(UroToday.com) The 2024 Advanced Prostate Cancer Consensus Conference (APCCC) meeting featured a session on global access to advanced prostate cancer in low- and lower-middle-income countries, and a presentation by Dr. Omolara Aminat Fatiregun discussing how we can maximize the use of radiotherapy for prostate cancer in Africa.
Dr. Fatiregun started by emphasizing that we are seeing a surge in prostate cancer secondary to an unpreventable increase despite other interventions such as lifestyle and public health initiatives. Importantly, men of African descent present at younger ages and with late-stage disease. In order to maximize radiotherapy for prostate cancer we need to answer several outstanding questions:
- What is the big question?
- Are we preparing for a surge of late-stage disease?
- How do we incorporate radiotherapy into palliative treatment?
- How do we incorporate radiotherapy into localized treatment?
Surmountable challenges to radiotherapy abound in Africa with regard to availability, accessibility, and affordability. The following highlights the global distribution of access to radiotherapy per 100,000 people, notably with many parts of Africa having zero access:
\Some identifiable challenges as highlighted by Dr. Fatiregun include:
- Availability of cancer treatment services
- Radiotherapy treatment machines
- Cancer medications
- Capacity building for personnel
- Accessibility services
- Affordable costs
- Political will – to provide leadership in cancer control
Dr. Fatiregun highlighted that Nigeria is a West African country with a population of 200 million and six geopolitical zones:
Several lessons have been learned thus far in Nigeria:
- There is political will
- Establishment of the National Cancer Control Program (NCCP) in 2006, comprising:
- Public Education on Cancer
- Cancer Prevention
- Early Diagnosis and Treatment
- Effective Therapy
- Palliative Care
- Updates of the National Plan are to be provided every five years
- Includes involvement of private stakeholders
- Includes diverse backgrounds and expertise involved in cancer care
Furthermore, the National Institute for Cancer Research and Treatment (NICRAT) was established by the federal government to provide national leadership in cancer research, treatment, and control in Nigeria. NICRAT developed a National Strategic Cancer Control plan for 2023-2027 launched by the Honorable Minister at the opening ceremony of the 2023 International Cancer Week.
With regard to radiotherapy availability, the first radiotherapy machine was installed in Nigeria in 1969. In 2024, the current status of radiotherapy machines in Nigeria includes 25 new radiotherapy machines (and counting), as well as the first PET scan machine in West Africa (private):
The following three federal centers are awaiting new machines: University College Hospital, Ibadan, Oyo State; University of Benin Teaching Hospital, Benin; Ahmadu Bello Teaching Hospital, Zaria, Kaduna State. Centers in the pipeline include:
- Lagos State University Teaching Hospital, Ikeja, Lagos
- Lagos State Government
- Jos University Teaching Hospital, Jos, Plateau
- Lakeshore Cancer Center, Lagos
- Mercure Cancer Center, Lagos
- NSIA Cancer Centers in Abuja, Enugu, Kaduna State
- Katsina State Collaboration
- Private Center: Cedarcrest Comprehensive Center
Additional milestones as highlighted by Dr. Fatiregun include (i) The Nigerian Cancer Access Partnership (N-CAP) Program; (ii) ongoing upgrade of Oncology Centers of Excellence (UCH Ibadan, UNTH Enugu, ABUTH Zaria, UDUTH Sokoto, UBTH Benin, and National Hospital Abuja); (iii) implementation of Cancer Health Fund (CHF) in six federal teaching hospitals in each geopolitical zone, which is in the first phase for the treatment of indigent cancer patients of breast, cervix, and prostate; (iv) state and private insurance programs to cover cancer treatment; (v) sensitization of policymakers and stakeholders; (vi) development of cancer control programs by state governments; (vii) committee of CMDS; (viii) a National Cancer Society (NCS); (ix) the Association for Radiation and Clinical Oncologists (ARCON); (x) the African Coalition for Cancer; (xi) and NGOs. However, Dr. Fatiregun notes that there is a need for continued advocacy, given that Nigeria needs about 200 total radiotherapy machines, and the need to scale up current programs to improve availability, accessibility, and affordability. There is also a need for capacity development, personnel training, research, and more centers. Additionally, more public-private partnerships would be helpful, as would international collaborations, and maintenance and evaluation of processes to ensure sustainability.
Dr. Fatiregun concluded her presentation discussing how we can maximize the use of radiotherapy for prostate cancer in Africa with the following take-home messages:
- To prepare for this surge we need to maximize the use of radiotherapy in Africa
- African countries (low- and middle-income countries) must identify their unique challenges
- We must take deliberate and actionable steps toward achieving these goals
Presented by: Omolara Aminat Fatiregun, MBBS, MPH, FWACS, Lagos State University Teaching Hospital, Lagos, Nigeria
Written by: Zachary Klaassen, MD, MSc - Urologic Oncologist, Associate Professor of Urology, Georgia Cancer Center, Wellstar MCG Health, @zklaassen_md on Twitter during the 2024 Advanced Prostate Cancer Consensus Conference (APCCC) Meeting, Lugano, Switzerland, Thurs, Apr 25 - Sat, Apr 27, 2024.