The economic burden of cancer

A radiotherapy machine at Mulago hospital. Photo by Rachel Mabala

When Marion Okeya’s 30-year-old son was diagnosed with a cancerous brain tumour in January 2014, the urgent concern was the availability of treatment options at the Uganda Cancer Institute.

“There were many hospital visits before he was scheduled for surgery,” she says. “No one explained to us that more than a year after diagnosis, we would still be spending so much money on treatment.”

The surgery did not go well. Her son lost his motor skills and he cannot control his body functions. Before her son’s illness, Okeya was an accountant in a hotel but her employer could not tolerate her absenteeism.

“When my son lost control of himself, I failed to get a maid who could look after him, clean him and wash his bedsheets. I took sick leave from work for a month. After that, I used to take many days off until my employer terminated my contract.”
The surgery and palliative care ate up her savings. Today, most of her expenses revolve around drugs, pampers and bed sheets.

Cancer on the rise
Cancer is on the rampage: What are the challenges facing the Uganda Cancer Institute?, a briefing paper released by the Budget Monitoring and Accountability Unit (BMAU) of the Ministry of Finance, Planning and Economic Development, in May 2015, paints a bleak picture of the high rates of cancer diagnosis.

According to the paper, the number of patients diagnosed and treated with cancer in 2014 was 3,024, as compared to 2,037 in 2010.

Prof Henry Wabinga of the Kampala Cancer Registry, which carries out annual research, says there is a marked increase in the number of people diagnosed with cancer.

“For over 50 years, we have maintained the same sample area in Kyadondo County, which includes Kampala and surrounding areas up to Bombo, Bweyogerere, Makindye, and Nansana. There are about 2 million people in that area and every year, we register new cases.”
The incidence rates are higher for prostate, breast and cervical cancers.

“We registered 5.7 per cent new cases of prostate cancer. For breast and cervical cancer, it is 3.7 per cent and 1.5 per cent, respectively. In about 2o years, breast cancer will be the commonest cancer among women.”

In population of 100,000, 3,700 people are newly registered breast cancer patients. Using rough estimates, in the sample population of 2 million people in Kyadondo County, there were 74,000 new cases of breast cancer in 2014.

Prof Wabinga adds that: “When you use this sample to estimate the new cases of cancer in the whole country, the strain on the economy is quite high.”

Loss of productivity
According to Cancer Incidence in Five Continents Volume X, a report by the International Association of Cancer Registries and the International Agency for Research on Cancer in Uganda, the incidence rate for cervical cancer is highest in women of 50 – 60 years.

“Women in this age group are still professionally active,” says Prof Wabinga. “The time and mental energy which could have been used in their careers is instead lost in the treatment process.”

For the patients and caregivers, absenteeism from work is a constant because of the logistics of frequently travelling to treatment centres.

Employee absenteeism and disability lead to lost productivity, which reflects on the employer’s balance sheet. The minimal survival rate worsen the situation if the sick employee has health insurance.

For breast cancer, the five-year survival rate is slightly less than 50 per cent.
“By the end of five years, half of the breast cancer patients will be gone,” says Wabinga. “Our survival rate is the best in Africa, yet it is just 50 per cent.”

The survival rate for oesophagus and stomach cancers is 2 per cent. These statistics show that many people of employable age die prematurely from cancer. The cost of premature death on the economy, and on families, can only be estimated in terms of unrealised earnings.

Operation costs
Uganda Cancer Institute (UCI) is the only facility that provides specialised treatment for cancer.
“We budget $5 ( about Shs18,000) for registering a new patient,” says Prof Wabinga, who also sits on the board of UCI.
“A registered new patient has to go to the UCI for treatment, a third of which is paid for by the government. However, the annual budget of UCI is less than Shs2b.”

Depending on the stage of the cancer, direct medical costs take the form of surgery, chemotherapy, and radiotherapy. In a typical case of breast cancer at UCI, surgery costs Shs500,000, the recommended six cycles of radiotherapy cost Shs200,000 each, while the cheapest chemotherapy treatment costs Shs20,000 per month for five years.

According to the BMAU Paper, UCI is understaffed, has outdated equipment and inadequate drug combinations to manage cancer effectively.

One of the recommendations of the paper is that government should increase budget funding to the Institute. Because of drug shortages, patients get drugs for only one cycle and have to buy drugs in the next cycle. Those who cannot afford drugs in private pharmacies resort to herbal medicine, and because of this, the number of cancer patients followed up by UCI in 2014 was only 30,179.

The cost of treatment
Prof Wabinga adds that the incidence rates of prostate cancer are higher in men of more than 60 years of age.
“For such patients, their children bear the costs of managing the disease. If the caretaker is a breadwinner in his or her own family, this will affect their future investments.”

In the early detection stage, drugs, scans, and laboratory tests conducted in private health facilities are expensive. During the third and fourth stages, the patient may need palliative care. The drugs used are stronger, causing side effects, which include pain.

According to a report published in The Lancet Oncology in 2009, Cancer survival in Africa, Asia, and Central America; a population-based study, survival rates for cancer patients in Uganda do not exceed 13 per cent, except for breast cancer.
This means that a family will spend so much money on treating cancer, yet the chances of survival are low.

Since cancers are on the rise, more awareness needs to be raised among people if the costs are to be controlled.
Prof Wabinga says: “Many of these cancers are due to people’s lifestyles. People eat the wrong foods, they do not exercise, and obesity is becoming a problem. People need to be given more information about the causes of cancer.”
Awareness of the disease will also lead to early detection, which reduces the burden of treatment.