Bending the Cost Curve of Cancer Care Awareness and Campaigns Through Volunteers

Background and context: Nigeria has been rated the 1st nation in Africa and 5th in the world with highest cervical cancer deaths with >26 women dying daily. Breast cancer incidence is higher with 90 new cases per 100,000 women annually in some western countries, compared with 30 per 100,000 in some African countries. In contrast, breast cancer deaths are almost identical, at about 15 per 100,000, which clearly points that late diagnosis and much poorer survival in Africa. Late diagnosis of cancer is possibly encouraged due to low awareness and sporadic screenings across Nigeria. To mitigate this system-wide gap, huge resources are required from the government, corporate organizations and nonprofits engaged in cancer awareness and programs. For a nonprofit with limited resources, volunteers became the most significant resource to create the needed policy change, public awareness and fundraising for cancer patients. In 2013, Project PINK BLUE started as a personal community development service of the National Youth Service Corp (NYSC) in Nigeria with as little as 5 volunteers whom organized the first community awareness program that mobilized 168 women in Kabusa community in Abuja. By 2018, Project PINK BLUE has 501 volunteers across Nigeria and Cameroon. With impact awareness events engaging thousands of people and raising supports for cancer patients while advocating for policy change. Aim: To share how the use volunteers has propelled the nonprofit organization to reach millions in <5 years while spending less on human resource compared with her impact. Strategy/Tactics: Project PINK BLUE designed a volunteer program that provides young people the platform to learn, network, grow and cultivate opportunities for themselves. The organization engage volunteers base on projects and activities all year round. Program/Policy process: The program's policy for volunteers is strictly on nonpayment; several young people have used the volunteer program to gain employment opportunities, meet amazing friends, achieve their dream and most importantly touch lives. Outcomes: Our statistics showed that we have 277 volunteers with Bachelors of Science, 63 with Masters degree, 20 in high school, 14 with higher national diploma, 13 with OND and 114 others. 40% of the volunteers have basic knowledge of cancer, 45.7% intermediate and 14.3% advanced knowledge. 87% of the volunteers responded to be available for cancer awareness activities, 10.9% were undecided and <2% responded no. What was learned: Qualitative responses showed that the volunteers needed to be more engaged in series of cancer activities.

Men on Blue: Knowledge, Belief, Fear, Perceived Attitude of Men to Prostate Cancer Screening and Awareness in Sub-Saharan Africa

Background and context: In Nigeria, cancer leads to >72,000 deaths per annum (30,924 for male and 40,647 for female). This number is set to increase given that there are 102,000 new cases of cancer every year. The estimated incidence for prostate cancer is (12%) and estimated mortality prostate (13%). Prostate cancer is the third leading cancer death in Nigeria and the leading cause of cancer deaths in Nigerian men. However, very little or nothing is said about prostate cancer in Nigeria. Every October, virtually all cancer NGOs roll out their drums of awareness focused on breast cancer, prostate cancer is always missing, while several men die in silence and pain because their prostate cancer was discovered at late stages. Men on Blue is a health intervention focused on closing the gap of awareness, education and screenings for prostate cancer in rural communities of Lagos, Abuja and Enugu. The intervention will use 3 core strategies, such as: prostate cancer awareness, prostate cancer screenings and social media campaigns. Our target is to screen 2000 men, reach 20,000 men directly, reach 30,000 women and youth directly in rural communities of Lagos, Abuja and Enugu and 5 million indirectly through traditional and social media in Nigeria. Aim: To reduce the incidence of prostate cancer through the creation of a platform for prostate cancer awareness, screening and support in Nigeria. Program/Policy process: The program use focused on phasing out late diagnosis of prostate cancer through screenings outreaches in local communities in Nigeria. Men are always missing in cancer awareness and programs, hence, the program will bring men to the fore of cancer awareness. Outcomes: It is expected that this program will increase the level of prostate cancer awareness in Nigeria through the translation of information materials in local languages, engage men to lead the campaign and the use of strategic social media campaign. What was learned: Preliminary results of the planning process of the program, showed that several men are battling with prostate cancer, however, very few is said about them and they are dying in silence. Their voice need to be heard in sub-Saharan Africa.

Determinants of Early Cancer Screening Behaviour in Nigeria

Background: Early detection and improvements/advancements in medicine have contributed to an overall decrease in mortality and morbidity rates resulting from cancer diagnoses. Despite this improvement in national and global health status, Nigerians continue to be diagnosed at a later stage, with a more aggressive disease state. This is an important observation given the impact cancer has on the abilities of individuals to function physically, psychologically, and socially within the context of their environment. It is important therefore to identify and target specific groups that may be less willing to present for early cancer screening. Aim: To understand the characteristics of people who are likely or not likely to present for early cancer screening among Nigerians, and to address the use of mechanisms by which to ensure a timely diagnosis of preventable cancers among Nigerians. Methods: Adult Nigerians (N=144), 18-71 years of age who presented for clinical breast exam (CBE), visual inspection with acetic acid (VIA) and prostate specific antigen test (PSA) screenings after an awareness exercise; completed survey forms which included a personality inventory, early cancer detection behavior scale and a demography profile. Multiple regression and ANOVA were used to examine predictive patterns as well as differences between and within groups. Results: Results showed income ( b = 0.18, P < .05) to be a significant determinant of early cancer detection behavior, such that higher income earners were more likely to go for screening. There were also significant gender differences in current cancer detection behavior between males (M = 0.15, SD = 0.51) and females (M= 0.47, SD = 0.80); males are less likely to engage in early detection behavior ( F(1,145) = 4.76, P = .03). Data further show differences between older (≥ 41) and younger (≤ 40) participants in intention to screen for cancer, with older participants reporting more willingness to engage in cancer screening. Conclusion: Our finding enhances our understanding of the profile of the groups who are less likely to screen for cancer. Also, it suggests that awareness campaign and free screening exercises should target these at-risk groups in Nigeria.

The Burden of HER-2 Positive Patients in Sub-Saharan Africa: A Caregiver Perspective

Background and context: Several studies showed that the use of the recombinant monoclonal antibody trastuzumab, in addition to adjuvant chemotherapy, for breast cancer with overexpression of the HER-2 protein or amplification of the HER-2/neu gene reduced the risk of recurrence by 50% in women irrespective of nodal status. In Nigeria, breast cancer is the leading and the most common cancer in women. A trastuzumab brand known as Herceptin is the popular brand usually prescribed by the oncologist in Nigeria. Once a histopathology/immune-chemistry result shows HER-2 positive and oncologist informs that patient of the diagnosis being HER-2 positive; most patients emotionally breaks down due to cost of the drugs. In Nigeria, as at 2015 the cost of herceptin 455mg was N650,000 ($1857). As at June 2016 that same drug increased in cost to N1,100,000 ($3142) due to the unstable exchange rate in Nigeria. In Nigeria 90% of patients pay-out of pocket for treatment and drugs as the health insurance system in my country does not cover chemotherapy drugs. Several cancer patients with HER-2 patients face serious financial challenges in Nigeria, as so many experience spread of the cancer to vital organ when they are unable to get finance to purchase the life-saving drug for their HER-2 positive breast cancer subtype. Aim: To understand the burden of HER-2 diagnosis in Nigeria and stimulate advocacy for the reduction of the cost of Herceptin in Nigeria and other sub-Saharan Africa where finance is a serious impediment to accessing medical care. Strategy/Tactics: The study will present case studies of three Nigerian women who were diagnosed of HER-2. Interview was used as a method of data collection, informed consent were also completed by the patients before the interview. Program/Policy process: Our study reveals that there is a need to engage the federal and state governments, corporate organizations, insurance schemes and most importantly pharmaceutical companies to reduce cost of cancer drugs and particularly Herceptin. HER-2 breast cancer patients need to lead the advocacy for reduction in cost of drug at all levels. Outcomes: Our qualitative findings reveal that caregivers are mostly affected by the cost of drugs such as Herceptin. In some cases caregivers, sell valuables, take loan and go public to raise funds for the cancer drugs. What was learned: Most HER-2 positive breast cancer patient could not afford Herceptin and some waited for several months to raise funds, which is probably a factor in metastasis and low-survival.

From Diagnosis to Survivorship: Using Cancer Support Group as an Advocacy and Support Platform for Cancer Care in Nigeria

Background and context: Cancer diagnosis comes with a lot of challenges. It is a huge burden to the patient, family, and community; subjecting them to financial crisis, emotional distress, dearth of self-esteem, and physiologic deformations. From a patient's perspective, treatment of cancer is complex and complicated with the weak healthcare system, attitude of healthcare workers, lack of insurance, lack of trust to orthodox medicine and stigmatization. Cancer patients are constantly seeking solace, people to listen to them and people who understand their state of mind and can be a source of inspiration. Studies have shown that peer cancer support group results in psychological benefit and improve relationships. The 2016 World Cancer Congress patient's pavilion inspired us to start up a cancer support group for cancer patients, survivors and caregivers known as Abuja Breast Cancer Support Group (ABC-SG). The cancer support was primarily founded for only breast cancer patient, survivor, caregivers and for peer support; as at today the group has transited from being patient group to also being an advocacy group with a number of activities and programs aimed at propelling all cancer patients from diagnosis to survivorship. Aim: To disseminate impact of establishing a breast cancer support group in Abuja and how it has helped cancer patients/survivors inspire each other while engaging policymakers to make cancer control a national health priority in Nigeria. Strategy/Tactics: The study reviewed the 1-year activities of the ABC-SG and surveyed the impact of the peer support to the 36 members of the group. Program/Policy process: As part of Project PINK BLUE SPARC MBC activities, ABC-SG was supported in different activities and programs targeted at peer support and policy change advocacy. Outcomes: The cancer support group have become a point of networking and inspiration for several patients and survivors; hence, more cancer patients are beginning to come out from their closest to identify with the support and make their diagnosis public. What was learned: There is an improvement in psychological states of patients and their physiologic understanding of their diagnosis by meeting together, networking, and interaction through social media. Our qualitative finding also showed that cancer patients needs platforms to speak out, to advocate and to change the course of cancer care if provided with all the necessary training and support.