An analysis of cancer registry data has found that over a 10-year-period there was no record of treatment for 79% of cancer cases in Guyana.
This information was among data presented yesterday on the first day of a three-day workshop held at the Pegasus Hotel.
The workshop is being hosted by the Ministry of Public Health (MoPH) and the Pan American Health Organization (PAHO), with the goal of improving the prevention and control of non-communicable diseases in Guyana, with a focus on reducing morbidity and mortality as a result of cancers.
Even as the MoPH battles with a low treatment rate for cancer cases and risk factors, such as an overwhelming percentage of the population being considered physically inactive, yesterday’s forum marked the beginning of consultations for the development of a national cancer control plan, which is intended to be completed before the end of the year.
Dr Kavita Singh, of the MoPH, yesterday presented staggering statistics to the audience of health practitioners gathered during the ministry’s needs assessment for the cancer plan. She reported that in July, 2015, the MoPH and PAHO launched a 10-year cancer profile, compiling reports from the national cancer registry, spanning the years 2003 to 2012.
Among other things, it was found that there was no record of treatment for 79% of cancer cases in Guyana.
Asked to provide an explanation for this after yesterday’s presentation, Singh related that the reason for this could be put down to patients being unable to access cancer medications from their relevant health centres, as these medicines are not decentralised.
“Chemotherapeutic drugs, they’re not catered for in our essential medicine list because cancer treatment is not really a pillar that’s being offered at the primary healthcare level. So, the only place that did have that was GPHC, because they’re a corporation they’re allowed to have every single specialty, so they cater for that,” she explained.
As a result, she stated, in many cases patients would opt out of seeking treatment unless they felt they needed it, could afford it, or otherwise sought treatment from a private institution.
Shocking as well was Dr Singh’s account of the state of palliative care in Guyana. Palliative care is where drugs or medical treatment is administered to a patient to reduce their levels of pain.
“I don’t know how the rest of us define palliative care, but in Guyana, our use of morphine happens to be a staggering .5 milligrams per capita. Very low. Now what’s even lower is the 754 milligrams that’s recorded for cancer patients, when they should be getting over 6,000 milligrams. So, question yourselves, what sort of palliative care are we actually offering?” she questioned.
During the 10-year period mentioned above, it was found that 6,518 cancer cases were reported. The overall cumulative incidence rate calculated was 867.7 per 100,000 and the annual incidence rate was recorded at 87.3 per 100,000. Of that number, 3,956 or 60.7% of patients who reported were female, while 2,561 or 39.3% were male.
Those most affected by cancers were over 75 years old.
Risk factors
Figures also presented yesterday related to the data gathered from Guyana’s 2016 STEPwise Approach to Surveillance (STEPS) survey. Singh cautioned that those figures are tentative as the report is still being compiled. She stated that 3,456 households were targeted for this survey, and recipients were between the ages of 18 and 69.
According to the preliminary report of the STEPS survey, which is used for monitoring trends in and between countries, risk factors among the Guyanese population that increase the risk of developing cancer include: physical inactivity, harmful use of alcohol, unhealthy diets and tobacco use.
It was stated that 66% of the population is physically inactive; that 34% of the population is involved in the harmful use of alcohol—that is, they consume more than six standard drinks in one sitting; that the average serving of fruits and vegetables consumed daily is 1.5 servings compared to the average requirement of five servings per day, that the salt intake is as much as double the average amount; and that tobacco use was reported as being 11% among adults and 9.8% among youth 13 to 15 years old.
The figure related to tobacco use among youth came from the 2015 Global Youth Tobacco Survey (GYTS), which is a survey done every five years.
Singh further related that of the 2,604 persons surveyed, 1,612 were females in the age range of 18 to 69. Of this group of women, 95% had never had a mammogram, and only 17% had ever been subject to VIA screening.
Information presented by the MoPH stated that the data from the cancer registry show breast cancer, cervical cancer and uterine cancer to be among the leading causes of death in women, while prostate and colon cancers are the leading causes of death in men.
It was also found that while nearly a fifth of cancers were in persons older than 75 years old, the next group most affected were persons between the ages of 15 and 39, who accounted for 11% of cancer cases, followed by those aged 55 to 59, 50 to 54 and 65 to 69, which accounted for 10% of cases, respectively. The paediatric group – being those younger than 15 years old – made up 2% of all recorded cancers.
It was said that in the paediatric group and in those aged 75 and older, there were a higher number of males recorded, with the latter having nearly twice the number of recorded cancer cases than females.
It was noted by Singh that some gaps in addressing cancer care in Guyana are an ageing population; underreporting and under-diagnosing of cancer cases; the absence of systems to monitor and evaluate cancer management outcomes, although there is a cancer registry in existence; no existing tobacco legislation; and limited palliative care.
