Photo credit: Healthwise
In general, the COVID-19 outbreak in Nigeria has been a great source of frustration for sick people in desperate need of health care; but cancer patients seem to fare worse, as many hospitals keep postponing scheduled surgeries. LARA ADEJORO details the experience of such patients, among whom are 16-year-old Tomiwa Osisanya and 20-year-old Marvelous Oguru
Tomiwa Osisanya, 16, was meant to have his surgery in the first week of May but the plans changed. His surgery was put off because of concerns about the spread of COVID-19.
Tomiwa’s parents had eagerly looked forward to the surgery for their son who had craniopharyngioma.
According to a professor of surgery and surgical oncologist at the Abia State University Teaching Hospital, Aba, Charles Adeyinka Adisa, a craniopharyngioma is a rare type of brain tumour derived from pituitary gland embryonic tissue that occurs most commonly in children, but also affects adults.
“It may present at any age, even in the prenatal and neonatal periods, but peak incidence rates are childhood-onset at 5–14 years and adult-onset at 50–74 years,” Prof. Adisa noted.
Before the pandemic, Mr. Osisanya had regularly travelled from Ibadan, the capital city of Oyo state in southwestern Nigeria to the Lagos University Teaching Hospital, Idi-Araba, Lagos, with Tomiwa every month for check-up and he had been booked for surgery in the first week of May. But the COVID-19 outbreak in the country dashed their hopes and all the plans they had seem to have been blown away.
“He was meant to have the surgery in the first week of May at the Lagos University Teaching Hospital, Idi-Araba, Lagos, but the surgery was delayed because of COVID-19, Mr. Osisanya told PUNCH HealthWise.
Daily, Tomiwa’s condition deteriorates as the surgery delays. Presently, he is having urine incontinence – inability to control urine.
“COVID-19 has caused a lot because some people have tried to help me with cash and all the money is what we are spending daily for his drug,” the distraught father said.
Explaining further, Osisanya said after Tomiwa’s first surgery at the University College Hospital, Ibadan, two years ago, he was placed on medication to control his thirst and too much urination.
“We were told to use Desmopressin and the drug costs N1,000. We have to give him two of the drug per day or else he will urinate ceaselessly and might collapse.
“Some people had donated money for his treatment, but because of this COVID-19, we have used the donations for drug purchase.
“Initially, I wanted the surgery to be done in India but I was also told that it could be done in Nigeria. Since I don’t even have the money, I can’t dictate what happens.
“The founder of Children Living with Cancer Foundation, Dr. Nneka Nwobbi has been of great help to me and I can’t take her advice for granted,” Osisanya said.
Another breast cancer patient, Ebonyi-based Marvelous Oguru, 20, told PUNCH HealthWise that, after her radiotherapy in March, she had been booked for surgery but that became impossible because of the lockdown.
The postponement of her surgery is frustrating to her, as she is forced into a fight on two fronts – battling against her disease and fretting about not getting infected with COVID-19.
According to her, the medical team in the hospital told her that her surgery had to be delayed because of the pandemic.
Radiotherapy machine broke down
“I’ve not been able to travel down to the University of Nigeria Teaching Hospital, Enugu for the surgery. When I was meant to go for another radiotherapy last week, they said the machine broke down.
“This is not the first time they will be telling me that the radiotherapy machine has spoilt. This is frustrating me since I started my treatment and I’ve been having sleepless nights.
“The surgery is meant to be for malignant phyllodes tumour,” she said.
Oguru was referred from the Federal Teaching Hospital Abakaliki in Ebonyi State after having undergone her surgery four times in one year.
“Each time, I do the surgery, it will grow again. They have done the surgery for me four times at FETHA before I was referred to UNTH.”
According to Prof. Adisa, “Phyllodes tumour is typically large, fast-growing breast tumours. They account for less than 1 per cent of all breast tumours.
“Most phyllodes tumours are benign, but 10 per cent are malignant (cancerous). Cancerous phyllodes tumours are an unusual presentation of breast cancer. These tumours are a form of sarcoma because they grow in the connective tissue of the breast, not in the ducts.”
We are not putting any surgery on hold – LUTH
The Chairman, Medical Advisory Committee at Lagos University Teaching Hospital, Prof. Wasiu Adeyemo, however, told our correspondent that the cancer centre in the hospital has been open for cancer patients requiring chemotherapy and radiotherapy but surgeries are done one after the other.
“We are not putting any surgery on hold. What we are doing is to plan the way we are going to do the surgery. There are many of them and cancer surgery is not like urgent surgery. You know there was a lockdown but now we are opening up gradually. Those who require surgery, we are doing them one after the other but those who require chemotherapy and radiotherapy, we’ve never shut down for one day; our cancer centre is still open,” Adeyemo said.
No response from UNTH
When our correspondent called the Public Relations Unit of University of Nigeria Teaching Hospital, Mr. Boniface Uchelue who said he was the Deputy PRO said he was not competent to speak on the issue.
“This is the Deputy PRO, I will give you the phone number of my boss. I’m not competent to talk regarding UNTH matters. I’m the Deputy PRO,” Mr. Uchelue said.
However, Uchelue did not get back to our correspondent until the time of filing this report.
Surgery for cancer patients should be prioritised – Surgical Oncologist
Prof. Adisa said cancer patients should have the same priority as those who have life-threatening emergencies.
Adisa said delaying surgeries for cancer patients is unfortunate but most hospitals, especially in the developed world, were overwhelmed by the COVID-19 cases.
“Part of the instructions from most medical professional associations, including the America College of Surgeons, to which I belong, is that all elective surgeries should be suspended but all life-threatening emergencies, as well as cancer patients, should be treated.
“Cancer patients should have the same priority as those who have life-threatening emergencies because you can’t joke with cancer.
“Cancer can spread and become worse over time because the tumour cells continue to grow and multiply and they have the tendency to spread to other parts of the body.”
The surgical oncologist noted that cancer patients should not be denied the opportunity of having either a biopsy or surgical treatment to remove the tumour
“This is because, by the time they come back, they may discover that the tumour has advanced.”
Surgeons wary of insufficient COVID-19 testing capacity
Adisa, however, said surgeons are wary of the insufficient capacity for COVID-19 testing in the country.
“A surgeon wants to be assured that he and other medical staff are not going to be infected when carrying out a surgery. If the testing is widespread, that will go a long way.
“Another challenge is that the doctors are not happy because the personal protective equipment is not widely distributed and so, one has to take care of himself.
“Then, people are not motivated because doctors in some of the hotspot states like Ogun are not paid and you don’t expect them to endanger their lives when you’re not motivated enough,” Adisa said.
Craniopharyngioma surgery should not be delayed
“Craniopharyngioma surgery should not be delayed. Craniopharyngioma is a non-cancerous tumour of the pituitary gland in the brain. It is benign but tends to grow and compress vital nerves in the brain, especially the optic nerve that controls vision.
“The fact that it arises from the pituitary gland, which is like a master control organ for most other organs that produce hormones, make it necessary to do early surgery.
“However, surgeries can be done in a minimally invasive way through the sphenoid instead of open surgery,” Adisa added.
He said some variants of the tumour with some peculiar mutations also respond to targeted molecular therapy. However, one needs to take a tissue sample from the tumour to establish this mutant type.
“Chemotherapy is also an option. Radiotherapy in combination with Surgery is used especially with big tumours.
“Craniopharyngioma can recur after surgery,” the expert said.
Majority of phyllodes tumours are benign
Adisa said a large series from the M.D. Anderson Cancer Centre reported the incidence of each as benign (58 per cent), borderline (12 per cent), and malignant (30 per cent).
“Malignant phyllodes tumours behave like sarcomas and can develop blood-borne metastases.
Approximately 10 per cent of patients with phyllodes tumours develop distant metastases and this can go up to 20 per cent in patients with histologically malignant tumours.
“Since you can’t determine which one is malignant or benign until you do the surgery and send the specimens for histological examination, it’s better to do the surgery as early as possible,” he advised.
Surgeries should be prioritised – NMA
The President of the Nigerian Medical Association, Prof. Innocent Ujah, in an interview with PUNCH HealthWise, said surgeries are meant to be prioritised.
“There are some that if you do not do, nothing happens to patients but the patients probably will have some discomfort. However, if it’s an emergency, the doctors have to carry out the surgery.
“Others may have to wait because, in a period of this global health emergency, we leave the doctors with the prerogative of what we think can be done. If you think the patient will suffer undue complication or die if nothing is done; there will be prioritisation of cases.”
Ujah added that the delay in surgeries may depend on the status of the patient.
“You have to build the patient up for surgery. If the patient has not been prepared enough, he may not survive the surgery; you can’t just rush the patient to the theatre. So, it may not necessarily be because of the pandemic but it may depend on the status of the patient.”
Lack of equipment is a challenge
Ujah said having adequate equipment in the hospitals is a challenge in Nigeria.
“Also, if the patient and the doctor are ready and there is no equipment, surgery will not be done.
“The equipment has been our challenge and I believe with the pandemic exposing the weak status of the health sector now, the government and the private sector will come together to equip the hospitals” he said.