Cancer Care in Sudan: Current Situation and Challenges

Abstract

Sudan is one of the largest countries in Africa with 67 % of the total population living in rural areas. Poor services prevail especially in distant areas. Cancer has been one of the major ten killer diseases. The country is suffering from double morbidity: high incidence of communicable diseases and an increasing incidence of noncommunicable diseases. Lack of education, awareness, and misconceptions contribute to delayed presentation of patients with cancer, affecting survival. In the culture, there is a stigma about cancer and another stigma about discussing death.

Sudan is relatively poor economically and has experienced protracted social conflict, wars, and recent loss of one quarters of its land.

There are two main oncology centers in Sudan. One situated at Khartoum, the capital and the other in Wad Madani state. Cancer registry depends on hospital-based information. There is an increase in the number of new cases presenting each year at these centers. More than 80 % of cases present with stages III and IV.

Not a lot of efforts are doing on in terms of prevention and early detection of cancer. Even in terms of diagnosis, several factors play part in the current services offered: lack of trained qualified personnel, namely histopathologists, radiologists, and surgeons; lack of protocols, lack of equipment or lab reagents.

In regard to cancer treatment, the Ministry of Health is providing all main chemotherapeutics for free, and the radiotherapy with minimal charges. Improper planning and management of resources (e.g., opting for brand names instead of generic) leads to shortages in basic drugs for periods reaching to months. There is a local training for clinical oncologists, but lack of subspecialties, e.g., surgical oncologists, palliative care specialists, and even proper linkage and multidisciplinary meetings leads to a lower quality of service.

Palliative care started voluntarily, offered by few individuals. It still remains a new concept. The community is still not sensitized nor involved. The Ministry of Health and the cancer centers are seeking ways to support this service. Currently, palliative care is not given a share of attention or resources in order to cover the huge needs. A lot of training and advocacy is requested in order to avail oral opioids outside the cancer centers.