MILESTONES IN ORTHOPAEDIC ONCOLOGY IN NIGERIA

MILESTONES IN ORTHOPAEDIC ONCOLOGY IN NIGERIA
SEYI IDOWU
MCh MD FMCEM FWACS FMCOrtho

Cancer and Orthopaedic Oncology Overview

Cancer is a group of diseases involving abnormal growth with a potential for spread to other parts of the body. Orthopaedic oncology is a medical specialty that focuses on the diagnosis, treatment, and management of tumors and cancers that affect the bones, muscles, cartilage, and other tissues of the skeletal system. It’s a multidisciplinary field that combines expertise from orthopaedics and oncology.

CLINICAL PRESENTATION
Grimer RJ, 1460 patients

• Lumps and bumps the size of a golf ball (or table tennis) >4cm diameter
• Treat seriously as sarcoma!

Epidemiology and Problem Statement (1947-2000)

• Advocacy and Capacity Building
• Improvement in Diagnosis and Treatment
• Impact on Medical Education and Orthopaedic Specialties
• Improved Funding (NHIS)
• Improved Advocacy
• Specialised Facility Hubs
  (tertiary/quaternary care)
• Closed-loop Electronic Communication Networks

Challenges

• Late presentation
• Limited facilities (3 bone scans for a population of 170 million)
• Limited number of specialists
• Inadequate funding
• Services divided along geographical lines

From 2000: Advocacy and Capacity Building

• Challenges in the diagnosis and management of musculoskeletal tumors in Nigeria
• Pathological Study of Bone Tumours at the National Orthopaedic Hospital, Lagos, Nigeria
• Fine needle aspiration of bone tumours – the experience from the National Orthopaedic and Lagos University Teaching Hospitals, Lagos, Nigeria

Improvement in Diagnosis and Treatment (From 2010)

• Good surgical technique necessary!
• Endoprosthesis in the management of bone defects after bone tumor resection
• Over 100 cases from 2012 to date

Results

• 57 patients reviewed
• M:F Ratio 1.1:1
• Mean age: 44.8 years (21-71 years)
• Mean duration of symptoms: 33.2 months (6–108 months)

Costs and Outcomes

• Symptoms interval: 3 – 84 months
• Resection length: 12 – 27 cm
• MSTS score: 24 – 96 (mean: 81.9)
• Out-of-pocket payment: 75-100%
• 15-25% of cost of treatment borne by insurance and donor agencies
• Mean cost of treatment:
  • Proximal tibia EPR: 5956 USD
  • Distal femur EPR: 4303 USD
  • Proximal femur EPR: 6918 USD

Pelvic Tumor Resection and Reconstructions

• Over 12 cases from 2020 to date

Use of Fibular Grafts in the Management of Bone Defects Following Resection of Bone Tumours

• Union Rate: 100%
• Average time to union:
  • Non-vascularized FG: 32 weeks (8 months)
  • Vascularized FG: 24 weeks (6 months)

From 2020: Impact on Medical Education and Orthopaedic Specialties

• Establish a formal referral pathway
• Grants applications
• Funding for MDT
• Funding for precise investigations and specialist care
• Effective and cheaper chemotherapy

Strategies: Overcoming the Challenges (Beyond 2024)

• Health education programs
• Focused education programs for PHCs
• General practitioners through AGPMPN, etc.
• Nurses through the Nursing Council, etc.
• Medical Laboratory Scientists and other professionals

Policy Advocacy and Regulation

• The Federal Ministry of Health (FMOH) well-equipped to regulate and drive advocacy for policies that promote access to emergencies and urgent conditions requiring complex management.

Commissioning of Specialised Facilities Hubs

• Hubs/networks: Tertiary institutions grouped into specialized sectors: CVS, NEURO, ONCO, TRAUMA
• States with larger populations may require each of these specialized hubs in the territory. Smaller populations may share common hubs.

Close Loop Electronic Communication Networks

• Primary, secondary, and tertiary healthcare sectors connected through software that enables integration, analysis, storage, and delivery of patient records within specialist networks or hubs.