Podcast "Let’s Talk Cancer" – Innovating awareness and strengthening patient support in cancer control across South Africa

Cary Adams: Welcome to a new episode of Let's Talk Cancer, the podcast where we explore the latest developments, stories, and insights in cancer control worldwide. I'm your host, Cary Adams, the CEO of the Union for International Cancer Control, an organisation that unites and supports the cancer community to reduce the global cancer burden. In this episode, we turn our attention to how creative partnerships and community engagement can drive progress in cancer awareness, early detection, and care. Our guest today is Elize Joubert, CEO of the Cancer Association of South Africa, CANSA, one of the country's leading cancer organisations and a long-term UICC member. CANSA's work addresses research, education, advocacy, screening and patient support, with a strong focus on ensuring that no one affected by cancer has to face their journey alone. We will be discussing CANSA's wide-ranging work, from awareness, prevention and early detection to patient care, as well as one of their latest initiatives, the Check Your Package campaign, developed in partnership with Takealot. This innovative campaign transforms everyday delivery boxes into a life-saving reminder, encouraging men to perform simple self-checks for testicular cancer, which is a highly curable disease when detected early. Together, we'll explore the thinking behind this campaign, the importance of reaching people in new and engaging ways, and how organisations like CANSA continue to adapt to deliver impact at scale through innovative partnerships. Elize, it's a pleasure to have you on this podcast.

Elize Joubert: I am so grateful that you are hosting me. Thank you, Cary.

Cary Adams: So, talk about the situation in South Africa. What's it like? What's the most prevalent cancer? Give us an idea of what you face in South Africa when it comes to cancer.

Elize Joubert: South Africa is faced with an exponential rise in the burden of cancer. It's indeed a serious public health concern. It's shaped, inter alia, by population diversity, but also still low awareness and unequal access to care. And the most important cancers are breast, cervical, prostate, colorectal and lung cancer. HIV-associated cancers such as cervical cancer and Kaposi sarcoma remain important, as we still have a very high HIV prevalence in South Africa. When we see current rates of about 116,000 newly diagnosed cases and over 56,000 deaths per annum, and it's projected that the cancer incidence will actually double by 2050. But there are certainly also many challenges in cancer control. It's late-stage diagnosis due to limited screening access and low awareness and even primary care capacity to detect and refer appropriately, especially outside our major urban centres.

Cary Adams: You've been the CEO of CANSA, and I know CANSA is a very old organisation, going back older than UICC, which is very unusual, that I meet an organisation older than us. You're 95 years old, I think. But you must have changed over time. So what have you seen recently in terms of the way that you operate as an organisation, given the challenges that you've outlined in that previous question?

Elize Joubert: Cary, reflecting on 95 years, it fills me with awe and gratitude. We were founded in 1931, and then our focus was mainly on cancer research, and it was volunteer-driven. But the organisation progressed and accelerated in the 1950s and then started to do educational drives on early detection and healthy living. Our first laboratory was established in those years with a focus on cervical cancer screening. Then, in the 1960s, we started to pioneer our care homes. So indeed, we've grown from very humble beginnings to really being a multifaceted organisation now, funding research. I think over the last 50 years, CANSA has been the biggest sole funder of cancer research in South Africa, and we now run cancer care centres across our country, from where we deploy our cancer screening services and clinics. We've got stoma support, home-based care, and many, many other care and support programmes. Our services are both offered in person and virtually. COVID taught us a lot and improved our efficiency in delivering services online, and currently technology and data drive our targeted risk-reduction efforts, but we always try to adapt to South Africa's unique challenges.

Cary Adams: So, what do you think are those unique challenges that set South Africa apart from others? You mentioned HIV as being one, but is that the only one or are there others?

Elize Joubert: As I've mentioned, Cary, specifically with cancer control, it's the inequities, our rural areas, the limited access, still the low awareness. We've got 11 languages, so whilst we do run a lot of health campaigns, it's quite expensive to translate into 11 languages. So, we really try to do so. But then it's also data access. In South Africa, our patients, as well as the public, still have to pay extensive and expensive rates for data. So, all of this is very limiting. But then, as I've said, in terms of the health system, there are really a lot of health system challenges. Our primary healthcare capacity and our primary healthcare providers are scarce skills, and they are overloaded, overburdened and, in terms of cancer, have limited knowledge. Then we also have our traditional health practitioners because many of our people still consult their traditional healers. We work within this holistic approach with traditional health practitioners to make them aware of the early warning signs of cancer and encourage them to refer their patients timeously.

Cary Adams: So, it's working in collaboration with traditional medicine advisers as well. Now, when I was reading about meeting you again, I saw the thing about Check Your Package, the campaign with Takealot, and perhaps you could tell us what this campaign is all about.

Elize Joubert: Yes. Check Your Package is actually a behavioural awareness campaign. We do it in partnership with Takealot, South Africa's leading online store, that uses delivery boxes and inserts to remind men to perform their monthly testicular self-checks. The idea married CANSA's expertise in behaviour-focused campaigns. By placing these short, snappy messages on the boxes, we meet men in a familiar, high-engagement moment when they're opening a parcel, to prompt a simple life-saving action. And you might ask, why testicular cancer? Well, it accounts for only 0.5% of all cancers amongst men, but it's one of the most common cancers in South African men aged 15 to 49. And the fact that it's highly curable when detected early, with a cumulative 10-year survival rate exceeding 90%, means we have to reach our younger men. Younger men still think they're healthy. They avoid preventative care and conversations about their bodies. Therefore, targeted and stigma-free messaging is so critical to raise awareness because this prompts earlier presentation and can potentially save lives.

Cary Adams: I don't know where I was, but I went to the toilet in a hotel. I shut the door and sat down, and on the back of the door it had a sign. It said, "Don't just sit there, do something." And it said, "Go home and check your testicles." It was in the men's toilets. I thought that was very clever, actually. You've just reminded me about it because that's when you've got a man's concentration, staring at the door. Anyway, Elize, if I get one of these packages, and I'm not in South Africa obviously, but if I did get one of these packages and I opened it up, what will I see? What is it asking me to do? And how does it refer me to CANSA? Or does it refer me to something else?

Elize Joubert: The packaging has these little hobbles, so the box feels different from just a plain box. So that already stimulates attention. And then when they open it, they get the inserts where it explains what it is all about. And yes, it's not a plain infographic. It's teaching them, showing them how to do that self-examination.

Cary Adams: And does it say what they should do if they do find a lump or something they're worried about?

Elize Joubert: Yes, of course. Then CANSA is the referral point. They can visit our website, call our toll-free number, message us on our WhatsApp channel, or even find us on social media. We offer free tele-counselling and can refer them appropriately. We say to them that whenever a lump is felt, we encourage them to go to their GP. That is the first step. Today, in South Africa, about 80% of the public don't have health insurance. So we would then refer them to primary healthcare clinics and say, just let it be checked.

Cary Adams: Yes, that's excellent. So, in terms of the success of this campaign, how are you going to measure it, or are you measuring the success of the campaign? What is the outcome that you're expecting?

Elize Joubert: It's tricky to measure long-term impact. Behaviour changes over time. But we can point out that about 10,000 special boxes and over 500,000 leaflets were distributed. The message and awareness thus landed in over 500,000 people's homes. And we say, if one life is saved, it's successful. So yes, as I said, it's tricky to measure the long-term impact, but we know that tapping into daily routines is so vital for awareness campaigns because it makes health behaviour feel more natural and relatable, rather than an abstract or intimidating thing.

Cary Adams: Yes, and I guess that's the key thing. It's almost to get people talking, isn't it? And discussing it. If one man says to another man, "Did you get that in the post? Did you read it?" actually, that's good. If they're going down the golf course or they're in a bar and it opens a conversation because we know men are not really open to talking about their health. They don't like talking about those sorts of things. So in some ways, you're giving them an opportunity to talk about something which is not normally in their vocabulary. Is that something you're aiming to do?

Elize Joubert: Yes, absolutely. And that's the whole aim of this campaign, to do something that is, as I said, snappy and different. It catches attention. I can maybe mention another attention-grabber. One of our other campaigns is our annual Hollard Daredevil Run. Hollard is an insurance company and the Daredevil Run, for which we have been the beneficiary for the past 13 years, is all about raising awareness of prostate and testicular cancer. On this day, participants wear nothing but a purple Speedo and run in public. This catches the attention of the public. So that's what we try to do: normalise, destigmatise and attach the message to something that we do every day.

Cary Adams: Well, that sounds fantastic. Campaigns like this, as we've said, are about raising awareness and hopefully opening the conversation. You seem to be quite an innovative organisation when it comes to these things, working in partnership with others. Is that something that you think other cancer organisations should do, work in partnership and find innovative ways to reach different populations?

Elize Joubert: Absolutely. Partnerships are central to CANSA's ability, and I believe they would be for any other cancer organisation, to extend reach and impact. Through collaborations with retail partners, community organisations and corporate stakeholders, it allows us to amplify awareness campaigns and broaden access to screening and support services. You engage with diverse audiences that you would never otherwise have been able to reach. So they are definitely important. I can mention another one that UICC actually recognised last year. That was our breast cancer awareness campaign with PEP, a retail company in South Africa. That is a clear example of how partnerships multiply effectiveness. You combine your expertise with the retailer's national footprint, and that enables us to reach thousands more women with life-saving information and screening opportunities. We find that partnerships also strengthen sustainability because we pool resources, expertise and networks. Therefore, we can deliver programmes that are both impactful and scalable, ensuring that prevention, early detection and patient support remain accessible across all South African communities.

Cary Adams: And I guess it works the other way as well and encourages companies to work with cancer organisations because their staff are subject to the challenges of getting cancer, being treated for cancer, and being exposed to risk factors. As you've just described, you've got a packaging company, an insurance company and a retail company. Clearly they've benefited through this as well. You're a bit of an inspiration for companies to get involved with local cancer organisations.

Elize Joubert: Absolutely. We are very grateful for how many companies now approach us to work with them because they do see the benefits. For many of them, there's also a promotional side to it because they associate with a credible brand. It shows that CANSA is still that trusted partner and recognised as a credible organisation in terms of cancer control. Other companies again see the benefits for their employees.

Cary Adams: Elize, we work in quite a complicated disease environment, and part of the challenge of reaching out to the general public is to convert that into understandable, simple messaging. We try to do that, obviously, through World Cancer Day each year. But it seems to me that you've developed a capability for converting what can be quite complicated subject matter into clear, simple messaging for the general public. Is that something that you think you're skilled at and that others could learn from?

Elize Joubert: Cary, it's so important that one balances innovation with accuracy and sensitivity in communication. And that requires a delicate approach because, on the one hand, creative campaigns are essential to capture attention, reduce stigma and communicate complex information. But on the other hand, you need to do it with the necessary accuracy and empathy. That is non-negotiable to us. So we need to balance it. We try to ground our creativity in evidence. Every message is built on medically verified facts, but it is also tested for sensitivity. We always pilot with patient groups and caregivers to ensure that the tone and language are respectful, supportive and culturally aligned. Another thing that helps is that we use clear and relatable storytelling because narratives, visuals and interactive tools help simplify the science without distorting it. But we always try to maintain transparency.

Cary Adams: Do you find that when you're working with the companies that you've mentioned, their marketing skills and messaging skills complement you in your endeavour to be honest, factual, but at the same time inspirational and positive? Does it work in that way?

Elize Joubert: We have to intervene. We have to advise. That's why we join hands because we know the patients and the communities we work in, and they might not have that health background. So it is definitely a collaboration and partnership. We can help marketing companies understand what we are trying to do. We need to use their creativity and skills, but it needs to be combined with our understanding of our audiences.

Cary Adams: So looking forward then, Elize, you mentioned earlier all these challenges you have in equity, the HIV burden, a growing number of people developing cancer and an ageing population as well. So what are your priorities over the next few years in terms of keeping on top of all those challenges?

Elize Joubert: It stays with the basics. Firstly, we need to expand our public education and awareness campaigns and use creativity so that we can reach communities at all levels, but with messages that are culturally sensitive. Secondly, early detection services must simply be scaled up. This means we have to work with government and the private sector to increase access to affordable screening, especially in our rural areas. Thirdly, I would say our patient support systems definitely need reinforcement. We must ensure that individuals diagnosed with cancer have access not only to medical treatment, but also to psychosocial support, nutritional support and palliative care. Importantly, advocacy is absolutely one of our strategic pillars because we need to advocate for policy changes that will strengthen cancer care infrastructure and funding in South Africa. There is still not enough political will to put sufficient resources behind cancer control. We have to work hand in hand with partners across all sectors so that we can continue with effective cancer control in South Africa.

Cary Adams: Well, it sounds like you've got a lot of work to do, but you've also been doing a lot. So I feel confident that you and the team will do a great job of improving the situation for cancer patients in the country. Thank you very, very much for joining us. I really appreciate talking to you and hopefully we will catch up soon.

Elize Joubert: Cary, it was absolutely my pleasure to have spoken with you, and best wishes for all your endeavours.

Cary Adams: You're very kind. Thank you very much. Thank you for listening to this episode of Let's Talk Cancer. If you like this podcast, please give us a rating and subscribe for more content every month. And if you want to know more about UICC's work, visit uicc.org or follow us on social media.