WITH the number of people diagnosed with cancer expected to balloon in coming years, one of the nation’s leading surgeons and university professors is urging his colleagues and the Government to address current barriers to cancer care delivery.
In a sit-down with the Jamaica Observer editors and reporters last week to discuss Jamaica Cancer Society’s upcoming Relay for Life fundraiser, Professor Joseph Plummer cited a May 8 article published by The Lancet Oncology online, which says that by 2040, “there is projected a 75 per cent increase in the need for chemotherapy in low- and middle-income countries”.
“That’s exactly where Jamaica falls,” said Plummer, who is head of the Department of Surgery, Radiology, Anaesthesia, and Intensive Care at the University Hospital of the West Indies (UHWI) in St Andrew.
“It reflects both the increasing incidence of the disease and the fact that still, in these [low- and middle-income] countries, the majority of patients are advanced at the time of their diagnosis,” the surgeon said.
The study, as reported by Medscape Medical News, warns that almost all countries will face serious problems in their ability to deliver chemotherapy to cancer patients by the year 2040.
Medscape said the study predicts that the demand for chemotherapy will double by 2040, estimating that the number of patients who will require first-line chemotherapy will increase from 9.8 million in 2018 to 15 million in 2040. The largest proportion of those patients, Medscape said, will be residing in upper-middle-income countries, but of the remainder, an “estimated 75 per cent… will be living in low- and middle-income countries”.
Professor Plummer explained that in Jamaica, the incidence of cancer is increasing, and for the common ones — breast, cervical, prostate, and colorectal — at least 60 per cent of patients are locally advanced or metastatic at the time of their diagnosis.
“So either they are incurable or they need relatively expensive chemotherapy to prolong life,” he said, indicating that at the advanced state, options like surgery alone or radiotherapy alone are insufficent as oftentimes these patients need a combination of surgery, radiation and chemotherapy in an attempt to cure them.
Professor Plummer also pointed out that since chemotherapy drugs are not produced locally, increasing their accesibility would require a larger outlay of already scarce foreign exchange.
“Given the projected increase… we need to be looking forward and planning, therefore, for an increase in the number of medical oncologists in Jamaica.
“I know right now, for example, between Cornwall Regional [Hospital] and Kingston, that is KPH (Kingston Public Hospital), and University Hospital [of the West Indies], there is no other Government-sanctioned place to get chemotherapy. [At] Mandeville [Regional Hospital], there is a visiting oncologist, but we need to have more formal services in those hospitals, because that’s what will cause death…” the surgeon said.
He also highlighted the work of Jamaica Reach to Recovery, an affiliate of the Jamaica Cancer Society that offers financial, psychological, and emotional support to breast cancer survivors, and called for similar groups to be set up in light of the projections.
“One of the things we don’t do well are the support groups. So we have Jamaica Reach to Recovery, but someone who has bleeding and is worried that they may have to get a stoma bag, that is going to prevent them from ever going for a colonoscopy even when they have bleeding.
“Or a man who, just being fearful of the implications of a prostate examination, [saying] ‘I’m going to lose my potency’, without being aware that 80 per cent or more of men who have a radical prostatectomy will be potent, and those who are not, periodic use of medication and other means can help them to maintain some level of sexual activity,” he said, reiterating that the hope supportive programmes provide is necessary, but is currently lacking.
Dr Plummer was quick to point out, however, that the importance of prevention cannot be overemphasised because the country’s attitude should really be, ‘Let’s not reach the 2040 projections’. For this to happen, Professor Plummer said general education and preventative programmes are crucial.
“There is a lot to be said about societies like the Jamaica Cancer Society in terms of sensitising the public. [They are] educating the public in being aware of themselves so that they are aware of the early [symptons] of the disease, because a lot of times the disease doesn’t give early clinical features [and] the need for screening, even in the asymptomatic phase,” he said.
In the meantime, he lauded the Government for setting up two radiation oncologist centres in the island, one at St Joseph’s Hospital in Kingston and the other at Cornwall Regional Hospital in St James. He said it is increasingly being recognised that radiation alone, as a form of treatment, can cure about 20 per cent of cancers.
The 16th annual Relay for Life is scheduled for June 2-3 on the University of Technology, Jamaica campus.