Dr Omar Abdihamid
There is a moment in the cancer journey that we often underestimate.
It is not the scan.
It is not the biopsy.
It is not even the first treatment.
It is the moment a doctor says: “You have cancer.”
For many men, those words do more than announce a diagnosis. They can change how a man sees his future, his body, his family—and himself.
Our recently published study, “When the Doctor Said Cancer, Everything Stopped”: A Qualitative Study of the Lived Experiences of Men With Prostate Cancer in Kenya”explored these experiences among 130 men across five Kenyan counties.
Five themes stood out:
Diagnosis can bring shock, fear and a confrontation with mortality.
Treatment can be both a source of hope and a source of hardship.
Cancer can challenge masculine identity, independence and sexuality.
Family, faith and community can provide support—but stigma and silence can also make the journey harder.
Over time, many men move from fear toward acceptance and adaptation.
Cancer is more than a tumour
As oncologists, we naturally think in terms of stage, grade, PSA, imaging and treatment options.
Patients experience cancer differently.
They experience the diagnosis as a disruption of everyday life.
For a Kenyan man, prostate cancer may threaten much more than his health. It can challenge his ability to work, provide for his family, remain independent and maintain his sense of masculinity.
This is particularly important because discussions around prostate cancer can quickly become uncomfortable.
Urinary symptoms, incontinence, erectile dysfunction and changes in sexual function are not simply “side effects” to be documented.
They can affect relationships, confidence, dignity and identity.
Survival matters. But how a man lives after treatment matters too.
The treatment is not the whole story
Cancer treatment can be an enormous source of hope.
But hope does not mean that treatment is easy.
A man may have to travel long distances for care, spend money on transport, accommodation and medicines, miss work, depend on relatives and cope with treatment-related symptoms.
These costs are often invisible when we discuss treatment plans.
Yet from the patient’s perspective, they are part of cancer care.
This is where value-based cancer care becomes particularly relevant.
Value is not simply about finding the cheapest treatment.
It is about achieving outcomes that matter to patients while minimising unnecessary harm and burden.
A treatment plan that is clinically appropriate but impossible for a patient to sustain is not necessarily a successful treatment plan.
Culture belongs in the consultation room
We sometimes speak about culture as though it is an obstacle to modern medicine.
It isn’t.
Culture is part of the clinical context.
In our study, family and faith were important sources of support for many men. But family relationships could also make certain conversations difficult. Some men preferred silence rather than discussing their illness openly.
For prostate cancer, this becomes particularly relevant when we talk about sexuality and masculinity.
In many Kenyan communities, masculinity is closely connected with strength, independence and the ability to provide.
Cancer can threaten all three.
A man who once cared for everyone else may suddenly need help from his children. Treatment may affect sexual function or urinary control. These changes can be deeply personal.
If we do not create a safe environment to discuss them, patients may simply suffer in silence.
Are we giving advice—or giving practical care?
The study also reminds us that context matters.
Medical advice may be scientifically sound but practically unrealistic.
Lifestyle and dietary recommendations, for example, need to recognise what people can actually access and afford.
The same applies to treatment pathways.
We cannot design cancer services as though every patient lives close to a comprehensive cancer centre, has reliable transport, can take time away from work and can easily pay for every additional expense.
Common Sense Oncology means asking not only, “Does this treatment work?” but also, “Does this make sense for this patient, in this setting?”
What should better prostate cancer care look like?
Perhaps it starts with listening differently.
When a man enters an oncology clinic, we should see more than his PSA, Gleason score and stage.
We should ask:
What are you most worried about?
How is this affecting your family?
Are you worried about sexual function?
Can you afford to keep coming for treatment?
How far do you have to travel?
What does getting better mean to you?
These questions do not replace evidence-based oncology.
They make evidence-based oncology more meaningful.
Because a treatment can be technically excellent and still fail to address what matters most to the person receiving it.
The bigger lesson
This study is about prostate cancer, but its message extends much further.
Cancer care in Kenya cannot simply be about importing treatment guidelines and measuring whether patients received the recommended intervention.
We need to ask whether care is accessible, affordable, culturally sensitive, understandable and aligned with the outcomes patients value.
That is the heart of patient-centred and value-based cancer care.
The 130 men who shared their experiences have reminded us of something simple but easily forgotten:
Behind every tumour is a person whose life continues beyond the clinic.
If we listen carefully enough, patients will tell us what better cancer care should look like.
And perhaps the first step is simply to listen.
About the Author:
Dr Omar Abdihamid, MD, MMed, MPH (c) is a Consultant Clinical Oncologist and Cancer Research Fellow . He is the Lead Clinical Oncologist at Garissa Regional Cancer Center and practices in Nairobi. His work focuses on global oncology, equitable access, value-based cancer care and strengthening cancer services across Africa.
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