1. CURRENT SITUATION ON THE TREATMENT OF CANCER IN GHANA
Dr Hannah N.G.Ayettey Anie

2. 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

3. 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

5. 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”

6. 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

7. 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

8. 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

9. Korle Bu Teaching Hospital

10. 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%

11. 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

12. National Centre for Radiotherapy and Nuclear Medicine

16. 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

17. Engineers - 4
Secretaries ( Including Bilingual secretaries) -5
Records/Statisticians – 3
Orderlies- 3
Security men – 4
Driver - 1

18. 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

25. Other oncology centres
Public- Oncology Department, Komfo Anokye teaching Hospital
Private- Swedish Ghana Medical Centre

26. 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

27. Referrals from Neighbouring countries:- 5% of Patients
Cote D’Ivoire
Togo
Benin
Burkina Faso
Sierra Leone
Liberia
Referrals from Overseas:- UK, USA, South Africa

28. 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

29. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. Thank you