Cancer: how do you prepare a treatment pathway in Morocco from sub-Saharan Africa?

Step 1: confirm the diagnosis

A mass on ultrasound, an abnormality on a CT scan or a raised blood marker raise the suspicion of cancer but do not prove it. In the vast majority of cases, the diagnosis relies on a pathologist examining a sample, either a biopsy or a surgical specimen, under the microscope. This analysis specifies the type of cancer, its grade and, depending on the case, markers that guide treatment.

When the biopsy has already been carried out in the home country, the report is essential. Depending on the situation, the team may ask for the slides or paraffin blocks to be reviewed, or for some analyses to be completed. When no biopsy has yet been done, it needs to be established whether it can be carried out locally in good conditions or whether it is better organised on arrival.

Step 2: staging

Staging looks for whether the cancer has spread to the lymph nodes or other organs. It relies on tests chosen according to the type of cancer: CT, MRI, ultrasound, bone scan, sometimes a PET scan. Its result, the stage, determines the treatment. Recent, good-quality tests carried out in the home country can be used; a test that is too old, incomplete or for which only photos of the report are available may need to be repeated.

Step 3: the multidisciplinary decision

The treatment plan for a cancer is ideally discussed at a multidisciplinary team meeting, which brings together, depending on the case, the surgeon, oncologist, radiation oncologist, radiologist and pathologist. This discussion sets the goal of treatment, to cure, to control the disease or to relieve symptoms, and the order of treatments. The proposal is then explained to the patient in a consultation, with its benefits, risks and alternatives.

Step 4: understand the length and sequence of treatments

Cancer treatment often combines several modalities, each with its own logistics:

• surgery requires a few days to a few weeks on site, between the pre-operative assessment, the hospital stay and monitoring of wound healing;
• chemotherapy is given in cycles one to several weeks apart, over several months;
• external beam radiotherapy often involves daily sessions, five days a week, for several weeks;
• hormone therapy or targeted therapy may last months or years, with regular monitoring.

For a patient coming from abroad, this length has concrete consequences: staying in Morocco throughout treatment, alternating stays, or carrying out some steps in the home country when this is possible and safe. These arrangements are decided with the medical team, according to the protocol, the availability of treatments in the home country and the family’s situation.

Step 5: plan supportive care

Cancer treatments often come with side effects: fatigue, nausea, lowered resistance to infection, pain, weight loss. Nutrition, pain management, infection prevention and psychological support are part of treatment. For repeated infusions, an implantable port may be offered. A patient whose defences are low after chemotherapy must know which signs require urgent medical attention, including while travelling.

Step 6: estimate the cost step by step

An overall estimate for a whole course of cancer treatment is rarely possible at the outset, because what follows depends on the response to the first treatments. It is more realistic to ask for an estimate for each step: assessment and decision, surgery, chemotherapy cycles, radiotherapy. The estimate states what is and is not included, in particular expensive medicines, reassessment tests and the companion’s stay.

Step 7: prepare the return and follow-up

At each return to the home country, the patient takes the reports, the record of the multidisciplinary decision, prescriptions, the list of treatments received with doses and the schedule of check-ups. The doctor caring for the patient at home must know what to monitor, which side effects to report and how to contact the team that treated the patient.

Frequently asked questions