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Cancer Care in Tunisia: Changing Perceptions

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Participants of the IAEA Workshop on Radiotherapy in Tunisia, December 2012 (Photo credit: Salah Azaïez Cancer Institute) 

Cancer isn’t a death sentence. At least not anymore. This is the message Tunisian doctors are delivering to their patients: If detected and treated early, cancer is curable.

Increasing awareness about cancer prevention and treatment among the population at large is vital to the Ministry of Health’s outreach efforts. This includes education about the role of radiation medicine and technology, explaining to people that nuclear imaging techniques are safe, painless and cost effective.

“There is a phobia about nuclear applications in medicine,” said Mohmed Faouzi Ben Slimene, Head of Biophysic and Nuclear Medicine Department at the Salah Azaïez Institute-Cancer Centre of Tunis and Head of National Centre of Radiation Protection. “Public campaign drives are regularly conducted to remove the ignorance and widen awareness about the benefits and effectiveness of radiation technology for cancer treatment.”

The doctors are confident that the psychological barrier can be overcome through a well-constructed and targeted campaign that provides simple, relevant and practical information about medical imaging and radiotherapy, and how it can help to improve patient care. “The success is that we are demystifying the ‘taboo’ attached to cancer, resulting in more people coming forward for check-ups,” Ben Slimene said.

Public campaign drives are regularly conducted to remove the ignorance and widen awareness about the benefits and effectiveness of radiation technology for cancer treatment.
Mohmed Faouzi Ben Slimene, Head, Biophysic and Nuclear Medicine Department, Salah Azaïez Institute-Cancer Centre, Tunis

About 6600 new cases of cancer were recorded in Tunisia in 2014, according to the Ministry of Health, with lung and breast cancer being the most common. According to Ben Slimene, over 19 000 diagnoses are conducted annually at the Salah Azaïez Institute, with over 9000 patients undergoing treatment. “We have to ensure that the radiation treatment and dosages are accurate, carefully monitored, as our prime priority is the care given to cancer patients,” he added. Tunisia also has an active cancer registry that keeps track of cancer cases.

As in a majority of low and middle income countries, especially in Africa, the growing cancer burden is putting considerable strain on the public health system in Tunisia. Tunisian doctors are working hard, with the support of the IAEA, to meet the growing demands in cancer care, which includes convincing people to undertake cancer therapy at the earliest opportunity, Ben Slimene said.

Catch early, treat swiftly

Ongoing training of medical staff is also essential. “Not only do these technologies help oncologists like me to view the body and to select the best treatment required to deal with different types of cancer, but we need to use the correct radiopharmaceuticals, which are vital to track the progress achieved, and assess how the body is reacting and functioning,” Ben Slimene said.

This is where the IAEA is playing an important role. It has assisted Tunisia with training, knowledge transfer, and assistance in the proper and safe use of radioactive sources in cancer treatment. IAEA experts have conducted workshops for radiopharmacists and medical physicists to improve quality control and the safe use of radiation medicine and equipment for cancer control.

“We work hand-in-hand with medical physicists to ensure that they have the right knowledge and training to protect themselves and the patients,” said Azza Hammou, a paediatric radiologist and the former Head of the National Centre of Radiation Protection. “Our safety protocols are in line with the IAEA Safety Standards.” Doctors and technicians handling nuclear medical applications have to implement correct procedures while following safety guidelines strictly, he said.

Quality assurance in radiation medicine is a multi-step process. It covers the assessment of clinical, physical and technical aspects of diagnostic imaging and radiation treatment, and management controls that are essential to avoid errors, accidents and misdiagnoses. The IAEA’s support includes technical guidance for implementing and reviewing quality assurance programmes at hospitals for radiotherapy, nuclear medicine and diagnostic radiology.

IAEA support

The IAEA has supported Tunisia in its efforts towards cancer control for decades. The country now has 17 radiotherapy machines for its population of 10 million, placing Tunisia above the most countries in Africa with regard to access to radiotherapy, said Abdou Salam Ndiath, programme management officer at the IAEA. Since 2013, the Tunisian government, with IAEA support, has established three radiotherapy centres in Tunis, Sousse and Sfax, which are equipped with a new generation of linear accelerators (LINAC). These accelerators are most commonly used to treat patients by delivering very precisely localised, high-energy x-ray irradiation to tumours. The IAEA is also assisting the country with training in medical physics and radiotherapy. 

To assess Tunisia’s cancer control capacities and provide recommendations on the comprehensive national cancer control programme, the IAEA and its partners conducted an imPACT review in Tunisia in late 2013. This has helped the country to identify priority actions for strengthening cancer control planning, prevention, early detection, diagnosis, treatment and palliative care capacities.

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