South Africa’s Cancer Alliance has released a groundbreaking report spelling out the anticipated costs of cancer over the next 10 years, reports MedicalBrief.
With cases expected to double by 2030, the report zooms in on the inequitable and inefficient access to quality healthcare for patients with financial challenges, as well as the need for government, civil society partners and health workers in the public and private sectors to develop a roadmap to ensure equal access to cancer care for all.
The evidence of the increasing burden of cervical, breast, prostate, lung, haematologic and paediatric cancers over the next decade should, says the report, provide the National Department of Health (NDoH) with the required information to motivate to the National Treasury for increased expenditure of R50 billion over 10 years for the public sector alone.
However, the Alliance says it recognises that within the current financial climate of COVID-19, along with growing corruption and unrest, the demand for increased investment in cancer as a speciality disease may have to be toned down.
The reality is, though, that defining cancer as a speciality disease will cost the country much more if a concerted effort is not made to tackle the impact of the increasing cancer burden.
According to the report, female breast cancer, cervical cancer and prostate cancer have the highest incidence. Non-Hodgkin’s lymphoma cases are increasing at the highest rate, followed by prostate and then cervical cancer.
Head of the Surgical Oncology Unit in Groote Schuur Dr Lydia Cairncross said cancer cases are rising globally but proportionally faster in Low-to-Middle Income-Countries (LMIC) where already some 70% of cancer-related deaths are recorded.
The cost of cancer is measured not only in terms of rands and cents but importantly, also the cost of the human lives affected and lost, she said, and the related impact this has on individuals, families and communities.
Infectious diseases such as HIV, TB and in the past 18 months, COVID-19, have already stretched and tested and, in some areas nearly collapsed, parts of the South African health system. In this context, a projected increase in cancer incidence from approximately 80 000 cases per year to more than double this in 2030 is sobering.
Treating cancer appropriately requires investment in specialised equipment, procurement of necessary drugs, training of skilled and specialised health workers and functional health systems to ensure secondary prevention. It also requires early diagnosis, treatment and support for survivorship and palliative care. To meet this need, the report projects that an additional R50 billion will be needed for cancer care by 2030.
While this might sound enormous, it is actually less than half of the R105,8 billion in medical legal claims paid out by the provincial health departments in 2019/2020 alone. With proper planning and control measures it is not an impossible task to dramatically reduce these claims and free up the money needed for cancer treatment, adds the report.
The report not only sounds the alarm for the future of cancer care in South Africa, but it also highlights the current and ongoing inequities with accessing quality cancer care, writes the Cancer Alliance. Of the 200 radiation oncologists in the country, only 44 are employed in the state sector, a shocking indicator of disparities in the delivery of cancer care. The inequitable distribution of resources between public and private health sectors extends to other categories of health workers, such as lymphoedema specialists, palliative care nurses and other critical human resources.
The reports spells out that health promotion activities assigned to the national Department of Health and community health workers (CHWs) are only assigned to HIV/Aids and TB. CHWs are not trained in cancer early warning signs and symptoms. Non-profit organisations do not have the same footprint as the CHWs assigned to primary health care clinics.
NCD education and monitoring should become part of the curriculum of CHWs who are the foot soldiers to ensure communities are well informed and are able to access secondary prevention strategies such as earlier screening to detect cancer. Traditional healers should also be included in health education and awareness training, given the importance of this cadre of health care workers in the various populations represented in South Africa. This would also contribute to reducing cancer stigma.
An additional factor is that health-seeking behaviour in men is poor. Given our patriarchal society, there is little room for education and awareness-creation by women in the household or even in the community
In the private sector, screening for certain cancers such as cervical, breast and prostate cancer are linked to loyalty programmes. Baseline screening for cancer is low and this was affected even more as a result of COVID-19 lockdown. Discovery Health recorded an overall 16% drop in cancer screening in 2020, with a specific drop of 17% for breast cancer and 18% for cervical cancer. An increase in cancer recorded at late stage of disease (Stage 4) was also recorded. Medscheme and GEMS reported similar trends.
What is needed are solutions that have been developed in a consensus, adds the report, which is why the Cancer Alliance will undertake a series of high-level discussions with selected influencers, focusing on: cancer within the public service; financing cancer within the NHI; public private partnerships for cancer services – radiation oncology/surgery/medical oncology; cancer medicines pricing and access; value-based care in cancer care; legal and policy frameworks; synergies with NCD policies and other prevention strategies as well as data collection and surveillance systems to enhance the NHI
The outcomes of these discussions will be presented as recommendations to be shared with decision-makers on how cancer can be incorporated within the NHI, sooner rather than later.
Cancer Alliance chairperson Linda Greeff despite the challenges, the organisation sees itself as the “voice of the cancer community”, and will not reduce its efforts or throw in the towel.
“The Cancer Alliance will remain vigilant in its effort to mobilise all stakeholders to become part of innovative think tanks that will focus on reshaping the cancer landscape in South Africa. We have to ensure that the human rights of all cancer patients are being protected.
“Cancer services must be delivered in an ethical manner, focusing on early detection and timeous treatment. We call on all stakeholders to be part of the innovation and re-engineering of cancer services in South Africa because together, we can remain committed to being the watchdog for cancer services in South Africa,” she said.
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