UGANDA: We Can Treat 90 Percent of Cancers At Mulago – UCI Director

April 2015 TheObserver; Cancer has made headlines recently for killing several prominent people in quick succession, including journalists Rosemary Nankabirwa, Bbale Francis and Danny Kyazze.Shortly before Bbale and Nankabirwa died, there were public fundraisers for their costly treatment, which raised several questions about Uganda’s capacity to manage the disease effectively, why the old cobalt radiotherapy equipment hasn’t been replaced, and where and how people can get cancer screening. DR JACKSON OREM is the executive director of the Uganda Cancer Institute at Mulago hospital. He joined UCI in 1991, although he only trained in oncology between 2002 and 2004. Diana Nabiruma put the above and other questions to Dr Orem.

What has changed since you joined Uganda Cancer Institute?

A lot has changed. When I joined, the institute was just a unit in the department of medicine in Mulago [hospital]. But the institute is now autonomous. Not only that, we are also a centre for referral for not only Uganda but the region.

As regards the public, people are now more aware that there is a disease called cancer. Disease management has also improved.

How so? What are your treatment outcomes?

 

If patients do not present late, some cancers have good treatment outcomes. In children, despite inefficient systems that include poor referrals, 75 per cent children who are treated are cured. In leukemia in children, 70 per cent are cured. Sixty per cent of breast cancer patients who are well treated also get cured.

If we are to look at all the cancers, I would say that our cure outcomes stand at below 50 per cent, but they are only slightly below.

Does Uganda have the capacity to be the regional centre of excellence as regards cancer, with the generalised treatment outcomes being below 50 per cent?

We need a big investment to put in place a centre of excellence; to kick-start the process, we need an injection of $80m. With that amount, we would be able to open up a few centres for cancer management in the East, West, North and North west.

We would also be able to put up more infrastructure, train more staff and acquire more equipment such as MRI and PET scans.

Do you have capacity to diagnose all cancers? There have been instances where diagnoses have been done or confirmed abroad.

Yes, we have the capacity but it is shared with Mulago. Not every sample is taken abroad; we only refer diagnoses that are not very conclusive or are difficult to make.

Why would a diagnosis done in Uganda be inconclusive?

It depends. The doctor might not have taken the right sample.

Why would a doctor do that?

There are a number of factors; they might not be well trained.

What is being done to acquire a radiotherapy machine; the old one reportedly breaks down often?

In a year’s time, the story will be different. What is key is that the equipment was already procured from Europe. What we need to do now is to build a bunker for the machine. It is a complicated process and I don’t think a company in Uganda has built a bunker like it before.

We procured a Ugandan company to help design the bunker and this company partnered with one in India that has built such bunkers before. I am optimistic that by June to July, the process of building the bunker will have begun.

Are we about to see the end of cancer drug stock-outs too?

The system in place does not allow us to always have medicines because the procurement and treatment departments are separate. We are, however, talking with the National Medical Stores to effect changes. The changes may take a while, though.

Following news of several people dying from cancer, including Rosemary Nankabirwa, some people have wondered how they can test for cancer.

 

People should be doing annual routine checkups and these should be guided by age, sex and their family’s history of cancer. If a woman is above 30, she should screen for cervical cancer every year. It is assumed that sexual debut in our society stands at between ages 12 and 15.

As you know, the process of cancer development is slow, taking up to 10 years to show up. If a woman had her first sexual debut at 15, cancer cells will show 10 years after that, if they have any.

Women can also do self breast examinations. In this, women are lucky because it is easy to test for cancers that most affect them. For men, we have the PSA test [for prostate cancer] but it is not very accurate. It is better than nothing, though. Men should start checking for prostate cancer at the age of 40. This is more important with people with a family history of prostate cancer.

Which are the most commonly seen cancers in Uganda?

Cervical and breast cancer are the most commonly seen in women. Prostate cancer is the most seen in men. Kaposi’s sarcoma and cancer of the stomach -which is caused by H.Pylori [which also causes peptic ulcers] is also commonly seen in men and women. Burkitt’s lymphoma is the most seen in children.

What challenges does the institute face?

Lack of resources. The [Shs] 10bn that the government is providing annually is still a drop in the ocean. The public is also not that well-informed and they hold misconceptions.

Misconceptions such as?

That cancers can’t be treated here; that patients have to go abroad to get treatment.

Don’t they?

No. We can treat about 90 per cent of all cancers here; just give us technology and we will do it. We can treat breast, cervical, Kaposi’s sarcoma, prostate and the children’s cancers.

Actually, the 10 per cent cancers we can’t treat here are also hard to treat in some places. We refer cases we can’t treat to places where treatment is possible. And we aren’t the only country to do this; referrals are also made from the UK.

What cancers can’t be treated in Uganda?

A certain cancer of the brain in children. It needs precise technology. Some people complain about the treatment of stomach cancers, they say patients are operated on several times, and still, they die. The problem is people present late so that where one operation of the stomach would have sufficed, several have to be done.

Is the institute looking at alternative treatments? Some of the treatments used, such as chemotherapy, are said to be rather harsh.

 

We are currently using chemotherapy, radiotherapy and surgery to treat cancers. This is the treatment being used elsewhere in the world too. Yes, targeted treatment exists but only a few cancers can be treated that way. It is expensive here but we are using it to treat Non-Hodgkins Lymphoma and [some types of] chronic leukemia.

Is any research being done to improve treatment and prognoses?

Yes, but it is collaborative. We lack the money to undertake our own, which is unfortunate. With collaborations, some collaborators may have their own agenda.

Finally, what generalised reaction do patients experience when they are told they have cancer?

They start with disbelief and denial but come around later on. Cancer management is done in teams. All my staff are trained in counseling and can deliver news in such a way that it will not shock.

The team also manages a patient until they have accepted their diagnosis and prognosis. I advise Ugandans to listen to their doctors more than anyone else. With a doctor, cancer is managed as best as possible.

 

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