As the world marks Cancer Day on the backdrop of a stubborn Covid-19 pandemic, Clifford Akumu talked to Dr Miriam Mutebi, consultant Breast Surgical Oncologist at Aga Khan University Hospital, Board Member, Union for International Cancer Control (UICC) and Chair, Kenya Society of Haematology and Oncology on lessons learnt.

The world is celebrating Cancer Day at a time when Covid-19 pandemic is battering the economy and disrupting healthcare systems. How has it affected cancer patients in the country?

Dr Mutebi:  The pandemic has revealed considerable weaknesses in health systems and caused severe disruptions to organisations (both private and public facilities) working in the cancer space and their ability to deliver their services.

However, it has also shown considerable resilience and energy of individuals and organisations as they continue to adapt and innovate to overcome these challenges.

The Union for International Cancer Control conducted a survey with over 100 of its member organisations in 55 countries, which revealed that their income and organisational activities are under significant pressure.

Three-quarters of the organisations anticipated a reduction in finances of 25-75 per cent, while four projected that up to 100 per cent of their income could disappear.

A rapid assessment report by WHO from May 2020 on the initial impact of Covid-19 on NCDs had already shown that 56 per cent of 155 participating countries had partially or completely disrupted services for cancer treatment during that phase of the pandemic.

Top five most common disruptions to services across the non-communicable diseases noted by WHO were: cancellation of elective care; closure of population-level screening programmes; transport lockdowns, closure of disease-specific consultation clinics; insufficient protective equipment; NCD related clinical staff deployed to provide Covid-19 relief, and closure of outpatient disease specific consultation clinics

What hurdles do women and men face in accessing breast cancer treatment and care during this pandemic and what can be done to address the challenges?

 The consequences of disruptions to cancer care have resulted in delayed treatment, screenings, diagnostics and research around cancer.

This could lead to a later increase in cancer incidence, later diagnosis and therefore potentially more serious outcomes, and ultimately higher mortality. 

Less support and navigation assistance mean that patients won’t necessarily receive the appropriate treatment at the appropriate time or develop co-morbidities.

Less research means not only that the development of possible future medications will be delayed, but also that patients who rely on clinical trials will not be treated. 

There have been a few silver linings from the pandemic.  There has been greater collaboration and patient-centred care.

Even before the pandemic, there was a growing appetite for multi-disciplinary and multi-sectorial collaborations, which included the voices of physicians, pathologists, oncologists, therapists, psycho-oncologists, nurses, community and social workers, palliative caregivers, economists and others, offering multi-dimensional solutions focused on the needs of patients and their families.

The global nature of the pandemic has only reinforced international collaborations and highlighted the need for care that is less siloed and more patient-centred.

Locally, we have had to innovate and think about different modes of care delivery and there has been an increase in telemedicine to provide care for patients, but also in knowledge sharing and learning for physicians and multi-disciplinary team members.

More tumour boards are now virtual and so are various patient support groups and services.

There has  been a rise in patient navigation strategies with use of mobile phones to talk to patients and improve adherence to therapies at the main public referral centres.

On a global scale there has been accelerated approval of treatment. Regulators are moving more swiftly on approving more efficient medicines or treatment protocols that reduce the number of consultations in clinical settings in the pursuit of treatment.

This can only be a win for limited resource settings. In addition, there has been an emergence of new diagnostics and therapeutics, remote diagnostics and care, big data and artificial intelligence (AI), which are enabling more personalised care and diagnosis, increasing the ability to identify and treat disease earlier.

What is the latest breast cancer landscape in Kenya? 

Data from Globocan 2020, showed that for the first time, breast cancer is now the most commonly diagnosed cancer in the world.

This is due largely to the increasing incidence in low and middle income countries like ours.

In Kenya, breast cancer is the most common cancer affecting both men and women with 6,799 new cases diagnosed in 2020, comprising 16 per cent of all cancers diagnosed and 25 per cent of all cancers diagnosed in women. 

Tell us a little bit about the cost of cancer management and role of Universal Health Coverage.

A frequent barrier to accessing care is the cost of cancer therapies as patients have to frequently pay out of pocket for their therapies resulting in financial toxicity and catastrophic health expenditure.

The National Hospital Insurance Fund has tried to mitigate some of the costs resulting in more patients completing their treatment, but more efforts are needed to ensure that all patients are able to access timely and appropriate therapies.

UHC provides a promising start to achieving equitable services. These must, however, go hand in hand with awareness, prevention, screening and early detection strategies that ensure that cancers are detected early or prevented with less costs and expenditures to systems.