As the World Cancer Day was marked on February 4, Kenyan patients sat anxiously waiting for a new equipment that has become the talk of town in the health sector.
The equipment has been promoted as a hi-tech cancer screening machine called a positron emission tomography/computed tomography (PET/CT) scanner, simply referred to as a PET scanner.
The machine, set to be procured at a cost of Sh619 million by the Aga Khan University Hospital by March, is commonly used in cancer treatment, neurology and cardiology.
Combined with a CT or magnetic resonance imaging (MRI) scan, a PET scan can produce multidimensional, colour images of the inside workings of the human body and not only shows what an organ looks like, but also how it is functioning.
The machine, commonly found in India, gained popularity after TV personality Janet Kanini, who died last year after she was diagnosed with lung cancer in 2015, talked about it when sharing her experience in India.
Her experience, coupled with that of other patients who have gone abroad for treatment, doctors say, has seen an increase in the number of patients’ request to undergo diagnosis using a PET scan.
A PET scan is used to diagnose certain health conditions, to plan treatment, find out how an existing condition is developing, and check how effective treatment is.
For some patients, going for a PET scan is seen as a favourable route to establishing the extent of the cancer than other tests, or having to undergo an exploratory operation.
Without PET scanners in Kenya, the automatic option is to travel abroad, with India being the favoured destination. Reports estimate that Kenyans are spending Sh8 billion annually to seek treatment for cancer abroad.
The machine is also deemed fairly cheaper than the India option where the patient incurs visa fees, an airline ticket costing up to Sh130,000 and Sh60,000 for the scan.
For those diagnosed using the PET scan, it is a far easier option than having to undergo different often inconclusive tests
For civil servants, who are fully covered by the National Hospital Insurance Fund, the insurer agrees to pay for treatment only if that service is not available locally, which makes it possible for patients under their cover to travel to India.
Information available online shows that a PET scanner can be bought for as low as $95,000 (Sh9.5 million) for a single-slice machine up to $550,000 (Sh55 million) for a 64-slice machine. With approximately 41,000 Kenyans being diagnosed with cancer annually, and about 28,000 dying, the country has been putting in place measures to combat the deadly disease.
But how crucial is a PET scan in the diagnosis and treatment of cancer?
The use of this machine, oncologists say, is just one of the many ways of tracing cancer and learning its stage, whether it has spread, and if it is changing how the patient’s organs work.
Dr Andrew Odhiambo, an oncologist, agrees that the machine is quite an important diagnostic tool for cancer as it helps doctors to make decisions in certain dicey situations where the normal CT or MRI scan is not able to give all the answers.
For this, he adds, the machine can be very useful in specific types of cancers such as a group of blood cancers.
“We also heavily rely on the PET scan when managing patients with lung cancer stage three to decide on whether to operate on the patient or not,” says Dr Odhiambo.
Some stages of kidney cancer also rely on the machine.
For other cancers, Dr Odhiambo adds, and in situations where the doctor lacks a critical answer that will influence whether a certain treatment is done or not, the PET scan can help give a clear way forward.
But he adds that the PET scan does not treat cancer and patients should be advised to know that the utility of this machine has to be limited to situations where it can influence what the doctors does.
“Ideally, the PET is supposed to help doctors make a decision on the mode of treatment. However, if the mode of treatment will not change whether or not the PET scan is done, then it is not really useful,” he says.
Further, the machine only works in situations and countries where the cancer is detected early.
“In the Kenyan set up where about 80 per cent of cancers are diagnosed late, in stage four, doing a PET scan does not add value since it will not change what the doctor is going to do,” says Dr Odhiambo.
According to Dr Odhiambo, who is also a lecturer at the University of Nairobi, the only way of diagnosing cancer is by conducting a biopsy where a sample of tissue is taken from the patient’s body in order to examine it.
“At the end of the day, the cells observed on a slide under a microscope is what will determine if a patient has cancer or not. A PET scan does not treat cancer,” he says, adding there are three ways of treating cancer: chemotherapy, radiotherapy and surgery.
To him, a PET scan will not change patients’ survival rate if the diagnosis is not made early. “It will be here, but unless it influences the treatment decision, we will just continue doing unnecessary PET scans,” he says.
His sentiments are also shared by Prof Nicholas Abinya, who says only a small percentage of patients will need the machine to monitor their cancer after treatment.
Instead, he advises that in order for patients to get the best services, doctors should know when to aggressively treat the disease and when not to treat at all, and instead offer best supportive care in terms of pain management and palliative care.
“Patients go abroad and come back claiming they are cured. Months later, they fall ill and are in denial when we tell them they still have the disease. As a country we may not have all the resources but as specialists, we know when to refer patient or not,” he adds.