Early diagnosis through screening offers the best chance of cure and survival in patients with cervical cancer.
Two years ago, Agnes, 48, started experiencing excessive abnormal foul smelling vaginal discharge and abdominal pains. She visited Embu Level V hospital, was admitted and investigated for cervical cancer. “I was then advised to come with a friend to collect results where I was told I had cervical cancer,” she says. The mother of three was found to have advanced cervical cancer and referred to Nairobi, Kenya to undergo further treatment of which she has been following up since. “I go to Nairobi for treatment every month. If I miss, I start feeling bad. I don’t do the activities I used to do before.”
Cervical cancer is the leading cause of cancer deaths among women in Kenya killing as many as 1700 women every year. Early diagnosis through screening and treatment is critical to surviving the cancer. Early stages of cervical cancer are normally treated with surgery and are likely to achieve complete cure. For late stage cervical cancer, the chance of complete cure is very low and palliative care is usually employed as a treatment approach together with other treatment methods.
Palliative care is a treatment approach to patients diagnosed with life limiting illnesses from time of diagnosis till death and bereavement so as to be able to cope with the illness and improve the quality of their lives and those of their families.
Palliative care normally involves counseling of the sick patient and their relative. “When a person is referred to us by the doctors the first thing is counseling,” says Ann Wachira, a palliative care nurse at Embu Level V Hospital. “They should come here accompanied by a close relative, a spouse, or a trusted friend so that when we break the bad news they have a shoulder to lean on.”
“When they come here they are very curious to know what the results of the tests are and the expectations. So we break the bad news and give them the treatment options,” she says. “Early cancers go to surgery first since they are curable while late stage cancers go to cancer specialists for radiotherapy and chemotherapy. We also enroll them in palliative care program to help them manage the symptoms including the psycho-social pain which encompasses stress and depression.”
Benefits of palliative care
Palliative care helps the patients live a proactive life by addressing many challenges faced because of cervical cancer. “We manage physical pain using medications and the emotional stress associated with the problem,” she says. Patients are placed in social groups where they meet others who have gone through similar problems. This helps to manage the stress since they learn that they are not alone. The care is equally extended to their homes relieving them the burden of being away from their families.
“We also give them comfort by training them techniques to manage their hygiene. Those with excessive vaginal discharge are assisted with diapers.”
Palliative care helps them with legal aspect of the illness. “We help them with will writing by directing them to appropriate legal services. They do not need to be worried about their children’s future when they die.”
Challenges of advanced cancer
Surviving cervical cancer faces many challenges. High costs arising from treatment discourage many patients. “Nowadays the treatment is easier since after seeing a cancer specialist one can go to other centers offering radiotherapy and chemotherapy services and still pay with social insurance service.” Still the drugs used to treat the disease are very expensive.
Sometimes the patients lack professional palliative care services since many cannot afford them and there is inadequate support of the services from the local authorities.
Depression is one of the challenges encountered by many cervical cancer patients. “They develop anger and severe depression which has led to many patients to commit suicide, depression is often worsened by the rejection they face from their partners.”
“Many patients present late with the disease which limits the role of curative treatment.”
People still do not talk of sexual matters and cancer openly due to stigmatization. “The minute you talk of vaginal discharge, you are labeled as promiscuous,” she says. “In other cases, your family lineage is accused of harboring cancer.”
Many patients fail to receive optimal care due to inefficiencies of the healthcare system. “Inefficient system and recurrent strikes by healthcare workers have led to many patients with cervical cancer being lost to follow-up even before they commence treatment.”
There is excessive lack of awareness on the danger of cervical cancer which leads to a lot of unnecessary suffering among women and their families. “Many women are not aware of the need for a Pap smear test to detect early cervical cancer which is curable. People should be made aware so that they survive the disease,” says Ann.