We Need To Increase Access To Cancer Surgery

Across the world, there is an increasing incidence and mortality of cancers, particularly in low and middle-income countries, such as Kenya.

The recent Lancet commission on cancer in sub-Saharan Africa in 2021, showed that over the past 30 years, there has been a doubling in cancer incidence, with over half a million deaths in 2020. This number is predicted to double by 2030 thus underscoring a need for urgent action.

This incidence may be attributed to a combination of factors such as an increase in life expectancy combined with the adoption of unhealthy dietary habits, consumption of tobacco and alcohol and lack of physical exercise and environmental factors and exposure, infections (a quarter of cancers in Africa are associated with infectious diseases such as hepatitis B and c and human papillomavirus) and genetics.

The Health Cabinet Secretary, H.E, Susan Nakhumicha, while reflecting on the recently released ‘Status of Cancer in Kenya Report’ by the National Cancer Institute of Kenya, noted that there are 27,000 cancer-related deaths recorded every year in Kenya, with about 75 deaths a day.

The leading cause of cancer deaths is esophageal, followed by cervix, breast, and liver cancers. Breast cancer is the most commonly diagnosed cancer in Kenya, with an annual incidence of about 6,000 new cases and 2,500 cancer-related deaths.

The government of Kenya has made considerable strides in improving access to cancer services and has launched many initiatives to address this rising cancer burden. The national hospital insurance fund now covers some of the costs of treatment such as chemotherapy and radiotherapy.

There have been commendable efforts to decentralize access to chemotherapy, having established 10 fully functional county-level chemotherapy centers, and radiotherapy services with the development of regional comprehensive cancer centers in Nairobi, Mombasa, Nakuru, and Garissa. There has also been an increase in diagnostic equipment in a number of counties, including CT-Scans, ultrasonography, mammography, etc.

There has been an expansion of enabling policy with the launch of the New Cancer Control Strategy 2017-2022, by the Ministry of Health and its current ongoing revision.  This is a national effort to address the growing burden of the disease in the country.

The care and treatment of cancer involve three major aspects: systemic treatments like chemotherapy and immunotherapy, and local treatments like radiotherapy and surgery. These are frequently used in combination to treat and potentially cure or palliate patients.

The government’s efforts in increasing chemotherapy and radiotherapy services are laudable. However, surgical services continue to lag behind the progress made in the other aspects of cancer care. We have also had a promising expansion in local and regional training in both medical oncology and clinical oncology, but there has not been much surgical oncology training in the East African Region.

Surgery is one of the major pillars of cancer care and control. More than 80 percent of all cancer patients will require surgical procedures and one-third of patients will require multiple surgical procedures thus underscoring the need to develop these critical services.  Surgery can be preventive, for instance, removing a polyp before it turns into cancer, diagnostic: when biopsies are performed, curative when a breast lump or colonic tumor is completely removed or supportive, palliative or reconstructive (e.g. reconstructing a limb or breast after removal of cancer.

The Lancet Commission on global surgery in 2014 showed that nine out of ten people (5 billion people) have no access to safe, timely, and affordable surgery with an additional 143 million more surgical procedures needed in lower medium-income countries every year, to prevent death and disability.

Safe surgery does not refer to the actual surgery only but also includes the peri-operative care, anesthesia, and diagnostics that help to support successful surgical outcomes. This is particularly pertinent in Africa, where data from the African Surgical Outcomes Study (ASOS) shows that patients are twice as likely to die from routine, planned, common surgeries as compared to the global standard.

The Lancet Commission on Cancer Surgery in 2015 showed that less than a quarter of patients globally had access to affordable, safe, timely cancer surgery with 15.2 million new cancer patients requiring surgery in 2015 and a projected estimation of 48 million cancer surgeries being required by