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 Table of Contents  
Year : 2022  |  Volume : 22  |  Issue : 2  |  Page : 59-61

Uptake and adherence to treatment for lung cancers in Nigeria: A single-centre experience

1 Department of Medicine, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
2 Department of Mordbid Anatomy and Forensic Pathology, OAUTHC, Ile-Ife, Osun State, Nigeria

Date of Submission12-Jan-2023
Date of Acceptance28-Dec-2022
Date of Web Publication21-Mar-2023

Correspondence Address:
Prof. O O Adewole
Obafemi Awolowo University, Ile-Ife, Osun State
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njhs.njhs_1_23

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How to cite this article:
Adewole O O, Awopeju O, Komolafe A, Osigbeme A, Andero V, Erhabor G. Uptake and adherence to treatment for lung cancers in Nigeria: A single-centre experience. Niger J Health Sci 2022;22:59-61

How to cite this URL:
Adewole O O, Awopeju O, Komolafe A, Osigbeme A, Andero V, Erhabor G. Uptake and adherence to treatment for lung cancers in Nigeria: A single-centre experience. Niger J Health Sci [serial online] 2022 [cited 2023 Oct 3];22:59-61. Available from: http://www.https://chs-journal.com//text.asp?2022/22/2/59/372258

Dear Editor,

Lung cancer even though is one of the most preventable of all the major malignancies; it is leading cancer and leading cause of cancer mortality worldwide.[1] Lung cancer accounts for almost 10% of all cancers, with a 5-year survival rate averaging about 15%.[2],[3] This may be lower in low-income countries.[2],[3]

While it appears that lung cancer incidence may be declining in the developed countries, evidence indicates a different trend in developing countries. Although there are challenges to accurate statistics and data, reports from GLOBOCAN, affirm that most of the global cancer burden, including lung cancer, now occurs in developing countries.[2],[4] It is projected that the incidence will rise in the next decades if the current rates remain unchanged.[2]

There are lots of gaps and unmet needs in lung cancer in developing countries. While there are robust data on survival outcome amongst patients with lung cancer in developed countries, this is not the case in most developing countries. Few available studies relating to lung cancer in Nigeria have focused on clinicopathologic descriptions and risk factors.[5],[6] There have been few or no data on treatment pathways and uptake of chemotherapy in patients with lung cancers in Nigeria.

With the rising epidemic of lung cancer in developing countries, such data become imperative for effective health planning for the treatment of lung cancer. It will address the issues responsible for limited access and availability of treatment. This will ultimately improve the outcome. This study, therefore, seeks to fill this gap.

The goal of this study is to provide information about treatment uptake and adherence amongst patients with lung cancer in Nigeria.

We conducted a retrospective review of all cases of lung cancer seen and managed at the Respiratory Unit, Obafemi Awolowo University Teaching Hospital, (OAUTHC) Ile Ife, between January 2010 and December 2020. The OAUTHC is a tertiary centre located in Southwestern part of Nigeria. It has over 600-bed complements. There is a full-fledged pulmonology unit with the capacity for bronchoscopy and expertise in lung cancer treatment.

Medical records of patients with a diagnosis of lung cancer were retrieved from the medical records library. To be included in the study, patients must have a diagnosis of primary lung cancer that is confirmed histologically (must be seen). Information on sociodemographics, symptoms and duration, risk factors, histological type and stage of the lung cancer was retrieved. We also retrieved information on the type of treatment received; surgery, chemotherapy or radiotherapy including the number of courses. In addition, we noted the time interval between diagnosis and death where they are available. Anyone whose diagnosis was not a primary lung cancer was excluded from the study.

During the period under review, a total of 64 cases of suspected lung cancer were identified.

The diagnosis of lung cancer in the patients was made from bronchoscopic biopsy samples were thereafter sent for histological diagnosis. Of these, 22 were cases of secondary lung cancer. There were 20 cases of suspected lung cancer with no documented histological confirmation. They were all excluded from further analysis. We, therefore, present 21 cases of lung cancers with histological confirmation for analysis. Patients were categorised into two groups – those who received specific treatment and those who did not.

Twelve (57%) patients received specific treatment (chemotherapy), whereas the remaining nine did not receive any chemotherapy [Figure 1]. Overall, there were more females, 13 (61%) with primary lung cancers. Those who received treatment had a longer mean duration of symptoms compared with those who did not receive any treatment. Exposure to biomass was the most common identified risk factor across the two groups. Adenocarcinoma was the most common histological type across both groups and overall. All the cases had advanced stage disease, stages III and IV disease, and chemotherapy was the only modality of treatment given. Platinum doublet consisting of cisplatin/carboplatin with paclitaxel or docetaxel was commonly used.
Figure 1: Chemotherapy treatment uptake amongst lung cancer patients

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Of those who who received chemotherapy, 4(33%) completed the full course of treatment. Majority 67% of patients who initially received chemotherapy defaulted to subsequent therapy after one-to-three cycles.

Major reasons for default were high cost of medication and treatment (80%) and advice from family members.

The interval between diagnosis and death ranged from 3 to 12 months (mean ± standard deviation [SD] of 7.5 ± 2.3 months) for those who were treated and 1–4 months (mean ± SD of 3.6 ± 1.3 months) for those who were not treated.

Overall, this study indicates a low treatment uptake, a high default rate and an abysmally low 1-year survival rate amongst patients with primary lung cancer in Nigeria. The initial overall treatment uptake rate was 57%. Treatment uptake and adherence fell amongst those who were treated. Patients who were treated lived for a longer period. Overall, 67% of patients defaulted treatment.

In oncology settings in the USA and Canada, treatment uptake for systemic chemotherapy was higher, up to 75% and as high as 93% in contrast to our finding.[2],[7] Data obtained in this study may be a reflection of the situation in many centres. These observable differences in treatment uptake and completion rates obtained in this study could be attributed to many factors including but not limited to the treatment cost and awareness.[8]

In our setting, most patients pay for lung cancer care as out-of-pocket expenses irrespective of the employers; government, self or other private establishments. Even though, there is a National Health Insurance Scheme, coverage is still low, with <10% of the population enrolled.[9] Importantly, cancer care is not adequately covered. The cost of a cycle of treatment of lung cancer is more than the minimum monthly wage in Nigeria. So many who managed to start were not able to sustain. This may account for the default and low treatment uptake rate. As shown cost of treatment was a major factor for default.

Apart from the cost of treatment, there is a general apathy amongst the people to receive chemotherapy for cancer.[10] Ten most believe that it accelerates deaths while others believe that herbal medicine, alternative and complementary drugs are more effective against cancer.[11] Most patients also experience worrisome side effects with chemotherapy that may influence uptake.

Although the number is small to conclude a survival analysis, cumulatively, those who received chemotherapy lived longer than those who did not. Systemic chemotherapy is still beneficial despite its challenges. It is known that it provides symptom palliation, reducing the risk of death by at least a quarter and increased survival at 1 year by 10% compared to best supportive care alone.[12]

Majority of the cases were adenocarcinomas, unfortunately, mutations for the epidermal growth factor receptor, tyrosine kinase inhibitors were not available. Similarly, immunotherapy was not available. Genetic testing for driver mutations in lung cancers especially non-small cell lung cancer should be available in low-resource setting, in line with the current recommendations.[13]

This study is limited by its small sample size, its retrospective nature and being a single-centre experience. Despite these, the study has brought to the fore, gaps, unmet needs and insights into the travail of lung cancer patients, caregivers and practitioners in low-resource settings. To address the issues and challenges related to treatment uptake, and adherence a Global Drug Facility for Lung Cancer is suggested for low-income countries. This will be a well-coordinated global initiative that will provide these medications for low-resource settings at highly subsided rates. This has been done successfully for some communicable diseases. Alternative therapy through repurposing trial could also be considered. More awareness is needed to ensure timely presentation at the hospitals.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organisation. Projections of Mortality and Burden of Disease; 2002-2030. Available from: http://www.who.int/healthinfo/global_burden_disease/Projections2002/en. [Last accessed on 2023 Jan 10].  Back to cited text no. 1
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49.  Back to cited text no. 2
Stock-Martineau S, Laurie K, McKinnon M, Zhang T, Wheatley-Price P. Evolution of systemic treatment uptake and survival in advanced non-small cell lung cancer. Curr Oncol 2020;28:60-8.  Back to cited text no. 3
Cheng TY, Cramb SM, Baade PD, Youlden DR, Nwogu C, Reid ME. The international epidemiology of lung cancer: Latest trends, disparities, and tumor characteristics. J Thorac Oncol 2016;11:1653-71.  Back to cited text no. 4
Adewole O, Anteyi O, Dosunmu EA, Ajuwon AE, Erhabor ZA, Greg EB, et al. Clinico pathologic features and management of lung cancer in a Nigeria. J Thorac Oncol (supplement) 2007;2:S553.  Back to cited text no. 5
Adeoye PO, Desalu OO, Ofoegbu CK, Fawibe AE, Salami AK, Akanbi OR, et al. Clinicopathological pattern and management of primary lung cancer in Ilorin, Nigeria. West Afr J Med 2021;38:380-6.  Back to cited text no. 6
Simeone JC, Nordstrom BL, Patel K, Klein AB. Treatment patterns and overall survival in metastatic non-small-cell lung cancer in a real-world, US setting. Future Oncol 2019;15:3491-502.  Back to cited text no. 7
Lubuzo B, Ginindza T, Hlongwana K. The barriers to initiating lung cancer care in low-and middle-income countries. Pan Afr Med J 2020;35:38.  Back to cited text no. 8
Alawode GO, Adewole DA. Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: A qualitative study among sub-national level actors, healthcare and insurance providers. BMC Public Health 2021;21:124.  Back to cited text no. 9
Labe RM, Otene SA, Obochi PE. Perception and attitude of cancer patients towards chemotherapy administration. J Palliat Care Med 2019;9:358.   Back to cited text no. 10
Malik IA, Khan NA, Khan W. Use of unconventional methods of therapy by cancer patients in Pakistan. Eur J Epidemiol 2000;16:155-60.  Back to cited text no. 11
Chemotherapy in non-small cell lung cancer: A meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ 1995;311:899-909.  Back to cited text no. 12
Planchard D, Popat S, Kerr K, Novello S, Smit EF, Faivre-Finn C, et al. Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018;29:v192-237.  Back to cited text no. 13


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