Cancer treatment: Patients bear the strain of huge treatment costs
Monica Wanjiru helps her 14-year-old son to get ready to attend a fundsdrive near their home in Karura, Kiambu county, on a Saturday morning.
The fundsdrive, like many others she has organised for the past three years, have been the main source of money to cater for the treatment of her firstborn child Benjamin Kariuki who was diagnosed with stage-three bone cancer in June, 2016.
What started as a small swelling on his left leg after he was hit while playing turned out to be cancer following months of misdiagnosis.
“Doctors initially said it was hematoma - a swelling caused by a blood clot. They gave him medication but the swelling did not go away,” she says.
Five months later, Kariuki was diagnosed with bone cancer at Kenyatta National Hospital. Doctors said it had spread to the point where the leg had to be amputated.
On seeking a second opinion, Wanjiru found a hospital in India where her son would be treated without necessarily amputating his leg.
Armed with Sh200,000 worth of her life savings and an additional Sh600,000 she had raised from friends and family, Wanjiru and her son left for India in November 2016.
At the time, the cancer had eaten away most of his shinbone. Kariuki would undergo eight chemotherapy sessions to fight the cancer cells before his leg was fitted with a metal plate to replace his bone.
During the treatment, mother and son lived in a hostel. The money in her account was running low. The treatment, slated to last nine months and cost Sh3 million, ended up taking 11 months and the cost rising to Sh8 million. Her family back home held several fundraisers.
“I depleted all my savings. Relying on people was difficult. Sometimes they would come through for me. Other times they wouldn’t,” she says.
At one point, when her family had exhausted all means of raising more funds, and doctors had suspended Kariuki’s treatment, Wanjiru had to leave him in a hostel in India and travel back home to look for money.
The single mother of three got a loan of Sh250,000 from a friend, got a well-wisher to pay for her plane ticket and travelled back to India.
Prior to her son’s illness, Wanjiru had been running a business selling shoes and clothes in Ruaka but had to close down.
During their recent visit to India in May this year, Wanjiru spent another Sh1.2 million, raised from wellwishers.
Benjamin, who was to join Form one this year, still requires another surgery that will cost up-to Sh 1.5 million. The mother has reached her wits end.
Physiotherapy sessions that Kariuki undertakes at MP Shah Hospital twice a week cost her up to Sh4,000 per visit and the Sh1,000 to hire a taxi for every trip to carry Kariuki who is using crutches.
Like in Monica’s case, cancer patients and their families still
incur debilitating costs treating the disease either locally or abroad.
Several factors influence the high cost of treatment locally. The Kenya National Cancer Strategy 2017-2022 says the economic impact of cancer increases significantly with the disease affecting patients through increased medical costs, lost income and by imposing financial, physical and emotional burden on families and caregivers.
Treatment involves chemotherapy, radiotherapy, surgery, brachytherapy, palliative and supportive care and rehabilitation. Even before the treatment commences, patients incur huge costs in tests.
The costs for diagnostic procedures for cervical cancer in Kenya are estimated at Sh18,000 in public hospitals and Sh55,000 in private hospitals.
That for diagnosing breast cancer is estimated at Sh40,100 at a public hospital and up-to Sh1.2 million in private hospitals, according to a 2018 peer reviewed journal on cost and affordability of Non-Communicable Diseases.
“These costs are probably incurred through x-rays and tests that are required before and in between treatment in addition to consultation fees which vary at different hospitals.
There is an additional cost in doing blood count tests, which must be done before every chemotherapy session,” says Dr David Makumi, Vice Chairman Non Communicable Diseases Alliance Kenya. A blood count test, done a week before chemotherapy, costs between Sh1,000 and 2,000.
Makumi says patients incur bigger costs during chemotherapy.
“Patients are treated with a combination of drugs that depend on the type of cancer. There are several types of breast cancer for instance which all require a different drug combination,” he says.
A chemotherapy cycle for breast cancer can cost between Sh75,000 and Sh300,000, with the patients requiring at least six.
For patients covered under NHIF, the insurance pays for up-to a maximum of Sh25,000 per chemotherapy session. NHIF covers up-to 20 sessions of radiotherapy at Sh3,500 each but some patients may require up-to 35 sessions.
Families of patients are forced to incur extra costs in paying for supportive treatment, which includes drugs to combat side effects such as vomiting. Other patients are put on blood count boosting drugs and supplements.
“Since the treatment started, my son has been on calcium supplements with a dose that lasts for three months costing Sh900,” says Wanjiru.
Some patients travel long distances to access treatment. Some put up in hotels, further eating up into already stretched finances. Usually, doctors recommend a special diet rich in proteins inclusive of fruits for patients, thus adding extra costs.
Depending on the type of cancer, some patients resort to targeted therapy. Targeted drugs work differently from chemotherapy drugs and focus on specific cell changes are not covered by NHIF.
“The cover is not inclusive of the targeted therapy yet it’s very expensive. One targeted therapy for breast cancer is Trastuzumab. One dose can cost up-to Sh200,000 and a patient may require up to 18 of them for specific breast cancers,” says Makumi.
Overall, the cost of accessing drugs varies in private and public health facilities, partly attributed to the sourcing criteria. Some facilities stock generics and others branded with the drugs sourced from different suppliers thus there is no mechanism to regulate the prices.
Dr Abdi Hadun, Programme Officer, Kenya Medical Supplies Authority, the organisation mainly stocks generic drugs which are cheaper and only stocks brand drugs on rare occasions.
Kemsa is mandated to procure and distribute drugs and medical supplies to public health facilities. The body has been encouraging county governments to procure generic drugs to make treatment affordable to Kenyans.
Another factor contributing to high costs of treatment is cancer aftercare. Cancer survivors require follow-up care, which involves regular checkups to watch for recurrence and monitor long term side effects of treatment.
For instance, patients of breast cancer who undergo mastectomy may require breast prosthesis, which cost between Sh2,000 and Sh5,000. For others who may opt for breast reconstructive surgery, the costs range from Sh300,000 to Sh 500,000.
Other additional costs for cancer are incurred through lost productivity, as some may not be able to resume work after treatment.
Many Kenyans resort to taking loans, selling property and fundraising to raise money for treatment. Worse still, others who have no means of raising money, resign to fate.