Cancer: Reflections and hopes for new year

A gentleman in his fifth year of using hormonal tablets for a specific type of breast cancer recently called me to clarify something his doctor had told him. He expected 2019 to be his final year of “those awful cancer tablets”.

His doctor had just told him that research shows taking the tablets for up to 10 years is associated with better outcomes.

Recommendations are always evolving because science is changing our understanding of cancer, not just at cellular level but how it interacts with the whole person as a bio-psychosocial and spiritual being.

Over the past decade, cancer civil society organisations (CSOs) and patient groups have been contributing to cancer control through screening and awareness campaigns.

Science now demands that such campaigns be smarter, targeted and evidence-driven with demonstrable outcomes that they actually save lives.

Cancer CSOs must forge alliances with research institutions, academia and oncology professionals to benefit from knowledge transfer.

A comprehensive cancer public education programme informed by scientific evidence should be among the first items on the cancer agenda for the year.

Reducing the cost of cancer care is, of course, the big ticket item that should kick-start the 2020 cancer conversations.

This year should get our policymakers to rationalise investment in cancer infrastructure. Nairobi is saturated with radiotherapy machines — more than 10 high-tech ones within a 10-kilometre radius of each other.

It may be time to press the pause button on further investment in radiotherapy in Nairobi and give incentives to investments in the counties.

Kenyatta National Hospital might also have to restructure the proposed model for cancer patient’s hostel.

In the next two years, many patients will likely be able to access radiotherapy in five or so locations across the country, eliminating the need to spend weeks in the city.

Integration of the HPV vaccine into the national immunisation programmes last year was a milestone in cancer control.

Parents largely ignored the social media naysayers on the vaccine and came out in large numbers to get their daughters vaccinated.

Ironically, the biggest threat to achieving and sustaining 100 per cent HPV vaccination coverage is not necessarily the anti-vaccine conspiracy groups who see doom in every public health initiative but the well-meaning donor-driven NGOs who pull in different directions depending on each funder’s priorities, thus setting the stage for duplication and divergent approaches to a problem.

As nurses who run immunisation clinics will tell you, most Kenyan mothers do not have a problem getting their children vaccinated.

All we need is to normalise the HPV vaccine, simplify the messaging to everyday language and do away with copy-paste donor public education templates.

As Kenya goes full throttle into universal health coverage (UHC), the pharmaceutical industry will continue to play an important role in the healthcare system.

But as commercial entities, industry players must not be allowed to influence decision-making, including sponsorship of seminars. CSOs must ensure policy and legislative interventions are devoid of interference.

Cancer and other non-communicable diseases (NCDs) have their own peculiar complexities associated with long-term medication and follow-up.

The architects of the UHC roll-out must take cognisance of this in the 2020s.

Mr Makumi is vice-chair, NCD Alliance Kenya, and patron, Oncology Nurses Chapter.