End cancer care inequity, an approach for achieving cancer care for all

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End cancer care inequity, an approach for achieving cancer care for all

Lack of access to cancer care due to geographical location, socioeconomic status, lack of information, or any other reason? Let us put hands together to close the cancer care gap.

Every year on February 4th, we commemorate World Cancer Day to encourage individuals, researchers, healthcare professionals, patients, governments, industry partners, and the media to work together to raise awareness and save millions of preventable cancer deaths from cancers. This year the theme is “closing the care gap.” Calling upon to close inequity for cancer care.

Rwanda NCD Alliance and partners joined the rest of the world in commemorating World Cancer Day on February 4, 2022. The day was preceded by a month-long awareness campaign in collaboration with Rwanda NCD Alliance (RNCDA), Rwanda Biomedical Center (RBC), Breast Cancer Initiative East Africa Inc (BCIEA), Women Cancer Relief (WCR), and Shema Clinic to raise public awareness about cancer prevention and control, improve equity and access to quality cancer care, and provide cervical cancer screening and early detection services. Local authorities, who also took part in the awareness campaign, adopted the activities as a model for routine NCD screening in the community. The week was capped off by a television talk organized around the theme:” What can be done to close the gap in cancer care?”, which gathered the Director of Cancer Diseases Unit at the Rwanda Biomedical Center (RBC) and a person with lived experience of Breas Cancer.

The National World Cancer Day celebration 2022 was held at Pink Wellness House (BCIEA, Headquarter), Narugunga Sector, Gihanga Village, to raise general population awareness about cancer prevention and encourage early cancer detection and treatment. Throughout the day, a breast cancer survivor and the founder of the Breast Cancer Initiative for East Africa witnessed how early cancer diagnosis increases the chances of cure. "I was diagnosed with breast cancer in 1994. Because the cancer was diagnosed at an early stage and had information on breast cancer, I received timely treatment and was cured," she testified. She fully committed to raising awareness for cancer and NCD prevention through health education and testimonies.

The Director of Cancer Unit at Rwanda Biomedical Center (RBC) stated: "Many NCDs, particulary cancers begin without a sign or symptom, so I encourage all Rwandans, particularly those over the age of 35, to reach out nearby health facility for NCDs screening. When they discover a threat, such as cancer, they treat you as soon as possible. There is a screening for breast and cervical cancer at health facilities. Cancer care has been decentralized to lower level and covered by Community-Based Health Insurence. Thus, women are motivated to go to the nearest health facility to be screened. Furthermore, Rwanda has made progress through improving awareness on prevention, scaling up cervical cancer screening and breast cancer early detection, upgrading diagnostic capacities through automated biopsy processing machines, and improving treatment capacity through Radiotherapy centre. Moreover, Morphine, the most commonly used opioid for severe cancer-related pain, is now produced in Rwanda in collaboration with Rwanda Medical Supply and LABOPHAR.”

In line with the commemoration of the World Cancer Day, the Director of Cancer Unit at Rwanda Biomedical Center was invited to participate in our regular Virtual Fitness Show Program, which is aired on National Television (RTV) every Saturday 8:00 to 9:00 a.mand Sunday from 6:00 to 7:00 a.m., to raise awareness about the role of sport in the fight against NCDs and deliver the general message in regards to this year's theme. He emphasized that doing physical activities at least four times per week for 50 minutes each time can reduce cancer risk in all its forms. Physical activities combined with other healthy lifestyle choices are cost-effective in reversing Rwanda's alarming increase in cancer prevalence. He ended up calling Rwandans to schedule an early check-up for cancer and other NCDs.

The burden of cancer in Rwanda

Cancer is the second leading cause of death worldwide. According to World Heart Organization (WHO), there were an estimated 19.3 million new cancer cases and 9.96 million cancer deaths worldwide in 2020.

Rwanda's cancer incidence is estimated to be 8,835 cases, with an annual mortality rate of 6,044 cases (Globocan report 2020). According to data from the Rwanda National Cancer Registry, which collects data on cancer patients who present at health facilities, there were 4,356 new cases in 2020. Breast, cervical, and prostate cancer are the most common cancers.

Though the prevalence is decreasing, significant work remains to be done to close the care gap and free our country from preventable cancer sufferings and deaths.

Closing cancer care gap in Rwanda 

Rwanda has made significant progress in cancer prevention and control, with increased public awareness of cancer risk factors, increased cervical cancer screening and breast cancer early detection, upgraded diagnostic capabilities, improved cancer treatment capacity, palliative care, and the establishment of cancer training and research center. The health system is decentralized from the village level with community health workers to the central level. 

However, gaps in equity and access to high-quality cancer prevention and control exist, such as low public awareness and geographical and financial barriers to access high-quality cancer diagnosis and treatment. Cancer treatment is still scarce. We now only have two cancer treatment centers, the Rwanda Cancer Center and the Butaro Cancer Center of Excellence. Rwanda cancer registry shows that half of the patients diagnosed with cancer did not complete the entire package from cancer diagnosis, treatment, and follow-up. This was associated with economic constraints for transport, hospital costs, and not having health insurance.

Despite these challenges, there is a great political commitment to promote community health. On World Cancer Day 2020, the Ministry of Health through Rwanda Biomedical Centre launched a 5 years National Cancer Control plan to drive activities to prevent cancer.

Substantial work is still needed to be done to close the cancer care gap in Rwanda. RBC and its partners, including Rwanda NCD Alliance, will conduct a countrywide awareness month campaign to educate the general public about cancer prevention, early detection, and treatment. In addition, from January 31st to February 28th, 2022, there will be increased cervical cancer screening and breast cancer early detection in the 12 districts participating in this program. This awareness campaign will also advocate for social support for cancer patients who are suspected or confirmed to have the disease but are unable to cover some of the necessary costs for diagnosis and treatment.