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There is an adage that says: “No one loves the messenger who brings bad news.” One of the most heartbreaking moments for any oncologist or physician is when they deliver news of positive confirmation for a new cancer diagnosis. The news can be shattering and for some time, one may lose the will to live. It is usually a very emotional experience but as doctors, we must always remain strong to support you through your treatment and possible recovery.

Undeniably, the stress that comes with a new cancer diagnosis can be quite overwhelming. Perhaps your immediate thoughts will be your family members and dear friends. However, there is a fair chance for you to get optimal cancer care and live normally afterwards. The secret, as I have stated before, is to go for early and regular cancer screening where applicable. This allows for early detection and treatment. This most important for breast, cervix, colon, and prostate cancer. It is nevertheless important to note that acute stress does not cause cancer. If the stress gets chronic, your immune system may be immobilized resulting in other health challenges over and above unfulfilled life.

April is the month of stress awareness where we are all encouraged to monitor our emotional and mental wellness including those of our family members and friends. Indeed, stress has become one of the contributing factors to mortality and a big public health issue. According to World Health Organization, mental health disorders make up 10% of the global burden of disease. This is just the tip of the iceberg because the trove of statistics around stress and depression paints even a grimmer picture.

While the situation might seem dire, stress caused by a cancer diagnosis can be managed and you will be able to cope and live a relatively meaningful and happy life. Even though you cannot eradicate stress from your life, you can take practical steps to reduce the number of stressors in your life even as you begin cancer treatment and counselling. Here are some five tips for dealing with stress after being diagnosed with cancer. They include:

1. Exercise regularly: Having an active lifestyle can help you stay energized and motivated to engage in your life’s purpose or mission. Depending on your stage of cancer, your oncologist/physician will be able to advise on an appropriate exercise routine. This could be as simple as taking a thirty to one hour stroll a couple of times a week around the neighbourhood.

2. Spend time outside: You will be surprised by what the fresh air, sunlight and tranquillity of nature can do for your mood. Stress, by its very nature, leads us to isolate ourselves from family and friends. With the bad news, you may feel defeated and would wish to stay by yourself in the house waiting for death. On the contrary, you need to spend time outside and engage in normal chit chat. It will give you the drive to live through your cancer treatment and recovery.

3. Join a support group: When you get a cancer diagnosis; it may seem like you are alone in the world. However, in reality, there are other people who also in your exact situation and they could draw inspiration from your story to live through the ordeal. You should consider joining a cancer support group where you will meet other cancer warriors to discuss and share your experiences. If you do not know where to start, you can always request your oncologist to recommend a cancer support group within your area or a treatement buddy to walk with you.

4. Learn a new hobby: You can also learn and develop a new hobby that will keep you preoccupied while enjoying yourself. This could be a wide range of activities including board games like Scrabble, playing musical instruments, dancing, painting, singing or simply reading books on subjects that you love.

5. Schedule social activities: Having cancer should not make you sever ties with people instead, you should reach out and socialize with family or friends. These interactions may adjust your perspective towards life and see how many things that we take for granted are valuable. Be sure to make time to meeting and spending time with people you treasure. It will make you feel better. Remember to pamper yourself and make yourself feel good always.

There is no doubt that a cancer diagnosis would be without stress and anxiety. It may seem like your world has come to an end but that is not true. All is you need is for you to manage your stress and anxiety so that you can leave a relatively normal life as you used to before the diagnosis. Remember you beat cancer by how you live, why you live and in the manner in which you live – Late ESPN Anchor Stuart Scott 2014 Jimmy V Award

For us at Prime Cancercare Clinic, we believe and choose hope. If in any case, a few bad chapters don’t mean your story is over. To this end, we provide holistic cancer treatment that includes counselling and support. Our Executive Care Coordinator will always be with you throughout your journey. Call us today for treatment consultation on 0724 831010 or click here to book an appointment.

As a Medical Oncologist practicing in Nairobi Metropolis, the question I get asked the most is:
“Is there any option other than chemotherapy? I’ve heard only bad things about it.”

Other popular phrases include:

“Chemotherapy is so toxic!!!”
“I hear chemotherapy kills you faster than the cancer itself!!”
“I want the other one that comes in tablets, …I don’t want chemo”

My answer is always, “Yes, there is another option!” We now have this new type of cancer treatment we call targeted therapy. And yes, we have immunotherapy as well which can also be classified as a form of targeted therapy but works differently. It modifies your immune system which then kills the cancer cells. This article intends to shed more light about this new (not so new really) treatment. I will tackle immunotherapy in one of my future articles. Chemo isn’t that bad either. All you need is an experienced Medical Oncologist or Clinical Oncologist to oversee your treatment and manage the effects early. You also need to be empowered. To read more about chemotherapy read my past article click here. It is important to know that we now have a majority of these targeted therapies in Kenya. You don’t have to fly overseas to get them. I will use my usual Q & A format to make it easy to read. Here we go!

What is targeted therapy?

These are cancer drugs that target specific genes or proteins involved in cancer cell growth and survival. These drugs may also modify the environment in which cancer cells thrive making their survival shorter, for instance, they can deny cancer cells blood supply to grow. Most of them come in tablet/oral formulation though some may still be in intravenous (IV) form. The majority are useful in advanced or stage 4 cancers to improve one’s survival. They are not typically designed to cure cancer but keep it suppressed for as long as possible. A common example that we use in stage 4 colon cancer is called “Bevacizumab”. It targets the gene/protein called “VEGF” that makes blood vessels grow quickly and feed cancer cells. This drug blocks the VEGF gene/protein thereby shortening the survival of colon cancer cells. Many others targeted therapies work in a similar manner.

Is targeted therapy used for all cancers?

The answer is no. Not all cancers benefit from targeted therapy. Many cancers still depend largely on chemotherapy for optimal survival. Targeted therapy is however gaining a lot of traction lately. It takes many years of research before a drug is approved for cancer treatment. For many cancers like colon cancer, lung, kidney, bladder, skin, breast, and pancreas, we have several approved targeted drugs. As mentioned earlier, targeted therapy is mostly useful for those with stage 4/advanced cancer though some are used also for stage 3.

How do I know if targeted therapy is for me?

Many times, your oncologist will offer you targeted therapy an option in accordance with the treatment guidelines. It is important to ask your oncologist whether you qualify for targeted therapy, especially if you have advanced or stage 4 cancer. Sometimes, special tests will be done on your cancer biopsy sample to determine whether you may qualify for targeted therapy or not. Some cancers may benefit from targeted therapy without any such prior testing. Targeted therapy may not work if the tumour doesn’t possess the target. It’s also important to understand that the mere presence of the target doesn’t necessarily mean that the tumour will respond to the targeted therapy. Even if it responds well, sometimes this may not last long and varies from drug to drug as well as cancer type. Cancer cells can over time develop resistance and become much stronger than the targeted therapy. Therefore, you may need to change to a different drug.

What are some examples of targeted therapy?

Below is a table of commonly used targeted therapies and which cancers they can be used to treat. Sometimes we may combine chemotherapy and targeted therapy to get a better effect. As scientists, we are still trying to predict which patient will benefit from targeted therapy or not.

How much does it cost in Kenya?

The cost will vary significantly with the drug and whether you are purchasing the original or generic/biosimilar. The typical range is about 180USD per month for generics of sorafenib (SORANIB) to over 4000 USD for the original sorafenib (NEXAVAR). See table above for some price estimates in USD and comparisons between originals and generics/biosimilars in Nairobi.

Where can I find targeted therapy?

Targeted therapy is available in most major hospitals like Nairobi Hospital Cancer Centre, Agakhan, MP Shah Hospital, and Kenyatta Hospital among others. Availability of stock may vary with prevailing circumstances. Ask your oncologist where you can access them. Both private insurance and NHIF come in handy to partially or fully offset the cost.

Who can prescribe targeted therapy for me and what are the common side effects?

This should be prescribed by an oncologist trained to prescribe and manage targeted therapy. This is preferably a Medical Oncologist or a Clinical Oncologist. Always remember to get information on potential side effects and how to monitor and manage them. Your oncologist may change the dose based on appearance of some side effects.

What are some of the common side effects?

Side effects will vary from drug to drug. Some are shared and some are unique to a particular drug. The most common side effects include but not limited to: (List not exhaustive)

• Diarrhoea
• Skin rash/dry skin
• Skin lightening especially in black Africans
• Liver inflammation
• High blood pressure
• Fatigue
• Mouth sores
• Loss of appetite.

It is very important that you keep a treatment journal and record all your side effects and discuss them with your oncologist so that they are managed quickly to avoid them getting worse. In case they occur, your oncologist may change the dose or stop the therapy. Continued communication with your Medical Oncologist is very important.

This article is not exhaustive as there are several targeted therapies in the market for different types of cancer. In one of my next articles, I will tackle immunotherapy. I hope this has helped you understand more about targeted therapy. If you have any further questions you can message me (on my website www.drandrewodhiambo.com or Facebook page) or tweet me @odhis1.

Yours truly,

Dr. Andrew Odhiambo

Did you know the word cancer comes from a “Greek” word meaning “crab” because of its finger-like projections resembling the shape of a crab? This already makes it sound spooky and it is no wonder that many people are not shy to say that “Cancer is a BITCH” and here is why. Not only have I stated why but I have also suggested ways you may overcome and rise above cancer. Here we go…..

1. Cancer is NOT a disease

Many people imagine that cancer is one disease when actually it is a group over 200 different types and subtypes of diseases. This explains why cancer is often complex to understand and may behave in many different ways. Take an example of breast cancer; there are at least 4 different subtypes which have different behaviour and prognosis. It is for this reason that there is no single test one can do for screening that excludes all cancer.

Now that you know this, it is paramount that you are aware and self-conscious about your body. Anytime something doesn’t feel right, and there is no explanation, please seek medical attention as soon as possible.

2. Cancer causes are not very well established

We often talk of risk factors and not direct causation. We know HIV causes AIDS but for the majority of the cancers, we don’t know what causes them. Tobacco use, heavy alcohol consumption and positive family history have been thought to be very important risk factors for many cancers. However, we still come across some cases of cancer that are strongly linked to these risk factors but lack the exposure. The best example is lung cancer. In many parts of Africa, we diagnose many cases of lung cancer in those who have never smoked cigarettes. Up to 66% of the time, we cannot identify any risk factor at all for the majority of cancers.

Now that you know this, you can still avoid all the known risk factors like tobacco and excessive alcohol use but at the same time, don’t live scare free and imagine that you are immune from getting cancer simply because you have no risk factors. Go for periodic checkups whether you have been exposed to risk factors or not.

3. Cancer often mimics symptoms of common diseases & ailments

This is the most notorious characteristic of many cancers. They hide for so long undetected and when they begin to show symptoms, they resemble that of common diseases and ailments. Top in the list in Kenya is H. Pylori, Amoeba, Typhoid, Brucellosis and Tuberculosis. This is because they share many symptoms and it isn’t possible for primary healthcare doctors, nurses and clinicians to tell the difference. Stomach cancer will often mimic gastritis and H pylori. Lung cancer & lymphoma will often mimic Tuberculosis etc. These ailments are indeed more common than cancer anyway and are easily treatable. What’s more interesting is that some but not all patients would prefer to be diagnosed with H pylori and not stomach cancer. They are mostly content with being told they have H pylori over and over. The moment a doctor suggests tests to look for cancer, they are off to the next doctor in another hospital ready to take more H pylori medication. It’s human nature to be afraid of cancer.

Now that you know this, if you are treated for the same “common ailment” over and over a month on month please seek a referral to a specialist to rule out the possibility of cancer. The earlier it’s caught, the better your chance of cure.

4. Cancer instils a lot of fear

The “C” word is what some call it. So afraid to even say cancer. The fear of death is real. Cancer is one of the scariest diseases. The fact that we do not fully understand its causes make us more scared. Fear causes a lot of stigmas. Stigma, in turn, results in ignorance and poor knowledge which in turn breeds more stigma. It is natural to be afraid of cancer. Now that you know this you can help break this cycle by empowering yourself with basic knowledge about cancer, the types, common symptoms, and where to go for checkups.

5. Cancer treatment is not often straightforward

Unlike swallowing malaria tablets for 3 days and being cured, cancer treatment is often protracted, convoluted and multidimensional. Most solid tumours like breast, lung and colon will often require more than one modality of treatment. Most cancer patients will need to have biopsies taken to ascertain the diagnosis which requires the highly skilled pathologist to read the slides and describe cancer. After which, one would require specialized body scans to know how far cancer has spread. This helps us to know the stage. After we stage cancer, we can then treat it. More often, cancer patients will need to see many different types of specialists’ throughout their journey. This may include the surgeon, oncologist, psychologist, therapist etc. Cancer surgery is often complicated. Chemotherapy and immunotherapy can also be long and very involving. After treatment, it’s more scans and tests. It takes a toll on one’s family both emotionally and financially.

Now that you know this, it is important to take part in the decision-making process of your treatment and be continuously involved. Ask for reading material concerning your type of cancer and don’t fear to question or challenge our decisions. Be empowered. We doctors are not gods to be worshipped.

6. Cancer can leave you mutilated

Cancer can be very destructive. Especially solid tumours. This is because surgery is a key modality in their treatment. Many breast cancer patients lose their breasts, sarcoma patients lose their limbs, and don’t get me started about colostomies and urostomies. These affect many patients’ quality of life and many will opt out of these procedures because of the emotional impact. I once had a patient refuse a colostomy because he knew his wife wouldn’t have sex with him ever if he got it. You can google what a colostomy is then you’ll understand. The physical disability is a permanent feature for many survivors’.

Now that you know this. It is possible that if your cancer is caught early, you will suffer less mutilation. But remember that sometimes it may be a sacrifice you have to make to remain alive. Should you be the one, remember you can apply for a disability card for tax and government benefits.

7. Cancer will bankrupt you and your family

Cancer treatment and care is very expensive. Don’t get me wrong. Not even the rich can afford comprehensive cancer care. I have seen rich families go broke and auction/sell everything. The more advanced cancer, the more expensive it gets. Remember earlier I said cancer treatment is multifaceted. Many specialists are involved. It can cost you millions. If you dare ask me how much immunotherapy costs you will faint.

Now that you know this, remember that early-stage cancer is cheaper to manage. Most times, a simple surgery will do. Once it starts spreading, then chemotherapy and radiotherapy are involved which raises the cost. Go for early screening and keep vigilant. Make sure your NHIF is up to date at the very least. If you can, add on private insurance. Don’t default on your NHIIF just because you are “healthy” lest you’re are caught pants down.

8. Cancer affects families not individuals

“Cancer doesn’t have a face until it’s yours or somebody you know” – Anthony DelMonte. A popular phrase we use. But be careful when your kin gets cancer, you will be affected just as much as the patient. I have many relatives calling me from America and Europe worried about their sick parents in Kenya. The fear makes you have insomnia. Cancer patients do not attend clinic alone like patients with hypertension or arthritis. The whole family is there plus grand-kids and in-laws. That’s one of the main reasons I moved into a bigger office. To accommodate the big numbers. As a cancer doctor, you become a member of many families. You provide hope where there is none and walk with the family throughout their cancer journey and ensure a safe landing. Whether we win or lose, a safe landing is very important. Now that you know this, please be patient with your oncologist. Support her/him when they are low. Call them once in a while to check upon them. We go through a lot just to make sure you are well and well taken care of. We have families too and want to feel loved.

9. Cancer once treated may still come back

This is one fact that always breaks my heart. Once successfully treated, cancer may still come back. Usually with a vengeance. Even after going through all the best treatment, whether abroad or locally it may still crop up. Sometimes we still catch it early, but sometimes we don’t.

Now that you know this, please pay attention to your follow up clinics. You may not tell on your own when something is wrong, but regular checkups may catch early recurrence.

10. Cancer affects children too

Lastly and very sadly, cancer affects children too. September which is around the corner is childhood cancer awareness month. Don’t imagine that young persons do not get cancer. They do, and it’s devastating when a life is lost. I always give props to my paediatric oncology colleagues. Big up!!! Because it’s not easy.

Now that you know this, remember to be extra vigilant when it comes to your child. Any unexplained tiredness, bleeding, body or abdominal swellings should demand thorough examination to exclude childhood cancer. Bathe your child frequently, don’t leave it all to the nanny, be vigilant and stay woke.

This was not meant to scare you but to make you empowered with knowledge because knowledge is power. Power is freedom. Freedom is life.

Disclaimer: My Views Are My Own and I Shall Bear No Responsibility for Any Actions That Are Influenced or Arise From My Blog

If you have any further questions you can message me (on my website www.drandrewodhiambo.com or facebook page) or tweet me @odhis1.

Yours truly,

Dr. Andrew Odhiambo