INTERVIEW: What Nigeria can do to reduce cancer burden – President, Nigeria Cancer Society

Cancer patients in Nigeria face significant challenges, including late-stage diagnosis, limited access to treatment, and high costs of treatment. In rural areas, lack of awareness and lack of access to early screening mean diagnosis is done when the disease is at an advanced stage, resulting in high mortality rates.

In this interview with PREMIUM TIMES, President of the Nigerian Cancer Society, Abidemi Omonisi, discusses the nation’s efforts and ongoing challenges in cancer care, highlighting disparities in access, specialist shortages, and the need for increased funding and awareness.

PT: How would you assess the current state of cancer care in Nigeria, particularly in terms of access to diagnosis, treatment, and palliative care?

Mr Omonisi: The federal government has made efforts to improve access to cancer care treatment, diagnosis and palliative but we are still where we are. The government has been upgrading some centres in the country, one per geopolitical zone, as a centre of excellence in cancer management. It has also promised to upgrade additional six centres as mentioned by the Minister of Health and Social Welfare, Muhammad Pate. There is however a huge gap between the federal, state and local governments. Many cancer cases presented at advanced stages are from the rural communities. The majority of the interventions being done at the federal level do not get to the state level and local government. We know health is on the concurrent list and that is why we encourage governors to try to do their best in their various states.

As we speak now, Nigerians still struggle to access quality healthcare when it comes to cancer management. For instance, in the North-east, the Federal Teaching Hospital, Gombe is the centre of excellence for oncology services. With the high cost of transportation, insecurity and bad roads in the geo-political region, how will you expect patients to travel all the way from Damaturu to access treatment in Gombe?

Looking at this scenario, the truth is that the country is still far from making access to cancer care easy for patients. Even where those facilities are available, the cost of managing cancer is another obstacle patients have to battle with. To commence chemotherapy for breast cancer, the drugs per month is almost N1.5 million, which average Nigerians cannot afford.

Even when it comes to the number of oncologists left in the country, it is less compared to the number of patients reporting daily. The ideal oncologist to patients (ratio) should be one to maximum of 500 patients, that is the standard. But in Nigeria now, we have one oncologist to almost 1,800 cancer patients because we have less than 80 clinical oncologists in the entire country. If you juxtapose that with the population of the entire country, you’ll find out that treatment remains a major challenge.

If you visit oncology centres across the country, you will see a long queue of patients waiting helplessly to be attended to. This shows that so much more work is still required to meet the actual standard of cancer care in the country.

PT: What policies has the government implemented to improve cancer care, and what gaps still need to be addressed?

Mr Omonisi: The federal government has been rolling out useful policies that would help improve cancer prevention and control in the country, especially the Strategic National Cancer Control Plan. Nigeria, perhaps, is one of very few countries in Africa that has an up-to-date National Cancer Control Plan. The World Health Organisation (WHO) recommends that every country should have a cancer control plan and Nigeria has that. We have other useful documents like the chemosafe policy, etc. Chemotherapy is a very sensitive drug which both the patients and physicians can be affected by. There are standard procedures that must be followed in administering chemotherapy drugs.

Cancer is not like malaria where a doctor can just prescribe medications. The standard treatment for cancer patients worldwide requires that every expert involved in cancer management must meet and develop a treatment plan for the patient. The pathologist that made the diagnosis must be there, the radiologist, oncologist and others must be present. The Federal Ministry of Health has sent out a circular mandating that all federal tertiary institutions where cancer patients are managed should have a Multidisciplinary Tumour Board (MTB), which means that every cancer patient case must be discussed. We have seen some cases where a doctor manages a patient and just prescribes some medications which might not be the best. But if all the experts in that field sit together, they can discuss and develop excellent treatment plans.

The Cancer Health Fund is also another existing policy, but most stakeholders, especially cancer survivors, are not satisfied with how the CHF is being implemented. There are serious challenges with accessing the fund by cancer patients who really need it.

PT: Could you assess the effectiveness of the Cancer Health Fund in supporting patients?

Mr Omonisi: Truth is cancer patients have experienced difficulty accessing the health fund. The Nigerian government had good intentions setting up that fund but the problem we have is implementation and government bureaucracy. The number of centres accredited and approved to administer the fund is very few. Just one centre per geo-political zone and this is a major limiting factor in accessing the fund. There is a need to accredit and open up more centres to be able to administer the fund.

Another major issue is that the amount budgeted for the cancer health fund calls for serious concern. When it first started, N700 million was budgeted by the government for that fund which was later reduced to N350 million. However, in the proposed 2025 budget, it is sad to say that only N150 million was budgeted for prostate, cervical and breast cancers which are the three adult cancers covered by the fund.

To manage a cancer patient from diagnosis to stabilisation, one would need an average of N16 million to N20 million. So how many patients can afford this? If you juxtapose that with the proposed budget, that fund will cover only 22 patients in the entire country. We have made our position known to the federal government and National Assembly to do something about increasing the fund to a minimum of N1 billion. Even that N1 billion will not cover all but it will prove serious commitment from the government in supporting cancer patients.

PT: Cancer treatment is often expensive and out of reach for many Nigerians. What steps is the Nigerian Cancer Society taking to make care more affordable and accessible?

Mr Omonisi: As a society, we are trying our best to ensure our members get access to treatment when needed. As I mentioned, even the cancer health fund does not cover all the cancer. For adults, the fund covers just breast, prostate and cervical cancer, but these are not the only cancers people are battling with. Also, a line budget has been created for childhood cancer in the 2025 budget for the very first time in the history of Nigeria, which is a great development.

It is important to state that there are some cancers that are killing Nigerians now. An example of such cancer is colorectal cancer which is the second most common cancer among males in Nigeria. It is sad to mention that colorectal cancer is affecting our younger ones. Furthermore, Nigerians are coming down and dying from hematological malignancies which are also not covered by the National Cancer Fund managed by the Federal Government.

In order to address the above deficiencies, the Nigerian Cancer Society under my leadership established an independent Cancer Intervention Fund and appointed a health system financing expert, Gafar Alawode, the Executive Director of Development Governance International ( DGI) Abuja as the Chairman of the Governing Board. We also have prominent Nigerians, members of Civil Society Organisations, cancer survivors, representatives of the organised private sector, cancer researchers, community representatives, media, etc as members of the board. Our plan is to raise N10 billion for this cancer intervention fund in the next two years.

Once we have this fund ready, it will go a long way to augment what the federal government is doing. As the president, I am aware of all the pains and sufferings cancer patients and survivors are facing in Nigeria.

Majority of these patients are unemployed because they lost their jobs due to the cancer ailment. You know they spend a very long time in the hospital while undergoing treatment, in this process, their employers terminate their appointments. This majorly affects those in the private sector, so we have to provide palliatives for them.

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The intervention fund will also promote cancer research. One thing I’m trying to do during my administration is to promote cancer research in the country. We need to venture into cancer research as we cannot continue to depend on foreign countries, particularly clinical trials. Cancer patients in Nigeria are not deriving the maximum efficacy from some of the drugs being used in the country. This is because most of these drugs were tested, and the clinical trials were conducted on the whites. This is why we are promoting cancer research in the country so that we can also develop our own drugs. Nigerians are very intelligent people. A proof of this is that some major cancer centres in the US are headed by Nigerians. We have the various human capacities to contribute significantly to major breakthroughs in the global oncology space.

PT: Late-stage diagnosis remains a major challenge. How is your organisation working to improve awareness, screening, and early detection?

Mr Omonisi: I am a pathologist, so I have a full understanding of what the problem is with diagnosis. Most cases that presented late are from the rural communities as most Nigerians in the rural communities are less aware about cancer. To an extent, people in the urban centre have enough information on cancer. The issue with urban centres is now decision-making, doing what is right. But people in rural areas are completely cut-off and they have limited knowledge on cancer. I was in a community in Kogi State years ago for a medical outreach and my team met a woman with breast cancer locked up in a room. We were informed that she has a disease affecting her breast, and her mother also died from the same disease. Members of our health team visited her and subsequently confirmed that she had advanced breast cancer. The major challenge with our health awareness on cancer in Nigeria is that most of these cancer awareness programmes are mostly carried out in cities like Abuja, Lagos, Calabar etc, neglecting the rural communities where the major issues exist. What I have done as the NCS president is to create state chapters to support the fight against cancer. The first assignment given to the state executives is to work with stakeholders in their state and organise a very befitting World Cancer Day. I also mandated the state chairman to carry out awareness in both English and native languages. We will not win the war against cancer until we start to focus on rural communities because the majority of the cancer cases presented late are from such areas.

The state’s executives have also been directed to develop a database for cancer stakeholders in their states and also work very closely with their respective states ministry of health. The Nigerian Cancer Society under my leadership is also willing to partner with the state governments, to help them develop their State Cancer Control Plan. We cannot sit down and watch Nigerians continue to die from cancer especially, the preventable ones. We will do everything possible to carry the state along in the fight against cancer.

We will also work with prominent religious and traditional rulers in the country to educate them. Truth is, some of our religious leaders are also doing more harm as some of them do not believe in medications.

We also need to be more aggressive with cancer screening because once screening is done early, we can pick up cancer cases at the early stages. This will also ensure the cancer patients also have a chance at survival following treatment.