The Burden of HER-2 Positive Patients in Sub-Saharan Africa: A Caregiver Perspective

Abstract

Background and context: Several studies showed that the use of the recombinant monoclonal antibody trastuzumab, in addition to adjuvant chemotherapy, for breast cancer with overexpression of the HER-2 protein or amplification of the HER-2/neu gene reduced the risk of recurrence by 50% in women irrespective of nodal status. In Nigeria, breast cancer is the leading and the most common cancer in women. A trastuzumab brand known as Herceptin is the popular brand usually prescribed by the oncologist in Nigeria. Once a histopathology/immune-chemistry result shows HER-2 positive and oncologist informs that patient of the diagnosis being HER-2 positive; most patients emotionally breaks down due to cost of the drugs. In Nigeria, as at 2015 the cost of herceptin 455mg was N650,000 ($1857). As at June 2016 that same drug increased in cost to N1,100,000 ($3142) due to the unstable exchange rate in Nigeria. In Nigeria 90% of patients pay-out of pocket for treatment and drugs as the health insurance system in my country does not cover chemotherapy drugs. Several cancer patients with HER-2 patients face serious financial challenges in Nigeria, as so many experience spread of the cancer to vital organ when they are unable to get finance to purchase the life-saving drug for their HER-2 positive breast cancer subtype. Aim: To understand the burden of HER-2 diagnosis in Nigeria and stimulate advocacy for the reduction of the cost of Herceptin in Nigeria and other sub-Saharan Africa where finance is a serious impediment to accessing medical care. Strategy/Tactics: The study will present case studies of three Nigerian women who were diagnosed of HER-2. Interview was used as a method of data collection, informed consent were also completed by the patients before the interview. Program/Policy process: Our study reveals that there is a need to engage the federal and state governments, corporate organizations, insurance schemes and most importantly pharmaceutical companies to reduce cost of cancer drugs and particularly Herceptin. HER-2 breast cancer patients need to lead the advocacy for reduction in cost of drug at all levels. Outcomes: Our qualitative findings reveal that caregivers are mostly affected by the cost of drugs such as Herceptin. In some cases caregivers, sell valuables, take loan and go public to raise funds for the cancer drugs. What was learned: Most HER-2 positive breast cancer patient could not afford Herceptin and some waited for several months to raise funds, which is probably a factor in metastasis and low-survival.