detailed analysis provides essential information for an implementation plan involving solutions from within Nigeria and with global partners.

Examining Cancer Patients' Perceptions of the Impact of COVID-19 on Teleoncology: Findings From 15 Nigerian Outpatient Cancer Clinics.

PURPOSE: To examine cancer patients' perspectives on the impact of COVID-19 on teleoncology in Nigeria. METHODS: Data from a multicenter survey conducted at 15 outpatient clinics to 1,097 patients with cancer from April and July 2020 were analyzed. The study outcome was telemedicine, defined as patients who reported their routine follow-up visits were converted to virtual visits because of COVID-19 (coded yes/no). Covariates included patient age, ethnicity, marital status, income, cancer treatment, service disruption, and cancer diagnosis/type. Stata/SE.v.17 (StataCorp, College Station, TX) was used to perform chi-square and logistic regression analyses. P values ≤ .05 were considered statistically significant. RESULTS: The majority of the 1,097 patients with cancer were female (65.7%) and age 55 years and older (35.0%). Because of COVID-19, 12.6% of patients' routine follow-ups were converted to virtual visits. More patients who canceled/postponed surgery (17.7% v 7.5%; P ≤ .001), radiotherapy (16.9% v 5.3%; P ≤ .001), and chemotherapy (22.8% v 8.5%; P ≤ .001), injection chemotherapy (20.6% v 8.7%; P ≤ .001) and those who reported being seen less by their doctor/nurse (60.3% v 11.4%; P ≤ .001) reported more follow-up conversions to virtual visits. In multivariate analyses, patients seen less by their doctors/nurses were 14.3 times more likely to have their routine follow-ups converted to virtual visits than those who did not (odds ratio, 14.33; 95% CI, 8.36 to 24.58). CONCLUSION: COVID-19 caused many patients with cancer in Nigeria to convert visits to a virtual format. These conversions were more common in patients whose surgery, radiotherapy, chemotherapy, and injection chemotherapy treatments were canceled or postponed. Our findings suggest how COVID-19 affects cancer treatment services and the importance of collecting teleoncological care data in Nigeria.

Patient's Perspective on the Impact of COVID-19 on Cancer Treatment in Nigeria.

PURPOSE: Because of the global COVID-19 pandemic, health care organizations introduced guidelines for modifications to health and cancer medical care delivery to mitigate transmission and ensure quality health outcomes. To examine the extent and impact of these modifications on oncology service disruptions in Nigeria, we surveyed oncology patients across selected public and private cancer treatment centers. MATERIALS AND METHODS: Participating in the study were 15 tertiary cancer treatment centers across 12 Nigerian states. We recruited adult patients with cancer (18+ years) on active treatment to complete a self-administered survey on cancer care during COVID-19. We conducted descriptive and multivariate data analysis using Stata 16.1. RESULTS: Respondents were (n = 1,072), female (65.7%), ages 18-49 years (50.3%), and married (80.7%). The top two cancers were breast and prostate. Overall, 17.3% of respondents reported disruptions to cancer care, and more than half (51.0%) reported difficulties accessing care. Changes in chemotherapy regimens or route of administration were reported in 8.4% of respondents. Odds for any disruption were highest for older patients, western states, patients with prostate cancer, and patients with two or more flu symptoms. Odds for radiotherapy cancellation were highest for older patients, those with prostate cancer, and those with medium service perception. CONCLUSION: This study investigated COVID-19-influenced cancer treatment disruptions in Nigeria. Patients with cancer experienced significant disruptions to cancer care. Vulnerable patients are most likely to be negatively affected. Policies and strategies aimed at minimizing service disruptions while maintaining cancer patients' safety should be a priority for all health care institutions in the COVID-19 era.

Emerging Use of Public-Private Partnerships in Public Radiotherapy Facilities in Nigeria.

PURPOSE: Radiotherapy (RT) treatment at public hospitals in Nigeria is often interrupted by prolonged periods of machine breakdown because of insufficient funds for maintenance and repair. These delays have prompted the uptake of public-private partnerships (PPPs) to acquire and maintain RT equipment. This study aimed to understand Nigeria's current RT capacity and the impact of PPPs on RT availability and cost. METHODS: Eleven radiation oncologists, each representing one of the 11 RT centers in Nigeria (eight public and three private), were invited to complete a survey on the type, status, acquisition, and maintenance plan of existing RT equipment, cost incurred by patients for external-beam radiation (EBRT) and brachytherapy treatment, and number of patients treated per year on each machine. Type and status of equipment at nonresponding facilities were obtained through literature review and confirmed with the facility. RESULTS: A total of eight (81%) respondents completed the survey, all representing public centers, three of which reported PPP use. They reported 11 megavoltage units in total (seven linear accelerators [LINACs] and four Cobalt-60s) and 10 brachytherapy afterloaders. Of those, 57% (4/7) of the LINACs, 100% (4/4) of the Cobalt-60s, and 63% (7/11) of the afterloaders were in clinical use. All commissioned equipment supported by PPPs (three LINACs and one afterloader) were in operation. The public EBRT equipment were nonfunctional 35% of the year (resulting in 60% fewer patients treated per year). The PPP EBRT and afterloaders did not experience any periods of breakdown, but PPP costs were 338% higher than public equipment. CONCLUSION: This study characterizes the use of PPP as a more reliable method of RT delivery in Nigeria, albeit at higher costs.

Pattern of survival of breast cancer patients in a tertiary hospital in South West Nigeria.

BACKGROUND OF THE STUDY: Breast cancer is the most common cancer among women in both developed and developing nations. The survival of breast cancer is increasing in developed countries with improved treatment modalities, while still very poor in developing countries. In Nigeria, few breast cancer survival data are available. RESEARCH DESIGN: This is a retrospective cross-sectional study. OBJECTIVES: To determine the survival of breast cancer patients and possible factors influencing it. METHODOLOGY: Socio-demographic and clinical variables from treatment records and case notes of breast cancer patients treated from 1 January 2004 to 31 December 2008 at the Department of Radiation Oncology, University College Hospital, Ibadan. The status of patients was determined at 2 and 5 years after diagnosis. The survival of patients with breast cancer was compared using Log Rank test according to socio-demographic and clinical variables. The median survival times were obtained from the Kaplan-Meier survival curve. Cox's proportional hazard model was fitted for those that were statistically significant in the Log Rank test. Missing data were reported as unknown, not documented or missing. RESULTS: A total of 378 patients were analysed. Age ranged between 22.0 and 87.0 years with mean of 47.6 (standard deviation (SD) = 11.2) years. Almost all patients were females (98.4%). More than half (55.3%) presented at stage III, 28.0% had metastasis and the stage was unknown in about 6.6% of the patients. Invasive ductal carcinoma was the most prevalent histology (89.2%). Only 124 (32.8%) patients had their histological grade stated and most of the patients had no immunohistochemistry done. All the patients had radiotherapy, chemotherapy and surgery. About 25.1% of the patients were lost to follow up. The 2- and 5-year survival rates were 56.4% and 37.6%, respectively. The 2- and 5-year survival rates according to stage were stage I (80.0% and 66.7%), stage II (67.7% and 57.6%), stage III (51.4% and 27.9%) and stage IV (37.9% and 13.8%). Median survival time was 41 months (95%CI = 35.0-44.0). The disease-free survival at 2 and 5 years was 66.6% and 60.3%, respectively. Median time for recurrence was 8.0 months. Level of education, height, tumour unilaterality, clinical tumour size, stage at presentation, presence of distant metastases, clinical axillary lymph node metastasis, supraclavicular node metastasis, mode of surgery and axillary clearance were found to have statistically significant association with survival. CONCLUSION: A large number of the patients in our study presented at a young age, late with advanced stage disease which results in poor survival outcome.

Oncology practice in the COVID-19 pandemic: a report of a Nigerian expert panel discussion (oncology care in Nigeria during the COVID-19 pandemic).

Since the first case of COVID-19 and its progression to a pandemic, healthcare systems the world over have experienced severe difficulties coping with patient care for both COVID-19 and other diseases most especially non communicable diseases like cancer. These difficulties in Low- and middle-income countries (LMICs), especially in Sub-Saharan Africa including Nigeria, are myriad. These LMICs are already bedeviled weak health systems, ill equipped cancer treatment centers, with outdated machines and grossly inadequate numbers of oncologists required to treat patients with cancer. As a result of these challenges coupled with unclear guidelines on how to manage cancer patients in the wake of the COVID-19 pandemic, 11 key Nigerian opinion leaders had a consensus meeting to identify challenges and possible workable solutions on continuing cancer care during the COVID-19 pandemic. The discussion highlighted ethical issues, barriers to continuing cancer care (such as lockdown, fear of contracting disease, downscaled health services) and resource constraints such unavailable personal protective equipment. Yet, practical solutions were proffered such as necessary protective measures, case by case prioritization or de-prioritization, telemedicine and other achievable means in the Nigerian setting.

Financial Burden of Cancer on Patients Treated at a Tertiary Health Facility in South West Nigeria.

Background: Cancer is a growing health concern in the world. The financial burden of cancer affects not only cancer patients and their families, but also the society as a whole. In Nigeria there is a dearth of information about the financial burden of cancer on patients. Hence, there is need to estimate the cost of cancer treatment and to show the resources being allocated to the problem. Objectives: The aim of this study was to estimate the financial burden of cancer on patients treated at a tertiary heath facility in South West Nigeria. Materials and Methods: The study was a cross-sectional study and patients were interviewed using a set of questionnaires that addresses sociodemographic and economic questions involving medical and nonmedical costs (direct medical costs). Data Analysis: Data obtained were analyzed using the Statistical Package for Social Sciences (SPSS), version 21.0. Descriptive statistics such as frequencies (%), mean, standard deviation, median, range and P-value were used to highlight important and relevant features of the data. For ease of analysis some of the variables such as sociodemographic, medical, and nonmedical costs were grouped or categorized. Results: Two hundred and twenty cancer patients participated in the study. The mean age of the patients was 54.1 (standard deviation [SD] = 13.4) years and majority were females (81.4%). Approximately one-third of the respondents were those with breast (35.9%) and cervical (35.5%) cancers, respectively. Majority perceived financial burden as a result of cancer to be significant (82.7%).The mean annual income of patients was $5,548.7(SD = $7,245.4). The main sources of income for their treatments were from their children (26.8%). The mean total cost incurred by patients with cancer was $5306.9 (SD = $5045.7), with medical costs accounting for the highest percentage $3889.4 (SD = $4372.9); 73.0% and nonmedical costs of $1417.5 (SD = $1085.6); 27.0%. Patients with colorectal cancer incurred the highest cost, whereas cervical cancer patients incurred the least cost. Conclusion: Financing cancer management is a major challenge for both patients and their caregivers. Cancer care also results in a loss of economic income available to the community/country.

Survival pattern of rare histological types of breast cancer in a Nigerian institution.

INTRODUCTION: breast cancer is the most common cancer affecting women worldwide. It is a heterogeneous disease with diverse histological types that are associated with different natural history and response to therapy. Invasive ductal and lobular carcinoma are the most common histological types. There are rare histological types with different biological behaviours from the common types, although treatment approaches are the same. Data on rare histological types of breast cancer in our population are scarce raising the need to identify these patients and document their treatment outcome. The objectives of this study are to determine the proportion and treatment outcomes of breast cancer patients with rare histological types. METHODS: this was an observational retrospective study using records of patients treated for breast cancer at the University College Hospital Ibadan Nigeria from 2008 to 2012. Patients with rare histological types were selected for further analysis. Data on patient and tumour characteristics were extracted and five-year survival pattern was determined using Kaplan Meier method. RESULTS: the total number of patients with breast cancer was 761. Thirty-two (4.2%) had rare histology that consisted of medullary carcinoma 14(1.9%), mucinous carcinoma 10(1.4%) and 2(0.3%) each for squamous cell carcinoma, stromal sarcoma, cribriform carcinoma and Paget's disease. The overall five-year survival was 50% with median survival of 52 months. CONCLUSION: the proportion of breast cancer patients with rare histology is low similar to other reports among Caucasians. Medullary adenocarcinoma was the most common subtype followed by mucinous adenocarcinoma.