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On The Path To A South African Cancer Care Solution

October 2020

Dr Thulo Molefi, Specialist and Senior Lecturer, Department of Medical Oncology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa

 

Globally, cancer rates are on a relentless proliferative path and despite death rates currently trailing behind those of cardiovascular disease, cancer is projected to establish itself as the leading cause of mortality worldwide as the 21st century progresses, with 70% of these deaths occurring in low to middle income countries (LMIC).

 

South Africa (SA), like other LMIC’s, is burdened with cancers related to infection and socioeconomic obstacles. As the country’s population steadily grows and ages, through advancing socioeconomic development and access to healthcare, particularly for the previously marginalized black population, this changes the prevalence and distribution of carcinogenic risk factors, resulting in cancer transitions, where cancer of the cervix is the most prevalent female malignancy in black women, however, breast cancer is on a steady rise in this population.

 

Despite improvements in access to healthcare, socioeconomic status and the ability to afford health insurance, cancer’s racial disparity still exists in SA between the public and private healthcare sectors. The public sector which caters to the majority of the country’s indigent population, is still overwhelmed and unable to adequately fulfil its duties.

 

SA has limited cancer treatment centres, which are mainly situated in academic institutions located in the country’s big city centres. Geographic distance from these institutions creates a detrimental disadvantage for patients settled in rural areas, where the nearest healthcare facility is a clinic or district hospital, unequipped to manage this disease.

 

The early diagnosis of cancer can improve patient outcomes, however, because of geographical, infrastructural, human resource and lack of patient awareness many patients are diagnosed at late stages of their cancers, with resultant dismal outcomes. One cannot forget about the issues of chemotherapy shortages, the unavailability of novel targeted agents and immunotherapy in state hospitals and the general cost of cancer care globally; but the early diagnosis of this health problem, circumvents the use of these unaffordable and often toxic modalities
With the knowledge of these limitations in the public healthcare sector, innovative approaches need to be established, particularly through collaboration between community, government and private entities. Cancer should be a communal conversation; its existence, diagnosis and treatment must not be limited to the urban cancer treatment centres; the treatment of this lethal disease might require expert knowledge but its awareness and screening does not.

 

In a journey of a million miles, AstraZeneca’s Phakamisa initiative, in trying to increase cancer awareness, facilitate early diagnosis and fast-track pathways to treatment, is a step in the right direction, our people need to be aware of this scourge, our clinics and district hospitals need to think of, screen for and diagnose this disease, our tertiary/quaternary hospital need to treat this cancer early, so our people can be rescued from an unnecessary early death.
Early stage cancer can be affordably managed and cured, so as communities let’s be curious about cancer, know our body’s, seek help when problems occur, make each other aware of where to go for help, support each other when calamity strikes and stay hopeful in the search for the eradication of cancer.

 

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