Cancer presentation patterns in Lagos, Nigeria: Experience from a private cancer center
Background: Cancer incidence and mortality is increasing worldwide. In 2018, there were an estimated 18.1 million new cancer cases and 9.6 million cancer deaths. In Nigeria, it is estimated that 100,000 new cases occur annually, with a high case fatality ratio. The burden of cancer in Nigeria is significant, as the country still grapples with infectious diseases and has limited data on cancer epidemiology. Our study is descriptive using data from a hospital-based registry.
Objectives: This retrospective study assesses the characteristics of patients that presented to a private cancer center in Lagos, Nigeria. We aimed to update knowledge on the current trends of cancer in Nigeria as exemplified by the experience of this cancer center and set a foundation for guiding future research and policy efforts in cancer screening, prevention, and control.
Methods: The records of all the 548 oncology patients registered at the Lakeshore Cancer Center (LCC) cancer registry from January 2015 to June 2018 were reviewed for this study.
Results: Most common cancer types were breast cancer for females (46%) and prostate cancer for males (32%). 92% of the tumors were malignant and 97% of the patients were symptomatic. Among patients diagnosed with cancer, 49% were ≤ 50 years old, 90% paid for their healthcare out of pocket, and 67% did not complete treatment.
Conclusions: This study highlights the state of cancer care in Nigeria and should guide future research, with a focus on public awareness, screening programs and implementation of novel cancer control policies and infrastructure that supports early detection.
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A cancer journal for clinicians 2018; 68(6), 394-424. DOI: https://doi.org/10.3322/caac.21492
“Cancer,” World Health Organization. [Online]. Available: http://www.who.int/news-room/fact-sheets/detail/cancer. [Accessed: 30-Sep-2018].
Kushi LH, Doyle C, McCullough M, et al. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012; 62: 30‐ 67. DOI: https://doi.org/10.3322/caac.20140
Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975‐2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer. 2010; 116: 544‐ 573. DOI: https://doi.org/10.1002/cncr.24760
Colditz GA, Baer HJ, Tamimi RM. Breast cancer. In: D Schottenfeld, JF Fraumeni, eds. Cancer Epidemiology and Prevention. 3rd ed. New York: Oxford University Press; 2006: 995‐ 1012. DOI: https://doi.org/10.1093/acprof:oso/9780195149616.003.0051
Colditz GA, Sellers TA, Trapido E. Epidemiology‐identifying the causes and preventability of cancer? Nat Rev Cancer. 2006; 6: 75‐ 83. DOI: https://doi.org/10.1038/nrc1784
Global Initiative for Cancer Registry Development (GICR) Website.” [Online]. Available: http://gicr.iarc.fr/en/. [Accessed: 30-Sep-2018].
Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International journal of cancer, 2010; 127(12), 2893-2917. DOI: https://doi.org/10.1002/ijc.25516
Fatunmbi M, Saunders A, Chugani B, et al. Cancer Registration in Resource-limited Environments-Experience in Lagos, Nigeria. J Surg Res. 2019;235:167-170. doi:10.1016/j.jss.2018.09.021 DOI: https://doi.org/10.1016/j.jss.2018.09.021
Jedy-Agba E, Curado MP, Ogunbiyi O, et al. Cancer incidence in Nigeria: a report from population-based cancer registries. Cancer Epidemiol. 2012;36(5):e271-e278. doi:10.1016/j.canep.2012.04.007. DOI: https://doi.org/10.1016/j.canep.2012.04.007
Parkin DM, Bray F, Ferlay J, & Jemal A. Cancer in Africa 2012. Cancer Epidemiology and Prevention Biomarkers 2014; 23(6), 953-966 DOI: https://doi.org/10.1158/1055-9965.EPI-14-0281
USAID African Strategies for Health. Health Financing Profile: Nigeria. Feb. 2016 http://www.africanstrategies4health.org/uploads/1/3/5/3/13538666/country_profile_-_nigeria_-_us_letter_final.pdf
World Health Organization Global Health Expenditure database . Current health expenditure (% of GDP) (https://apps.who.int/nha/database). 2020.
Bein, Murad A et al. “Healthcare spending and health outcomes: evidence from selected East African countries.” African health sciences vol. 17,1 (2017): 247-254. DOI: 10.4314/ahs.v17i1.30 DOI: https://doi.org/10.4314/ahs.v17i1.30
Makuta I, O'Hare B. Quality of governance, public spending on health and health status in Sub Saharan Africa: a panel data regression analysis. BMC Public Health. 2015;15:932. Published 2015 Sep 21. doi: 10.1186/s12889-015-2287-z;
Sango-Coke, Elizabeth Yinka, and Murad A Bein. “The Impact of Healthcare spending on Life Expectancy: Evidence from Selected West African Countries.” African journal of reproductive health vol. 22,4 (2018) 64-71. doi: 10.29063/ajrh2018/v22i4.7
A. Tandon, CJL Murray, JA Lauer, DB Evans. Measuring Overall Health System Performance for 191 Countries. GPE Discussion Paper Series: No. 30. EIP/GPE/EQC World Health Organization (2000). https://www.who.int/healthinfo/paper30.pdf.
World Health Organization Global Health Expenditure database. Out-of-pocket expenditure (% of current health expenditure) (http://apps.who.int/nha/database). 2020
Ramsden V, Eguzo K, Olatunbosun O, Ekanem U, Mpofu C, Walker V, et al. Review of cancer control policy in Nigeria and comparison with selected African countries implications for future policy making. Ibom Medical Journal 2019;13:1–11
Nwogu, Chukwumere E et al. “Role of Private Enterprise in Cancer Control in Low to Middle Income Countries.” Journal of cancer epidemiology. (2016):7121527. doi: 10.1155/2016/7121527 DOI: https://doi.org/10.1155/2016/7121527
Nigeria National System of Cancer Registries (NSCR). Federal Ministry of Health. https://nigeriancancerregistries.net/contact-details-of-nigerian-cancer-registries-personnel/
Nigeria. National Cancer Control Plan (NCCP) 2018-2022. April 2018 https://www.iccp-portal.org/system/files/plans/NCCP_Final%20%5B1%5D.pdf
Mathew A. Global Survey of Clinical Oncology Workforce. J Glob Oncol. 2018;4:1-12. doi:10.1200/JGO.17.00188 DOI: https://doi.org/10.1200/JGO.17.00188
P. Adepoju. For many in Nigeria, cancer care remains out of reach. DEVEX https://www.devex.com/news/for-many-in-nigeria-cancer-care-remains-out-of-reach-95669.
Stanford Medicine. Collaboration aims to improve cancer care in Nigeria. April 2018. https://med.stanford.edu/news/all-news/2018/04/collaboration-aims-to-improve-cancer-care-in-nigeria.html
Sylla BS, Wild CP. A million Africans a year dying from cancer by 2030: what can cancer research and control offer to the continent?. Int J Cancer. 2012;130(2):245-250. doi: 10.1002/ijc.26333 DOI: https://doi.org/10.1002/ijc.26333
Vanderpuye V, Hammad N, Martei Y, et al. Cancer care workforce in Africa: perspectives from a global survey. Infect Agent Cancer. 2019; 14:11. doi: 10.1186/s13027-019-0227-8 DOI: https://doi.org/10.1186/s13027-019-0227-8
Liese Pruitt, Tolulope Mumuni, Eugene Raikhel, Adeyinka Ademola, Temidayo Ogundiran, Adeniyi Adenipekun, Imran Morhason-Bello, Oladosu A. Ojengbede & Olufunmilayo I. Olopade (2015) Social barriers to diagnosis and treatment of breast cancer in patients presenting at a teaching hospital in Ibadan, Nigeria, Global Public Health, 10:3, 331-344, DOI: 10.1080/17441692.2014.974649 DOI: https://doi.org/10.1080/17441692.2014.974649
Asuzu, C.C., Akin-Odanye, E.O., Asuzu, M.C. et al. A socio-cultural study of traditional healers role in African health care. Infect Agents Cancer 14, 15 (2019). DOI: 10.1186/s13027-019-0232-y
Ibrahim, N.A., Odusanya, O.O. Knowledge of risk factors, beliefs and practices of female healthcare professionals towards breast cancer in a tertiary institution in Lagos, Nigeria. BMC Cancer 9, 76 (2009). DOI: 10.1186/1471-2407-9-76 DOI: https://doi.org/10.1186/1471-2407-9-76
National Cancer Institute. (2019). Age. [Online]. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/age
White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Henley SJ. Age and cancer risk: a potentially modifiable relationship. Am J Prev Med. 2014; 46(3 Suppl 1):S7-S15. doi: 10.1016/j.amepre.2013.10.029 DOI: https://doi.org/10.1016/j.amepre.2013.10.029
WHO Nigeria Key Indicators. http://apps.who.int/gho/data/node.cco.ki-NGA?lang=en [Accessed 8 Mar. 2019].
Awodele O, Adeyomoye AA, Awodele DF. Cancer distribution pattern in south-western Nigeria. Tanzania journal of health research 2011; 13(2), 106-108. DOI: https://doi.org/10.4314/thrb.v13i2.55226
Cancer in Nigeria 2009-2013. Abuja, Nigeria: Nigeria National System of Cancer Registries, 2016.
Hunt, Kate et al. “Do women consult more than men? A review of gender and consultation for back pain and headache.” Journal of health services research & policy vol. 16, 2 (2011): 108-17. doi: 10.1258/jhsrp.2010.009131).
Hall, Michaela T., et al. “The Projected Time Frame until Cervical Cancer Elimination in Australia: A Modelling Study.” The Lancet Public Health, vol. 4, no. 1, Elsevier, Jan. 2019, pp. e19–27. doi: 10.1016/S2468-2667(18)30183-X. DOI: https://doi.org/10.1016/S2468-2667(18)30183-X
A Oladeji, O Atalabi, M Jimoh, I Ntekim, T Elumelu. Delay in Presentation of Cancer Patients for Diagnosis and Management: An Institutional Report. The Internet Journal of Oncology. 2017 Volume 13 Number 1.
Ezeome, E R. “Delays in presentation and treatment of breast cancer in Enugu, Nigeria.” Nigerian journal of clinical practice vol. 13, 3 (2010): 311-6.
Koo, Minjoung Monica, et al. “Presenting Symptoms of Cancer and Stage at Diagnosis: Evidence from a Cross-Sectional, Population-Based Study.” The Lancet Oncology, vol. 21, no. 1, Elsevier, Jan. 2020, pp. 73–79, doi: 10.1016/S1470-2045(19)30595-9. DOI: https://doi.org/10.1016/S1470-2045(19)30595-9
Ishola, Foluso, and Oluwatosin Omole. “A vision for improved cancer screening in Nigeria.” The Lancet. Global health vol. 4, 6 (2016): e359-60. doi: 10.1016/S2214-109X(16)30062-6 DOI: https://doi.org/10.1016/S2214-109X(16)30062-6
Sarki, A., Roni, B. L. (2019). This disease is “not for hospital”: myths and misconceptions about cancers in Northern Nigeria. Journal of Global Health Reports, 3. DOI: https://doi.org/10.29392/joghr.3.e2019070
Ololade, Kehinde, et al. “The ‘Evil Arrow’ Myths and Misconceptions of Cancer at Lagos University Teaching Hospital, Nigeria.” South African Journal of Oncology, vol. 3, Jan. 2019, doi: 10.4102/sajo.v3i0.49 DOI: https://doi.org/10.4102/sajo.v3i0.49
Robertson, Charles, et al. A Survey of the Nigerian Middle Class. 26 Sept. 2011
Nigeria National Minimum Wage. 2018-2020 Data. 2021-2022 Forecast | Historical. tradingeconomics.com, https://tradingeconomics.com/nigeria/minimum-wages. Accessed 25 June 2020.
RFI. Forty percent of Nigerians live below poverty line: statistics office. April 2020. https://sundiatapost.com/40-of-nigerians-live-in-poverty-nbs/
Leng, Jim et al. “Infrastructural Challenges Lead to Delay of Curative Radiotherapy in Nigeria.” JCO global oncology vol. 6 (2020): 269-276. doi: 10.1200/JGO.19.00286 DOI: https://doi.org/10.1200/JGO.19.00286
Abubakar, Mohammed Yusuf, et al. Medical Tourism in Nigeria: Challenges and Remedies to Health Care System Development. 2018. Semantic Scholar, doi: 10.4314/ijdmr.v13i1
Healthnews.ng. Nigeria is buying radiotherapy machines but most patients cannot afford cancer drugs. http://www.healthnews.ng/nigeria-is-buying-radiotherapy-machines-but-most-patients-cannot-afford-cancer-drugs/ [Accessed 25 Jun. 2020].
Asuzu, C.C., Akin-Odanye, E.O., Asuzu, M.C. et al. A socio-cultural study of traditional healers role in African health care. Infect Agents Cancer 14, 15 (2019). DOI: 10.1186/s13027-019-0232-y DOI: https://doi.org/10.1186/s13027-019-0232-y
Asuzu, C. C., Elumelu‐Kupoluyi, T., Asuzu, M. C., Campbell, O. B., Akin‐Odanye, E. O., and Lounsbury, D. ( 2017) A pilot study of cancer patients' use of traditional healers in the Radiotherapy Department, University College Hospital, Ibadan, Nigeria. Psycho‐Oncology, 26: 369– 376. doi: 10.1002/pon.4033. DOI: https://doi.org/10.1002/pon.4033
Ezeome ER, Anarado AN. Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. BMC Complement Altern Med. 2007; 7:28. Published 2007 Sep 12. doi: 10.1186/1472-6882-7-28. DOI: https://doi.org/10.1186/1472-6882-7-28
- Abstract views: 3841
- PDF: 174
- HTML: 0
Copyright (c) 2020 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.