Cancer Treatment in South Africa: A Guide for Patients and Families

Where does cancer treatment begin?

For many people, the journey begins with a symptom, an unusual finding during a medical examination or an abnormal screening result.

Further investigations may include blood tests, imaging such as ultrasound, X-ray, CT, MRI or other scans, and sometimes a biopsy.

A biopsy involves examining a sample of cells or tissue and is often an important part of confirming a cancer diagnosis and identifying the specific type of cancer.

Once cancer has been diagnosed, additional investigations may be required to determine its extent or stage. This information helps the treating team develop an appropriate treatment plan.

Who treats cancer?

Cancer treatment often involves a multidisciplinary healthcare team.

Depending on the patient's diagnosis, this may include oncologists, surgeons, radiologists, pathologists, oncology nurses, pharmacists, dietitians, physiotherapists, psychologists, counsellors and other specialists.

Some South African patients receive treatment through the public healthcare system, while others receive treatment through private oncology practices and hospitals.

The pathway depends on the diagnosis, location, available services, medical-aid coverage and individual circumstances.

What treatments are used for cancer?

There is no single treatment for cancer.

Treatment depends on factors including the type of cancer, its stage and location, characteristics of the tumour, the patient's overall health and previous treatment.

Some patients require one form of treatment while others receive a combination.

Surgery

Surgery may be used to remove a tumour and sometimes surrounding tissue or lymph nodes.

Depending on the cancer, surgery may be the primary treatment or may be combined with chemotherapy, radiation therapy or other treatments.

Chemotherapy

Chemotherapy uses medicines to destroy cancer cells or interfere with their ability to grow and divide.

Treatment may be given intravenously, orally or by other methods depending on the medication and treatment plan.

Side effects vary considerably between medicines and patients. Your oncology team should explain what to expect from the treatment prescribed for you.

Radiation therapy

Radiation therapy uses high-energy radiation to damage cancer cells.

It may be used as a primary treatment, alongside other treatments, after surgery to reduce the risk of recurrence, or in certain situations to relieve symptoms.

Targeted therapy

Some cancers contain particular biological characteristics that can be targeted using specific medicines.

Testing may therefore be required to determine whether targeted treatment is appropriate.

Immunotherapy

Immunotherapy includes treatments designed to help the body's immune system recognise or attack cancer.

It is used for certain cancers but is not appropriate for every patient.

Hormone therapy

Some cancers—including certain breast and prostate cancers—can be influenced by hormones.

Hormone therapy may be used to reduce or block these hormonal signals.

Patients should ask their oncologist to explain why a particular treatment is recommended, its intended goal, potential benefits and risks, possible alternatives and what happens next.

Cancer treatment in South Africa's public healthcare system

Cancer services are available through South Africa's public healthcare system, although available services and referral pathways differ between provinces and facilities.

A patient may initially attend a clinic, community health centre or hospital before being referred to an appropriate specialist or oncology service.

Patients should establish:

• where they have been referred;
• when their appointment is scheduled;
• which documents they need;
• whether further tests are required; and
• whom they should contact if their condition changes.

Where possible, keep copies of referral letters, pathology reports, imaging reports, medication lists and appointment information.

Private cancer treatment and medical aid

Patients with medical aid may receive cancer treatment through private hospitals and oncology practices, subject to their medical scheme's benefits, rules, networks and authorisation requirements.

Patients should establish as early as possible what their medical scheme will cover.

Ask about treatment authorisation, approved providers, medication benefits, co-payments and expenses that may not be covered.

Cancer treatment can involve significant costs, so understanding these arrangements early can help families plan.

Cancer treatment involves more than medicine

Cancer can create practical challenges outside the hospital.

Patients may need repeated transport to chemotherapy or radiation appointments. Treatment can affect a person's ability to work. Parents and relatives may need to take time away from work to provide care.

Food, transport and other household expenses may increase while income is under pressure.

These challenges matter because practical difficulties can affect a patient's ability to continue treatment.

Supporting someone with cancer therefore means considering the person and family as well as the disease.

Nutrition during cancer treatment

Cancer and cancer treatment can affect appetite, taste, swallowing, digestion and body weight.

Patients experiencing difficulty eating or significant changes in weight should discuss this with their healthcare team. Where appropriate, a qualified dietitian can provide individual nutritional guidance.

Patients should also be cautious about supplements, restrictive diets or products claiming to cure cancer.

Supplements and major dietary changes should be discussed with the treating team because some products may interfere with treatment or medication.

Getting to treatment

Transport can become a serious practical challenge for patients requiring repeated hospital visits.

Chemotherapy and radiation treatment may require numerous appointments over weeks or months.

Patients struggling to reach treatment should tell their healthcare team rather than simply missing appointments.

Hospitals may have social workers or patient-support services that can help identify available assistance.

Emotional support

Cancer affects more than physical health.

Patients may experience fear and uncertainty about treatment, employment, finances, children and the future. Caregivers and family members can also experience considerable emotional strain.

Support can come from healthcare professionals, counsellors, social workers, family, friends, faith communities and cancer-support organisations.

Patients and families should not be afraid to ask for support.

Questions to ask your oncology team

Consider writing questions down before appointments.

Useful questions include:

• What type of cancer do I have?
• What stage is it?
• Do I require additional tests?
• What treatment are you recommending and why?
• What is the goal of my treatment?
• What side effects should I expect?
• Which symptoms require urgent medical attention?
• How long will treatment continue?
• Will treatment affect my ability to work, eat or drive?
• Are there medicines, supplements or foods I should avoid?
• Who should I contact if I become unwell between appointments?

If something isn't clear, ask your healthcare professional to explain it again in plain language.

When should cancer patients seek urgent medical attention?

Different treatments carry different risks, so patients should follow the specific instructions provided by their oncology team.

If your treating team has instructed you to contact them urgently when particular symptoms develop, follow those instructions rather than relying on information found online.

For severe illness or a medical emergency, seek urgent medical assistance.

Finding cancer support in South Africa

Support available to patients varies according to location and individual circumstances.

Assistance may be available through hospital social-work departments, government services, nonprofit organisations, community organisations and cancer-support programmes.

Patients experiencing financial difficulty, transport problems or difficulty obtaining adequate food should raise these concerns with their healthcare team as early as possible.