Cancer activists say they are exploring legal options to compel the government to deal with treatment backlogs in Gauteng. The move comes as the country faces its third high-profile cancer-care crisis in four years.
Johannesburg’s Charlotte Maxeke Academic Hospital is one of South Africa’s largest public cancer-treatment units. The facility treats about 2 500 chemotherapy patients each month. Another 2 500 patients pass through the facility’s radiation oncology unit, but only 300 of these patients are actually given radiation each month, the provincial health department said in May.
In April, a hospital fire forced the facility to close its oncology unit, leaving hundreds of people without treatment for at least three weeks before some were shifted to the province’s two other cancer-treatment centres. Although activists say chemotherapy services are getting back on track, almost 1 200 cancer patients are still awaiting radiation therapy two months after the fire, putting them at risk of relapsing. The majority of these people are prostate cancer patients, who are receiving hormone therapy to help to control the cancer while they wait for chemotherapy.
Patients who have had chemotherapy or who have had surgery to remove cancers are at risk of cancers coming back if they wait more than eight weeks for scheduled radiation, warns Dr Prinitha Pillay, a radiation oncologist in the private sector.
“Once you start treatment, timing is really important. It’s important when you start treatment, but also that you continue it without interruption,” she says.
The Gauteng health department maintained in May that new cancer patients are being seen within two to three weeks of diagnosis. But patient advocacy group the Cancer Alliance says the waiting time for radiation therapy is closer to months or years.
“You are sending those patients home to die,” says the alliance’s Salomé Meyer.
The fire left a wake of what Meyer calls “unco-ordinated chaos” in cancer care and revealed for the third time in almost as many years the dangers of an overly centralised system that relies almost solely on the state. The country last saw major provincial cancer-treatment crises in 2017 in KwaZulu-Natal and in Gauteng in 2018.
Cancer Alliance chairperson Linda Greeff says there are now backlogs in three provinces. And only about 10 state hospitals provide radiation oncology services. She estimates that there are more than 100 private oncology centres.
Statistics South Africa data shows that fewer than one in five South Africans had private medical aid as of 2017.
South Africa diagnoses about 42 000 cancer cases annually, based on the latest publically available figures from 2017. But cases — and deaths — remain under-reported. The country’s Covid-19 outbreak has made the situation worse. A recent study published in the South African Medical Journal found that major cancer diagnoses in the public sector fell by a third in the country’s Western Cape province in the first three months of the outbreak alone.
Greeff says underdiagnosis and the lack of data helps to keep the country’s cancer crisis out of the headlines and allows it to continue.
The Cancer Alliance is adamant that the state must begin to turn to the private sector to increase access to cancer treatment. Nationally, at least four radiation oncology public-private partnerships have sprung up in the past decade, but the alliance says the country needs more — including in Gauteng and even after the understaffed Charlotte Maxeke hospital reopens.
In May, that province’s health department released a statement saying it was in discussions with a major hospital group to possibly provide radiation services. The hospital also said it will be hiring four additional radiation oncologists by the end of July and that the province has plans to build cancer care facilities at other less-specialised hospitals.
The Cancer Alliance says it is aware of three private oncology groups that have offered to provide services to the state but the state of discussions remains unclear.