World doesn't have enough oncologists to treat rising cancer patients in Africa

As cancer rates rise in Africa, the world will be short of specialists who can deliver chemotherapy, according to a new study published by Lancet.

Between 2018 and 2040, the number of patients requiring first-course chemotherapy annually will increase to over 1.1 million from around 0.6 million. To deliver chemotherapy, 7,744 cancer specialists will be required in the next 22 years to treat nearly 2 lakh new cancer cases in Africa.

The number of people diagnosed with cancer is projected to increase from 1.03 lakh to cases to 2.05 lakh cases. Cancer cases in Eastern, Middle and Western Africa are projected to increase the most in these three regions. According to this study the burden of chemotherapy will also be the most here.  

In low- and middle-income countries (LMICs), including sub-Saharan African countries, the cost of chemotherapy drugs is a substantial barrier to delivery; and in the absence of public health insurance many patients are unable to pay.

Other major barriers to chemotherapy administration include a scarcity of chemotherapy drugs, infrastructure for drug delivery, supportive pathology and trained personnel. This restricted access to care of cancer patients directly affects their survival, says the World Health Organization (WHO).  In fact, people in two out of three countries in sub-Saharan Africa do not have general access to even the basic cancer services.

In the recent past, the International Agency for Research on Cancer (IARC) too has identified the gap in chemotherapy treatment in the region. Around 80 per cent of people diagnosed with cancer across 46 sub-Saharan African countries are in advanced stages and fewer than 10 per cent receive pain relief, chemotherapy or radiotherapy.

Physicians required

The study also voices concern over the global shortfall in the health workforce required to treat the growing number of cancer patients. The world will need 35,000 additional cancer physicians between 2018 and 2040 —nearly 54 per cent increase over 65,000 physicians required in 2018.

Of the total physicians needed in 2040, 31.4 per cent will be required in high-income countries, whereas 67.2 per cent will be needed in LMICs, including African nations. In fact, the greatest shortfalls in the oncology workforce will be in Africa, where many countries have no formally qualified cancer physicians despite growing needs.

The lack of trained personnel is a substantial barrier to expansion of cancer services in many African countries and needs to be addressed. Countries like Malawi and Rwanda have demonstrated that chemotherapy can be safely delivered by local physicians and nurses if provided with adequate remote support from specialist centres. 

The burden of cancer is increasing in African countries as a result of ageing, chronic infections and unhealthy lifestyles such as lack of physical activity, obesogenic diets and tobacco use. The gap in cancer services especially the chemotherapy treatment pointed out by this study needs to be addressed. It is even more critical as the African continent aims towards universal health coverage.

Globally, between 2018 and 2040, the number of patients requiring first-course chemotherapy annually will increase from 9.8 million to 15.0 million, a relative increase of 53 per cent, according to the study. 

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