Dr Kasturi Lal
A global comparison shows that though India has high incidents of cancers, there is no definite policy to control cancer. Public sector has not applied simple screening procedures for detection of disease in premalignant or early malignant stage in their programs to reduce the incidents of cancer in population. There are more deaths every hour due to cancers as compared to deaths put together either due to H1N1 or dengue. Majority of patients are reporting in late stages of disease for treatment. Morbidity and mortality associated with late stage of disease is very high. Recent data of the growing incidents of cancer in Jammu and Kashmir published by ICMR has received the attention of media which has blamed the inadequacy of facilities for treatment of cancer patients in public sector. There is no mention of inadequacy of infrastructure for promotion of education and awareness about prevention of cancer among the masses. Cost involved in treatment of cancer far exceeds the cost involved in prevention. Unfortunately, there is no public perception about the availability of treatment and awareness about the disease.
International Cancer Awareness Day
Till date when the technological evolution in cancer care has changed the perception of treatment, one fact remains that the results are not purely in the hands of surgeons or allied specialists but excellence in results depends upon the stage of the disease in which patients are received. Advanced technology in treatment of cancer is one tool which has improved the survival rates but there is no strategic planning for control of cancer. Surprisingly, we have not addressed to the issues of (1) cancer producing agents and (2) its prevention in our planning. Uncalled for delays, unaccountability of the work force and long waiting list in hospitals have pushed several curable cancers into incurable one. The justice of treatment is not dispensed. The problem requires clues. We cannot justify to stop treatment in the absence or deficiency of staff or some administrative regulations considered to be law breaking which are exploitary in nature being imposed on the treating physicians. This has led to long queues of cancer patients in hospitals. We find no way to reduce these long queues and waiting list. It is the most awful situation that reflect upon the mindset of the people who claimed to be involved in cancer care. We are not very serious to consider that we are wasting too much of resources on late stage of disease. We do not recognize that we are ignorant about harvesting early curable stage or prevent it completely. We have failed to admit that concurrent with the challenges to system, the availability of high qualified and cost effective multidisciplinary care has been adversely affected by a mismatch in supply and demand. The non-availability of specialist has restricted the hospitals to care of patients in safe timely and efficient manner.
There is no comprehensive training programs in oncology where there are functional surgical, medical radiation, oncopathology preventive oncology and palliative training courses. Training course for nurses technician and medical physicist do not exist. Nurses who could interact with community in villages for accepting screaming procedures do not exist. The medical regulating institution have not ensured compliance of tumor boards where decisions have to be taken in context with reality of cancer prevalent in India on the basis of evidence generated. The institutions which do not have the standard of infrastructure required for practicing evidence-based medicine should not be recognized. We have not taken up the issue of absence of tumor boards, the follow up, death certification, the availability of human resources which is cause of delay unaccountability and ignorance about treatment into account. These are main sources of deficiency in treatment. We have failed to acknowledge that education for developing skill is significant in shaping the future of cancer care. Public is now keen to be kept informed about the nature of disease and chosen model of treatment. Those who are not sincere enough to use skill on the basis of evidence-based medicine are amenable to fall in the trap of litigants
The problem of increased demand and unproportional supply of cancer care will continue to exist. The faculty in public cancer centers leaves institutions to serve the corporate hospitals for better salary. Nearly 80% of the cases of cancer are being treated in corporate sector. The interest of corporate sector which outsource services depends upon their capability to create demand. Business houses have no social responsibility but they definitely have an agenda to fleece public for pecuniary gains in the disguise of excellence of service. However, there has been no attempt to provide incentives to skilled human resources in public sector. It has become necessary to distinguish between proactive who would look forward to develop for better provider beneficiary relationship and the one in position concerned about the status than his actions socio-cultural relationship would demand as to what has been done for the upgradation of the faculty and the facilities we have provided to the beneficiaries. In reality the high percentage of low-income group must have the advantage of treatment in public institutions.
Existing inadequate preventive and therapeutic measures, demands for a growing cancer patient population, it is suggested that cancer should be declared as a notifiable disease. It will obviate the process of late stage of disease and provide information in access to preventive and therapeutic oncology services. Examination of patients expose to carcinogens, necessary investigations, information to health authorities about the disease, geographical demographic area to which the person, cause of cancer, the treatment planned and documentation of records in tumor registry. It will be a step for prevention of cancer related to epidemiology of tobacco, EMR and HPV. A separate cancer network within the framework of health infrastructure for a stable period with dedicated staff supported adequately with finance started in one district can be extended to other depending upon the rates of success. This program while maintaining its identity can be included in national rural health mission where provision of cancer diagnosis and treatment in rural area is recommended.
We have to create perception that cancer generally occurs in all socio-economic groups. The disease can be prevented. The economic and social return on the investment made in prevention is high. By education of community we can markedly reduce the incidents of cancer and detect cases in early stage when complete cure is possible. Our population faces religious geographical, educational and financial problems. The awareness about cancer to them is of secondary importance in their daily life. The rural masses are worried about fields and cattle than basic human health. It is essential to educate people to accept cancer as an unavoidable part of their lives. They must be educated to plan prevention. In order to give boost to prevention collective efforts are required to create mass movement about awareness against it. We have to support program which provide high-quality cost-effective cancer care to community at accessible centers.
Monetary incentive for the procurement of results in the field of awareness would be a step ahead against all expenditures incurred in the treatment of advanced stage of disease. Looking forward to future we focus on indicators such as help of NGO groups which in addition to their commitments would significantly help in implementation of reforms. The Government should not fail to recognize the role of NGO in bringing reforms for making cancer care accessible to the poor masses. This culture of partnership would encourage NGO’s to consider their social responsibilities to come forward to educate the masses about screening.
The role of social media in awareness about cancer has not been exploited in addition to DD and AIR the private sector T.V. channels which constitutes more than 50 percent of viewership can take part in reporting the sufferings of cancer patients. Media can be under obligation to report long waiting list in hospital and awareness about strategies for prevention of cancer.
The carcinogenicity related to mobile phones has been identified in gonads, as the sperm count gets affected by pocket mobile phones or laptops. The heart, the parotid and the brain especially in young children whose skull bones are thin affected by EMR. The dispute about EMR is similar to the one which we had with tobacco. Tobacco has taken away three times the revenue on treatment of tobacco related diseases as compared to revenue earned out of tobacco industry. The unprotected adolescent sexual habits have led to transmission of viral or bacterial infections. The spread of HIV, HPV, H1N1 and STD has not been recognized. There should be media support for education in schools and colleges about these diseases. Cancers found among elderly, lifestyle changes, depleting ozone layer atmospheric pollution, agricultural pollution and unavailability of anti-cancer foods have not received our attention. Self-examination should get attention in regular OPD’s as education of public to subject themselves to screening procedures can contribute significantly in reducing the incidence and detection of early cases to ensure adequate treatment.
It is a hard fact that we go through deepest agony when the patients in terminal stages seek help and we are left with nothing in our capacity to save such patients from agonizing end.
The next generation cancer care system should be considerably different than the one we have now. The human resources should be adequately prepared to face challenges that lie ahead. They use opportunities to study outcome majors and safety of patients because they and their patients are the ones who stands to benefit.
(The author is Director Lajwanti Hospital for Women)
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