Lung cancer diagnosis nightmare and the costly journey of seeking treatment

On one evening in 2016, Dickson Munala, 67, from Maraka village in Webuye, Bungoma County, collapsed in a toilet while at home. Then, he was living in a company house, seven years after losing his job as a supervisor at Webuye Pan Paper Mills. 

This incident prompted him to go to hospital for examination. At that time he was receiving treatment for high blood pressure, and he also had a stubborn cough that at times produced traces of blood.

According to Mr Munala, the doctor suggested more testing at a hospital in Kakamega. “He recommended that I get a CT scan done and also go through a biopsy just to be safe.”

However, the facility did not have the biopsy equipment,and he  thus had to go to another private facility in Kisumu. Two weeks later, the results came out, but when he took them back to the doctor, he was assured that there was nothing serious to warrant worry. He went back home a happy man .

But two years later in 2018, he collapsed again. “This time around the blood pressure was very high at 170/120. I went back to hospital in Webuye, where the doctor referred me to Moi Teaching and Referral Hospital.”

He had to do more tests, including another CT scan, and got diagnosed with lung cancer. Between July 2018 and November 2018, he went through the first stage of a six-course chemotherapy sessions.

In July 2020, he started coughing blood again. A CT scan was done and the doctor recommended another stage of six chemotherapy sessions, which ended in January last year.

Though Mr Munala is still battling the disease, he counts himself lucky that throughout his journey, he got funding to cater for all the costs that came with his treatment, which included tests, treatment, NHIF payments and transport costs.

But this is usually not the case for many liver cancer patients. Like any other form of cancer, tests, diagnosis and treatment is usually very costly.

According to Prof Fredrick Asirwa, an oncologist and haematologist, lung cancer treatment can cost between $10,000 (Sh1, 130,000) to $50,000 (5, 650,000). “This is because lung cancer is not one disease. It depends on the molecular targets as well as the stage of the disease and patient-related factors. The treatment is multi-modality with surgery, radiotherapy, targeted agents and chemotherapy in a multidisciplinary team approach,”

But the cost of treatment is usually not the only worry for patients in Kenya as diagnosis seems to be a big issue. “Many people are not diagnosed due to poor awareness on lung cancer, poor referral patterns, inadequate diagnostic tools in majority of facilities, lack of optimal therapies and poor supportive care/ inadequate palliative care,” says Prof Asirwa.

Dr Naftali Busakhala, a consultant physician and oncologist at the Moi Teaching and Referral Hospital and principal investigator at AMPATH-BMSF lung cancer care and research programme, says another challenge is inability to access diagnostic services. “Lung cancer diagnosis is not only an expensive procedure but one that requires high technical skills and expertise. Such services are not easily available.”

Outside the country

This scarcity of quality services has seen many seek treatment outside the country. 

Dr Busakhala adds that at the time of diagnosis, most patients will have been treated multiple times for other conditions and possibly exhausted their resources. “Diagnosis of lung cancer at an advanced stage is usually a relief of a diagnosis but equally a shock to both care supporters and the patients.”

“The diagnostic procedure takes a while and some patients are not able to wait that long. Some revert to alternative treatment or seek interventions elsewhere, which is not easily available. On average, it will take not less than two weeks for a patient to complete the diagnostic procedure prior to initiation to treatment. Unfortunately, some patients succumb to the disease prior to receiving the results and initiation of treatment.”

According to Dr Asirwa, though it is early to indicate whether Covid-19 is a risk factor for lung cancer, the pandemic could make things worse.

“We still receive at least two new lung cancer patients per week as before, but many patients delay in seeking care as it has similar symptoms with Covid-19, like shortness of breath/ difficulty in breathing, cough and chest discomfort. Some of these patients may have died without seeking care due to lockdowns and suspicion by relatives that they had Covid instead of lung cancer,” he adds.

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