Cancer burden in Nepal: a call for action

Abstract

According to World Health Organization (WHO), 9.6 million people died of cancer in 2018 of which 70% were from middle and low‒income countries. Cancer is also the second leading cause of deaths globally. The leading causes of deaths due to cancer worldwide were highest for lung cancer, followed by colorectal cancer, stomach cancer, liver cancer and breast cancer.1 A report published by WHO has shown that cancer mortality in Nepal is higher in females as compare to males‒7,400 and 6,900 respectively. The major risk factors are tobacco smoking, excessive alcohol consumption, household solid fuel, physical inactivity and obesity,2 along with others like environment pollution and excessive pesticides in vegetable and fruits.3,4 Based on hospitals’ data approximately 8,000‒10,000 new cases of cancer are identified every year in Nepal.5 Kathmandu, the capital of Nepal has been listed on top of the 10 most cancer affected districts in Nepal followed by Sunsari, Morang, Chitwan, Jhapa, Lalitpur, Rupandehi, Kaski, Nawalparasi and Bhaktapur.6 A retrospective study analysis data over the four year period between 2010 and 2013 of twelve hospital situated in Nepal showed that cancer of bronchus and lung, stomach and larynx are most common among men. In female, most common cancers were listed to be cervical/ uteri, breast, bronchus and lungs.7 According to a study conducted in central region of Nepal, of total 240 cancer patients, Newar were 30.42%, Chhetri were 22.92% and Brahmin were 20%. Most of the cancer cases were documented from Kathmandu, Lalitpur, Bhaktapur and Sindhupalchowk districts.8 Showed the age specific incidence of cancer in central Nepal. They showed that rapid increase in incidence was among 45‒49age group in male and 30‒34age group in female, the highest incidence rate was between age groups 70‒74years in male and 65‒69 age group in female.9 By 2020 the incidence rate of cancer per 100,000 is estimated to be 41.4 in female and 38.5 in male.10 Annual report published by Department of Health Services (DoHS), Nepal in 2018 depicted the morbidity of various cancers in all seven provinces between 2016 and 2017. A total of 13,997 cases were reported in Out Patients Department (OPD) attending patients all over Nepal. 9053 cases of different cancers were reported from Province 3 and 3865 from Province 4. The least number of cases were reported from Province 6 (70 cases). The higher number of cases reported in Province 3 and 4 may be due to easier accessibility to higher health care facilities and very low numbers in province 6 due to inaccessibility to better health care facilities. Overall, highest morbidity was noted for Breast and Lung cancer, 1863 and 1885 respectively, followed by Cervical/Uteri Cancer‒1425, Head and Neck Cancer‒866 all over Nepal as shown in Figure 1.11 Screening and early detection facilities are limited to the central cities of the nation. The rural communities are deprived of screening facility in primary public health care centers. In context of Nepal, the burden due to cancer is due to higher cost of treatment, lower economic status and unavailability of adequate radiation equipment and limited number and inadequate quantity of chemotherapeutic molecule. Estimated cost of cancer treatment in a Government hospital like Bir Hospital (US$ 68.22) is much lesser compared to private hospitals (US$ 200‒250).12 Besides this, the cost of chemotherapy regimen, radiotherapy, diagnosis and other surgical procedure add significant economic burden to the cancer victims.