By Dr. Raphael Nyarkotey Obu
A call to National Action: Ignoring Cancer Patients from LEAP won’t beat Cancer.
This is a Position Paper from Men’s Health Foundation Ghana Presented
To the Minister of Gender & Social Protection Hon. Afisa Otiko Dzaba Ministries Accra on 12-07-2017
EXECUTIVE SUMMARY
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Recently, the Ghana News Agency reported that, Dr Joel Yarney, the Head of the Medical Centre for Radiotherapy and Nuclear Medicine at the Korle-Bu Teaching Hospital, has said about 60, 000 cancer cases are recorded by the country annually. He said out of this figure 2,500 were breast cancer cases, and this requires that urgent action be taken to ensure prevention and treatment.
He said this when he chaired the opening ceremony of the second Ghana-Norway Summer School in Medical Physics and Radiology education which opened in Accra. According to the story he further said non-communicable diseases were on the increase. Indeed, Cancer cases in Ghana have risen to a very high figure than previously. For instance, With Cervical Cancer, 3, 000 cases are diagnosed yearly with 1,500 deaths. That accounts for 50% death rates seen yearly.
On prostate cancer, as at 2007, the Korle-Bu Teaching Hospital revealed that the country had exceeded the global average of 170 men out of every 100,000, recording a prevalence of 200 men out of every 100,000.Klufio study, which was based on a retrospective analysis of the frequency and pattern of genitourinary (GU) cancers seen at the Korle-Bu Teaching Hospital, in Accra, between 1980 and 1990 revealed prostate cancer accounted for 349/479 GU cancers in males (81.4 percent).
Wiredu and Armah (2006) conducted a similar analysis for all cancers at the same institution between 1991 and 2000. In this study, prostate cancer accounted for 17.35 percent of all cancers identified and about 31.8 percent of all cancers in males.
A global cancer database compiled in 2010 for the International Agency for Research on Cancer indicated that Ghana records an estimated number of 921 new prostate cancer cases every year while an estimated prostate cancer related death of 758 deaths are recorded every year.
Recently, another news on peacefmonline revealed that about 1600 childhood cancer cases diagnosed yearly.These figures are outrageous judging from the fact the country has no well-defined National Cancer register to collates all these figures. So obviously, more cancers incidences are not recorded. Currently the country has only two cancer registers: one in Accra and Kumasi and these are Hospital based registers.
Background:
Making the Case for cancer Patients on LEAP:
The financial costs of cancer are high for both the person with cancer and for society as a whole. For instance, The Agency for Healthcare research and Quality (AHRQ) estimate that the direct medical costs (total of all health care costs) for cancer in the US in 2014 were $87.8 billion.
58% of this cost is for hospital outpatient or doctor office visits
27% of this cost is for inpatient hospital stays
One of the major costs of cancer is cancer treatment in Ghana. But lack of health insurance and other barriers to health care prevent many Ghanaians from getting optimal health care. The Charity realized that increased financial burden as a result of cancer care costs is the strongest independent predictor of poor quality of life among cancer survivors in Ghana.
For a patient who receives a diagnosis of cancer, the financial impact of this diagnosis can be significant. The magnitude of the resulting financial burden is determined by a multitude of factors, including household income, socioeconomic status, insurance status, and extent of disease. Causes of cancer-related financial stress are multifactorial. Treatment-related costs can be substantial, including costs of chemotherapy, radiation, and surgery, as well as home health care and travel to treatment centers.
Patients who are employed may experience loss of productivity at work or total loss of employment and work-related benefits. Household finances may suffer if the patient’s family members take time away from work to help with their care. Other less apparent causes of financial burden include child care, domestic help, medical equipment, special foods, and nutritional supplements.
A high proportion of patients are affected economically by a cancer diagnosis. One study by The SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment) study found that approximately one third of families of seriously ill patients reported losing most or all of their family’s savings. There is evidence to suggest that patients who are economically affected by cancer are more likely to delay further medical treatment and avoid filling prescriptions, thus putting their physical health in jeopardy
Among Ghanaians patients with cancer, the degree of financial burden resulting from cancer care costs can be variable. Low-income patients have been shown to have disproportionately high expenses as a result cancer. Insurance coverage and cancer type can also affect an individual’s cancer-related economic burden. Depending on an individual’s particular financial and personal circumstances, the economic toll of cancer can be profound.
The psychosocial effects of cancer-related financial strain are understudied in Ghana, and the degree to which cancer-related monetary costs affect an individual’s overall quality of life has not been fully elucidated. Several studies have recently emerged reporting an association between increased economic burden resulting from cancer and decreased quality of life. As a charity we sought to characterize the relationship between cancer-related financial problems and self-reported quality of life through analysis of data from a nationwide, population-based study.
Review of cancer Mortality
According to the World Health Organisation (WHO) 2,000 Ghanaian women were diagnosed with breast cancer in the year 2012, and out of the number, about 1,000 representing 50 per cent of the cases, died. The report was made revealed to the Daily Graphic.
On cervical cancer, the Ghana Human Papillomavirus and Related Cancers, Fact Sheet 2017 estimates indicate that every year 3052 women are diagnosed with cervical cancer and 1556 die from the disease. Cervical cancer ranks as the 1st most frequent cancer among women in Ghana and the 1st most frequent cancer among women between 15 and 44 years of age.
For prostate cancer, the global cancer database compiled in 2010 for the International Agency for Research on Cancer indicated that Ghana records an estimated number of 921 new prostate cancer cases every year while an estimated prostate cancer related death of 758 deaths are recorded every year.
On Childhood cancers, The World Child Cancer revealed that 240 cases are presented each year at the Korle Bu and Komfo Anokye Teaching hospitals. However, only 20% of this figure survives because of late report of cases to the hospital.
Fig 1. Annual Incidence/Mortality Rates
Fig. 2: No. of cancer survival and their Percentages Annually
Who we are: Men’s Health Foundation Ghana
Men’s Health Foundation Ghana is the National Peak body of Prostate cancer and a charity working with men diagnosed with prostate cancer. We have a simple mission: To stop prostate cancer before its strikes in the black community. We provide policies on cancers to government to help address the disease. We provide awareness, Testing and right treatment information to men diagnosed with prostate cancer.
Our Position on LEAP and Cancer Patients:
The charity believes that ignoring cancer patient on the LEAP won’t beat it. But joining the fight to include them iskey to help address it. As a charity working with men affected by the disease, cancer patients have told us how they struggle to afford treatment and therefore there is need for the government to support them with a monthly token. We therefore appeal to your noble institution to include cancer patients on the project to help improve their Quality of life (QOL).
During this year’s fathers’ Day project at Akim-Asene, this issue came out and over hundred Men at Asene and Akim-Manso in the eastern region signed this petition to your outfit to include those affected by cancer in the country unto the National Livelihood Empowerment Scheme (LEAP).
The project was initiated by Men’s Health Foundation Ghana, the National peak body of prostate cancer and a men’s charity working with people affected by Prostate cancer. The charity has been in a forefront of providing the necessary policies to government to help shape cancer services in the country. Recently, the charity presented a proposal to the Presidency to declare fathers’ Day as a National Prostate Health Awareness Day and September as National Prostate Cancer Awareness Month to help strengthened the fight on the disease.
As part of the charity’s submission to the Presidency we also recommend the establishment of National Cancer Foundation to help shape cancer services in the country. The charity is motivated in providing all these national policies as the government made provisions in the 2016 New Patriotic Party’s Manifesto to recognized cancers as National Challenge.
The Men signed the petition as part of the Prostate cancer awareness Drive in the region during the father’s Day celebrations. This our position paper is to call on you to include the cancer patients onto the scheme as we believe it will go a long way to help the government in fulfilling its 2016 Manifesto promised Ghanaians on special cancer policy .
Summary:
Asa charity we know that the Livelihood Empowerment Against Poverty (LEAP) programme, is a social cash transfer programme that provides cash and health insurance to the extremely poor households across the country.
We also know that financial toxicity is a constellation of symptoms. Patients face difficulty meeting household expenses; they face financial stress/strain, loss of employment and income, debt, and bankruptcy. This can also take a psychological toll on the patient and impact their quality of life. It’s important to consider what factors predispose cancer patients to financial hardships.
We also stressed that younger age seems to be the most significant risk factor, and what this could ultimately lead to is an impact on clinical outcomes, resulting from issues with adherence, access, and trial participation, finally resulting in reduced survival. The problem requires a multifaceted solution, and lowering drug prices alone cannot mend the damage. A combination of short- and long-term interventions with contributions from policy makers, patients, providers, and payers are necessary. This is why we support this agenda and this our position paper and petition from the concerned Men who took their time to signed this is in the favor of those diagnosed with cancers in the country.
We are counting on you and hoping to hear from you soon on this petition from our outfit. We know this is a government that cares as stated in the 2016 Manifesto to have a special cancer policy at the Health page.
Conclusion:
Prostate cancer related death tops all other cancers in the country with only 17.70% of those diagnosed surviving yearly (Fig 2). It is followed by Childhood cancers also with 20% survival rates (Fig 2). The Women have done tremendously well with advocacy yet death rates from Breast and cervical cancers are not encouraging (Fig 2) with Cervical cancer only gaining 49% death annually and tops the cancer incidence rates in the country(Fig 1). For those diagnosed with Breast cancer it is like a football match. It is a 50:50 affairs until the game ends.Urgent national attention should be paid to these cancers.
NB:
We have attached a copysigned by the petitioners and pictures from Akim-Asene and Manso on the project.
Contacts
For further information kindly contact us on the following numbers:
0541234556/0541090045
References:
- Ghana records 60,000 cancer cases every year – Dr Joel Yarneyto be accessed at…https://www.ghanabusinessnews.com/…/ghana-records-60000-cancer-cases-every-yea…Jun 13, 2017 –
- Shocking Statistics On Ghana Prostate Cancer Revealed | Health …To be accessed atpeacefmonline.com/pages/local/health/201404/195626.phpApr 8, 2014 –
- Ghana losses 1,500 women to cervical cancer annually | Ghana News …to be accessed at www.ghananewsagency.org/…/ghana-losses-1-500-women-to-cervical-cancer-annually-…Mar 9, 2016
- Economic Impact of Cancer – American Cancer Society. To be accessed at https://www.cancer.org/cancer/cancer-basics/economic-impact-of-cancer.htmlApr 14, 2017
- KM Fenn et al 2014. Impact of Financial Burden of Cancer on Survivors’ Quality of Life …ascopubs.org/doi/full/10.1200/jop.2013.001322
- Understanding and Mitigating the Financial Burden of Cancer Patients. To be accessed at www.ajmc.com/…/understanding-and-mitigating-the-financial-burden-of-cancer-patie…Jul 18, 2016
- Ghana news: Breast cancer deaths high in Ghana – Graphic Onlinewww.graphic.com.gh › General-News. May 18, 2016
- Ghana: Human Papillomavirus and Related Cancers, Fact Sheet 2017. To be accessed at www.hpvcentre.net/statistics/reports/GHA_FS.pdf
