This headline is commonplace in oncology practice journals today, especially those published in the United States. This is where the bad reputation and narratives of how big pharma want to cash in on cancer comes from. The defence is that it takes a whole lot of dollars to innovate and churn out the latest cancer drugs some of which have a marginal effect such as in breast cancer and others which have been practice changing like in melanoma and lung cancer.
As I mention United States please stay with me as the relevance to Zambia is coming. In the U.S where a certain number of people can afford medical insurance (this is not a debate on Obama Care), the payment of expensive new cancer treatment can go along the lines of co payment, meaning the insurance company may be able to pay a percentage of the bill for the cancer treatment. Seems fair right? The term financial toxicity comes in where regardless how much someone else is helping you pay if you have to pay up to $ 2000 per month for 12 months or even the rest of your life that can turn one’s pockets inside out. Naturally and rightfully so there is uproar against this coupled with suspicion on the necessity of such expensive cancer medication.
Our Zambian scenario levels slightly different. In July 2007 the doors to our national Cancer Diseases Hospital opened having being built at the cost of $10-million. The then sitting president said it would alleviate the burden of sending patients for treatment abroad at an average cost of $10 000 per patient. The estimation was 5 000 cancer cases had required radiation between 1995 and 2004 and only 350 had received treatment. The rest of the patients had died.
At the opening it was said treatment at the hospital would be on a cost sharing basis but fortunately for the Zambian patient treatment ended up being provided free of charge. Therefore can we say our Zambian patients are spared the financial toxicity of cancer diagnosis compared to their American counterparts? Unfortunately no. The financial burden of cancer diagnosis is felt in a varied context no matter where you live.
Take for example Mrs Kanyata mother of five children between the ages of 3 and 17 years. She is a peasant farmer in a rural part of Zambia. She may not be educated but in her own local context she is content with her life. She is in a stable marriage and happily farms her patch of farmland with her husband to produce enough to sustain her family’s needs. Her children go to the local school and the future looks bright for the 17-year-old daughter who excels academically.
Unfortunately for her she has missed all the outreach activities on cancer awareness in her village, so when she has never been screened and when she starts exhibiting signs and symptoms of cervical cancer she takes it that someone is jealous of her marriage and gunning for her husband. She neglects going to the hospital and pursues other avenues, which by the way come at a higher cost than the free health services offered at district hospitals. The financial toxicity has begun. All the while the cancer keeps growing and her strength diminishes translating into less manpower for the patch of farmland resulting in a lower yield. With her worsening illness taking care of her husband also takes a secondary seat and this also results in reduced productivity on his part compounding their problem even more. Her oldest daughter, despite being academically strong is also at that age where motherly reinforcement is required regularly.
Finally they find themselves in the main stream healthcare system, a month or two later landing themselves in front of a doctor at the Cancer Diseases Hospital who is aware that they have come 1200 km out of the capital city but informs them it is St III cervical cancer and she needs to stay for a full 6 – 8 weeks of treatment. There are also blood tests and scans to be done. With no more money to expend, Mr Kanyata is very worried how they will afford this. They spent the children’s school uniform money to buy bus tickets and were hoping to be back in time for ploughing and planting as they have done comfortably for years. At the back of his mind he also knows his food stores are low due to the low yield.
Don’t worry the doctor says, luckily everything can be catered for by the government. Cancer treatment is free. The patient can stay free in the wards and he will try to expedite the tests to shorten the waiting period before treatment start. However, he gently reminds there are about 10 other people this week alone in the same situation. Have the Kanyatas been spared financial toxicity because of free health care?
No they haven’t. Even though the free health care lifts part of the burden, they are losing out on productivity that sustains the family. They have travelled miles away from home leaving young children to fend for themselves, disturbing their studies.
The financial toxicity of the west may differ in flesh and fabric from society to status but the skeleton remains the same.
I had an interesting conversation with a health-planning consultant recently who narrated how she had found it offensive at first when she got an assignment to detail the value of life lost due to cancer. Initially she had rejected it due to her pious reason that life lost to cancer cannot be valued in figured. However, when she begrudgingly started working on the project she realised that actually the literal cost of a full-blown cancer diagnosis can be numerated and it is colossal. This can be multiplied by the feminine co factor for the role that a woman plays in our society.
So next time you see an article on financial toxicity of cancer diagnosis don’t gloss over it. Read it and digest it, cancer is everyone’s problem. Remember the Kanyantas. Prevention is way better than cure. Go for screening!