Last week, another World Cancer Day came and went. It is globally commemorated each year on 4 February. This year the Union for International Cancer Control, a global organisation with more than 1,000 members in 170 countries, launched its advocacy campaign, United by Unique, to focus on people-centred care.
This theme resonates with the priorities of South Africa’s Cancer Alliance, as our focus is on promoting equitable and timely diagnosis and care of cancer for all.
This is becoming more and more urgent.
Cancer incidence is on the increase globally and in South Africa. In Estimating and Projecting the Burden of Cancer in South Africa, a report we published in 2021, experts projected an increase in cancers by 2030 to more than 154,451 new cases per year.
A major increase will be in cervical cancer and non-Hodgkin lymphoma, which is most common in people living with HIV.
Cervical cancer is projected to increase from 16,075 cases in 2019 to 35,800 in 2030. For non-Hodgkin lymphoma the increase is from 8,047 cases in 2019 to more than 22,000 by 2030.
While antiretroviral (ARV) treatment is increasing the health and lifespan of millions of people with HIV, a compromised immune system increases the risk for these cancers. In addition, there are still more than two million people living with HIV who are not on ARV treatment. This necessitates dedicated screening strategies for cervical cancer to ensure early detection for better treatment outcomes.
Prostate, lung and colorectal cancers are also increasing.
The cost of treatment of these cancers in the public sector alone by 2030 could be R70-billion. This is an increase from about R15-billion in 2019, reflective of the increased burden of cancer cases in South Africa. Faced with this scenario, we cannot afford not to invest in cancer prevention, diagnosis and treatment.
According to Professor Lydia Cairncross, head of the University of Cape Town’s department of surgery and a member of the People’s Health Movement, “the investment should not be seen as a vertical investment. It is an investment recognising that the full continuum of cancer care can only occur within a health system that focuses on primary and secondary prevention, has strong referral pathways and has robust systems for education and training all health workers, not only those traditionally associated with cancer care such as oncologists and surgeons.”
Cairncross said this in 2021. Sadly, not much has happened since then.
The call for people-centred care
However, while the prevalence of cancer is growing, the funding and commitment to treating it is declining.
We are facing more and more austerity measures in health. Provincial health budgets are curtailed. Healthcare posts are frozen. Budgets for the treatment of cancers are affected. The increase in incidence will lead to more cancer patients with less dedicated money.
In addition, recent geopolitical developments associated with the Trump administration in the US will also impact on cancer in the long run because many people with HIV may no longer have access to their treatments and face cancer diagnosis earlier.
Sadly, with underfunding comes increased inequality and very stark differences in cancer care access between the public and private sector.
In 2024, the Cancer Alliance and other civil society organisations called on the health minister to invest in a dedicated national cancer institute as a coordinating mechanism for cancer. This would be a way of bringing together the various responsibilities under one roof to work towards equitable and timely cancer care.
But little has happened.
Corruption kills people with cancer
Equally troubling is the adverse impact corruption and maladministration are having on cancer care.
For example, in 2024 the Cancer Alliance, represented by SECTION27, was forced to go to court to protect the rights of more than 3,000 patients from the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) who have been waiting for more than three years for radiation treatment.
This case was first brought to the attention of the health MEC in 2021. In response, in 2023, Gauteng Treasury allocated R784-million to address the cancer and surgical backlog lists.
But the allocation was not spent.
The case was heard on 21 November 2024. SECTION27 and the Cancer Alliance are asking the court:
- To declare the Gauteng Health Department’s failure to devise and implement a plan to provide radiation oncology services at CMJAH and Steve Biko Academic Hospital, unlawful and unconstitutional;
- To direct it to update the backlog list. This will help us to determine what has happened with the patients on the list;
- To direct it to take all necessary steps to provide radiation oncology services, whether it’s in public or private; and
- To interdict them from using any of the R250-million allocated for radiation oncology services or any other purposes.
A judgment by Justice AJ Nieuwenhuizen is expected soon.
Tragically, the problems are not limited to Gauteng. There are many other access issues that are not receiving dedicated attention:
- The Cervical Cancer Elimination Strategy is still not completed after a year, nor are the prostate and childhood cancer policies;
- Access to stoma pouches is problematic in most provinces where patients receive a minimum of four per month;
- Training of healthcare professionals at primary level, including community healthcare workers, is not prioritised; and
- Palliative care in communities is not happening, with very little funding available for these services.
Cancer requires an integrated all-of-government and all-of-society approach. We can only hope that in 2025 and beyond we will be able to address these issues as we carve out the future of health in South Africa. We need to walk the talk if we want to #ClosetheEquityGap to #LeaveNoOneBehind. DM