ASCO24 Updates: Improving Cancer Care in Nigeria: HE Zainab Shinkafi-Bagudu

The American Society of Clinical Oncology (ASCO) Annual Meeting is one of the largest and most prestigious conferences in the field of oncology. This year, the meeting took place from May 31 to June 4 in Chicago, Illinois. The event gathers oncologists, researchers, and healthcare professionals from around the world to discuss the latest advancements in cancer research, treatment, and patient care. Keynote sessions, research presentations, and panel discussions are typically part of the agenda, providing attendees with valuable insights into emerging trends and innovations in oncology.

This year, OncoDaily was at ASCO 2024 for the first time covering the meeting on-site. We had the pleasure of interviewing researchers who summarized the highlights of their work.

In this interview Zainab Shinkafi-Bagudu discusses cancer care and funding in Nigeria, with a particular emphasis on the MedicAid Foundation and beyond.

00:00 Introduction
00:53 First Ladies Against Cancer
02:49 MedicAid Foundation
7:04 Barriers in Cancer Care in Nigeria
8:12 Cancer Screening in Nigeria and Africa
8:36 Pediatrics in Nigeria
9:51 About Communication
13:05 About UICC

The Transcript of Improving Cancer Care in Nigeria: HE Zainab Shinkafi-Bagudu

As First Ladies, you tend to be the mother of your state and you can advocate for a lot of improvements in the plight of women and children in particular. 17 year old organization and that is where my passion started from. Lots of barriers when you talk about cancer, it’s not just about reporting, it’s about how the health attitude and seeking for care.

So we have beautiful cancer control plans, screening guidelines, but they’re not implemented. But the issues that we have in pediatrics in most low middle income countries are the infectious childhood diseases, vaccine preventable diseases. As the leader of any organization, your role would be to pull together the organization.

As the wife of a governor, I’m now a former, but FLAC, the First Ladies Against Cancer is an organization that is made up of spouses of current and former governor’s wives and it’s a very strong platform particularly to advocate for change in our communities. As First Ladies, you tend to be the mother of your state and you can advocate for a lot of improvements in the plight of women and children in particular. So a group of us came together with an interest in cancer control and we worked together to primarily do three things.

We create awareness, that’s in the communities, we create awareness by educating our women and youth through town hall meetings, market outreaches, going for different school programs and so on and educating the population about cancer, what exactly is cancer, what are the things to do, what kind of lifestyle, things like that, general awareness.

And then the second pillar of FLAC is to advocate for policy, better government policies and laws that will guide and help us to improve cancer control. Because of the special position that we occupy, we’re able to influence the leaders of the states, the political leaders as well as the legislators to have more laws, more guidelines for cancer.

The third and probably what we’re more seen for is to fundraise and support access to treatment, screening and treatment. FLAC focuses on three cancers, that is breast, cervical and childhood cancers. It’s a 17-year-old organization and that is where my passion started from.

The FLAC is there by virtue of being the spouse of a governor or former governor and the Medicaid Cancer Foundation on the other hand is an organization that we focus on a lot more. Aside from the pillars that I mentioned, we also do capacity building, we train nurses, we mentor girls and support girls through school to go into STEM courses, especially things like nursing and even medicine.

We sponsor the education so that we can improve the numbers of girls that we have in our communities that are involved in cancer care.

In Medicaid, we have run support programs. We have the patient access to cancer care program, which is one through which we enter partnerships with the major organizations, whether they are drugs or giving chemotherapy or institutions, cancer centers that provide radiotherapy. We go into partnerships with them, they give us a discounted rate.

We fundraise on a massive scale. We have the largest walk in Nigeria every October, where we have a lot of sponsorship and through the funds that we raise there, we’re able to further subsidize whatever assets that the care that cancer patients need and so they come to us for treatment a lot. Also personally, as somebody that has been involved in cancer care, I sit on different committees that have to do with national policies, like the National Cancer Control Program.

I work with them to, with the Federal Ministry of Health to put together these plans and to also implement them. Through the Medicaid Cancer Foundation, I also work on a global level with various partners like the WHO, IAEA that are all involved in cancer care. Those are the kind of organizations that we work with.

Like you may, I sit on the board of the UICC. I’m a three term board member. This is my third term.
Each term is two years. And at the time I was the first black person to be elected from Africa. So I think it was a huge achievement.

And it has really helped the profile of the UICC in Africa and in Nigeria in particular. And more than that, we have been able to close that gap in terms of diversity to show that it’s not an elitist organization. It’s an organization that is open.

And on my own part, I have learned a lot. I have been exposed to a lot of different global bodies and networking. And it has given me that edge to be able to speak with a voice of authority and occupying that respected position.

I think generally cancer in the world is growing because we are more aware. And Nigeria is no exception. What we do know is that it is grossly underreported in Nigeria because of the poor record and data keeping system.

We do not have the enough registries. And then also the health system is weak. People do not report illnesses.
It’s not a reportable illness. For breast cancer, we have about 120,000 new cases diagnosed every year, out of which only 70% survive. So the mortality rate is very high because most of them are diagnosed in the late stages.

And generally it’s the same. Cervical cancer is about 12,000 new cases every year. Again, 8,000 will die.

Again, late stages. And prostate cancer is also similar. Prostate has actually overtaken cervical as the second commonest cancer in Nigeria.

Well, there are lots of barriers when you talk about cancer. It’s not just about reporting. It’s about how the health attitude and seeking for care.

There are lots of cultural and sometimes they call them religious, but it’s just a misunderstanding of any religion to say that you shouldn’t seek for help. There are alternative medical methods that are available, traditional medicine, faith healing. People will go to the church or the preacher in the mosque to get some ease before they go to the hospital.

So that makes it difficult and it makes the treatment harder to be successful in. Unlike in the more developed parts of the world where you have a 90% cure rate, a five-year cure rate is 90%, we are beginning to see a slight improvement, but it’s really, really slight. It’s really slight.

When I say slight, we’re seeing more patients in stage two as opposed to before when you would hardly see any patients. It had to be an elite that was doing a regular screening and picked up like that. We have beautiful cancer control plans, screening guidelines, but they’re not implemented.

I was looking at a study yesterday that was carried out and a lot of African countries are in that same situation. I’d say they found out that about 80% had plans, but only about 40 were implementing the plans in any way at all. Pediatrics is a growing field and we have more people that are addressing it.

We now have a specialty known as family medicine where family physicians are doing a lot more pediatrics in their training and so children are able to access better care. But the issues that we have in pediatrics in most low middle income countries are the infectious childhood diseases, vaccine preventable diseases for which we have to keep on advocating for our children to be vaccinated.

Unfortunately, Nigeria has one of the highest rates of zero dose or misdose children when it comes to the childhood vaccination, but that might be a result of the total number of children you find in Nigeria anyway.

But then the system is addressing this through various means. We’ve had pockets of insurgency in some areas and there are some hard to reach areas, political instability that makes it difficult to get the vaccine logistic chain there. So through secondary efforts, we’re trying to cover those areas and the use of modern technology, drones being used in some states to deliver the vaccines and it’s working.

Well, as the leader of any organization, your role would be to pull together the organization and in this case we’re talking about members. There are over 1,000 member organizations and I would like to see more cohesion or more understanding between the members and the organization. To do this, we need to understand what exactly the members want and what they need.

In one continent, it could be technical support. In another continent, it could be what I hear the most spoken about is about the funds that is required for you to be a UICC member to be able to access all the advantages. The UICC offers an awful lot of advantages.

Like I mentioned, even I myself, it gives you that edge. But a lot of members do not necessarily understand that and it’s about communication and how we’re able to communicate the advantages and make it more known. So that is one thing I would focus on and communication comes in different languages.

Yes, we continue to focus on English and more and more there are now assets available, resources in different languages, Spanish, French, but it’s been a constant cry from the members and the organization is listening. I would forge that more. I also think that we should have more diverse representation in the membership or leadership of the UICC, both in terms of the board, the management.

The board is quite diverse but then we also have to work with the members a bit more and make sure that we have equity in the geographic distribution because that is what will enable the organization to know what the people of this area are going through when they have cancer and that area when they have cancer. It’s not a uniform one-size-fits-all. So the more we’re able to diversify that, the more it will be helpful.

The other thing that I think we need to do more urgently in the cancer space generally and not just UICC is to build a bridge between the advocates and the academia. There are advantages to both sides and there’s a lot of excellent work that both sides are doing and we need to work together. We need to work with each other so that we can support the work, the eventual improvements that we want to see in cancer control.

Scientists need advocates to advocate for more funding for their research. They don’t know how to do any advocacy and so on. They’re good at their work in the labs and we are good at saying why we need to support them, what we need to do.
They tell us the researches and then we need to go out there and then whatever they find, getting the messages out. So I’d like to see more of a merger between those two worlds in the UICC and this will also be reflected in the kind of programs that the UICC is running.

So if you think of the UICC as sort of the umbrella body or the WHO of cancer organizations, it’s a global organization and it has pillars of awareness, education, convening, capacity building.
So these are the pillars that the UICC exists on and the members are supposed to access all those things by being a member.

So it’s not a regulatory body per se but we run different fellowships, different programs that enable members to achieve all these things and there’s the young leaders program, very popular that through which those that participate can access other levels of oncology. And I’d like to see a few more in the advocacy programs that are ongoing so that we can, as I mentioned before, carry everyone along.

So it’s not a regulatory body at all. The UICC itself belongs to different organizations but it’s the go-to organization when you talk about cancer and you talk about civil society and what more needs to be done. It has a voice at the table in the global regulatory bodies such as WHO, such as IAEA, IAC and so on.

It’s 90 years old. It’s been in existence for 90 years so it’s stood the stand of time, quite significant, quite significant. And I feel that it’s time for us to have more representation from LMICs and Africa in particular.

More videos and content from ASCO 2024 on OncoDaily.