By Zineb Dahbi, MD, and Fadila Kouhen, MD
Cancer is a leading cause of death and disability in Africa and its burden on the continent is increasing. According to the World Health Organization (WHO), the number of patients with cancer in Africa is estimated to increase from 844,279 in 2012 to more than 1.5 million in 2030; this life-threatening disease is expected to become the leading cause of death in the region by 2040.1 Several factors contribute to the high burden of cancer in this continent, including the growing and the aging population, as well as the increasing prevalence of risk factors such as tobacco use, unhealthy diets, and physical inactivity. In addition, the lack of access to timely and appropriate cancer diagnostic facilities and treatments are major contributors to this disease, requiring collaborative efforts between countries in this region to offer optimal care and reduce the high number of patients in settings with limited resources. To address this massively growing burden, it is crucial for African countries to invest in cancer prevention and control programs, as well as to increase access to cancer diagnosis and treatments. This includes efforts to improve the availability of cancer screening and early-detection programs2 and to increase the capacity of health systems to diagnose and treat cancer, with ideal cooperation between African countries to address this emerging pandemic.3
There currently is a wide disparity in access to cancer care in countries across Africa.4 Some countries do not have radiotherapy equipment; others, such as Morocco, have achieved a significant improvement in cancer care. Morocco has largely exceeded the World Health Organization recommendations by having more than 40 linear accelerators for radiotherapy per population, relying currently on over 100 radiation oncologists to offer cancer care. In addition, Morocco has a newly developed health care system and a reputation for providing high-quality medical care, making it an attractive destination for patients with cancer in Africa to receive adequate treatment.
For instance, my institution, the International Cheikh Khalifa Ibn Zaid University Hospital, receives approximately 263 requests for care quotations from foreign African patients per semester, including 34.9% for surgery and 27.8% for medical and radiation oncology consultations. The percentage of African patients from outside Morocco accounts for 11.3% of the total number of patients received at the hospital per semester. A proposed package aims to facilitate the procedure of obtaining a visa, transportation, and accommodation in addition to the intra-hospital stay charges. 75% of these patients travel from their home country to receive optimal treatment for breast, cervical, or prostate cancers, and mostly arrive with disease in locally advanced stages, with an epidemiology that closely matches the local data of Morocco.
The COVID-19 pandemic has made medical travel delicate, nevertheless, it is still in high trend, due to the huge demand in Africa. Medical travel requires more careful planning for radiotherapy since it is a treatment that requires a daily visit to cancer centers, for a duration that can extend from one week to two months of treatment. However, since the COVID-19 crisis, recent radiotherapy protocols have been adapted with the concept of hypofractionation.5 This approach is effective in the treatment of certain types of cancer, such as prostate and breast cancers, and may be used in combination with other cancer treatments, such as chemotherapy, and is an option to propose to foreign patients, who are forced to reduce the duration of their stay.6 Furthermore, there are several telemedicine platforms available in Morocco, including both public and private providers, using videoconferencing, phone calls, and other forms of communication. Through telemedicine, patients with cancer in Morocco can receive remote consultations with their doctors as well as medication management and follow-up care. This can help to ensure that foreign patients with cancer receive the ongoing care and support they need to manage their condition when they go back to their home country.7
While the American Society of Plastic Surgeons advises people to carefully consider the destination and to wait 7 to 10 days before flying for some cosmetic procedures on the face and the body, to reduce the additional risk of complications seen with long-distance traveling, neither the European nor the American cancer treatment societies have issued recommendations regarding travel for cancer care. However, it would seem appropriate to carefully choose the destination, the level of expertise of the selected center, as well as the modalities of the post-treatment follow-up.
Prof. Dahbi is an assistant professor of radiation oncology at Mohammed VI University of Health Sciences, in Casablanca, Morocco. The contents of this paper reflect her own perspective and not that of her of affiliation. Disclosure.
Prof. Kouhen is an assistant professor at Mohammed VI University of Health Sciences, in Casablanca, Morocco. Disclosure.
- Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209-49.
- Elmore SNC, Polo A, Bourque JM, et al. Radiotherapy resources in Africa: an International Atomic Energy Agency update and analysis of projected needs. Lancet Oncol. 2021;22:e391-e399.
- World Health Organization. WHO list of priority medical devices for cancer management. 2017.
- Mousa AG, Bishr MK, Mula-Hussain L, et al. Is economic status the main determinant of radiation therapy availability? The Arab world as an example of developing countries. Radiother Oncol. 2019;140:182-9.
- Siavashpour Z, Goharpey N, Mobasheri M. Radiotherapy based management during Covid-19 pandemic - A systematic review of presented consensus and guidelines. Crit Rev Oncol Hematol. 2021;164:103402.
- Mukundan H, Vats P. Advances in radiotherapy in 2020: Hypofractionation - less is more in times of COVID-19. Indian J Cancer. 2021;58:41-4.
- West HJ, Barzi A, Wong D. Telemedicine in Cancer Care Beyond the COVID-19 Pandemic: Oncology 2.0? Curr Oncol Rep. 2022;24:1843-50.