The Struggles and Triumphs of Pediatric Oncology in Nigeria
In Nigeria, families facing the harrowing journey of a child’s cancer diagnosis often find themselves in dire financial straits. Adedayo Joseph, an oncologist and the director of clinical research at the Medserve-LUTH Cancer Center in Lagos University Teaching Hospital, recounts heartbreaking stories of families forced to sell properties, borrow money, and close businesses merely to afford the initial surgeries for their children. Tragically, many of these families do not return for the follow-up radiation treatments essential for recovery.
Joseph emphasizes a critical insight: “They are so broken that when we call them for a three-month follow-up appointment, they can’t show up.” This poignant reality underscores the urgent need for a systematic approach to cancer care that transcends mere surgical intervention.
Bridging the Treatment Gap with HYPOAfrica
This interlude between surgery and ongoing treatment is part of what prompted Joseph to become Nigeria’s principal investigator for HYPOAfrica, a multi-country trial focused on hypofractionated radiotherapy. This innovative treatment involves administering fewer but higher doses of radiation compared to traditional methods. The aim is to determine whether this approach can be equally effective and safe for African patients as it has proven to be in European and American settings.
Joseph firmly believes that “We don’t need to copy and paste international data. African patients deserve African evidence.” Prior studies have often included scant African participation, leaving a significant gap in relevant data that could guide local treatment practices.
Facing Systemic Challenges
The HYPOAfrica trial also investigates the feasibility of introducing this treatment in African healthcare systems, which frequently grapple with limited equipment and staff shortages. Many patients must travel vast distances to access care, compounding the challenges associated with their treatment. If hypofractionated radiotherapy proves successful, Joseph envisions a future where it could help broaden access to vital cancer care across the continent, improving survival outcomes for countless children.
Currently, the trial is in its follow-up phase, and Joseph’s ambition is to make hypofractionated radiotherapy a standard treatment across African institutions. This would necessitate significant government investment in equipment and training, which is critical to sustaining such initiatives and reducing the treatment timelines that disrupt the lives and livelihoods of families.
Pioneering Pediatric Radiation Oncology
Nigeria, home to approximately 238 million people, had no dedicated pediatric radiation oncology program until Joseph took the initiative to establish one in 2020. To build this essential service, she first sought training abroad—spending time at the West German Proton Therapy Centre and Vanderbilt University Medical Center—because no comparable program existed within Sub-Saharan Africa.
The challenges didn’t end with her training. Joseph faced the daunting task of assembling a competent team from scratch. She sought individuals demonstrating three key traits: competence, character, and commitment. “If someone is competent but has poor character or judgment, you’ll have a problem,” she acknowledged.
Building this foundational team required time, perseverance, and careful consideration. It involved not just hiring medical professionals but nurturing a culture of collaboration and trust within the team. Joseph describes her journey as intertwined with her faith, expressing that divine guidance has been a consistent source of strength, especially given the immense difficulties in establishing a new program in a struggling healthcare landscape.
A Holistic Approach to Care
Through the establishment of the Dorcas Cancer Foundation, which Joseph also leads, a significant realization emerged: focusing solely on medical treatment was insufficient. Many families were unable to comply with follow-up appointments due to financial strain and lack of understanding about the importance of ongoing care.
As a remedy, Joseph’s foundation implemented a comprehensive patient navigation program designed to bridge these gaps. This initiative includes arranging transport for families and conducting regular check-ins to ensure they adhere to their medical schedules. Remarkably, the time from diagnosis to treatment initiation has been slashed from around 200 days to just over 50 days, while the rate of treatment abandonment has plummeted from over 50% to under 10%.
Joseph passionately asserts, “No matter how brilliant you are as an oncologist, without psychosocial support all your work is going to be wasted.”
An Unlikely Journey to Oncology
Interestingly, radiation oncology was not Joseph’s initial career aspiration. Originally training in medical oncology in the U.S., she returned to Nigeria, only to discover there were no medical oncology programs—just a blended clinical oncology path. With no choice but to pivot, Joseph found her passion for radiation oncology developing as she immersed herself in the specialty.
Her commitment to this field has garnered notable recognition, such as chairing the scientific committee for the SIOP Africa Congress in 2026 and being included in the Ascent Top 100 Career Women in Africa list. These achievements signify more than personal success; they reflect the broader institutional changes she has championed, emphasizing the importance of sustainable healthcare systems that can endure long after she has moved on.
Redefining Leadership in Healthcare
In a predominantly male field, Joseph stands out not only for her achievements but also for her understanding of leadership. For her, leadership begins with self-discipline, commitment, and humility. “Leadership starts with leading yourself… You don’t have to become a clinical research director before you start leading.” This belief in initiating change from the ground up has been instrumental in her journey.
Joseph’s ongoing work and determination paint a picture of hope for pediatric oncology in Nigeria, revealing the profound impact of compassionate care and systemic innovation in the fight against childhood cancer.