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 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 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 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 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 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 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 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 Patients Cote D’Ivoire Togo Benin Burkina Faso Sierra Leone Liberia Referrals from Overseas:- UK, USA, South Africa

Common Cancers 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 2012 Total 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 38 187 Ovary 23 33 40 Endometrium 15 16 17 18 66 Lung 22 55 Wilms tumor 8 4 Bladder 14 Lymphoma 12 Multiple Myeloma Anus Liver Oesophagus

Patients commonly present with advanced stage 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 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