Dr Kasturi Lal
India is accountable to the highest number of cancer patients. The disease is often detected in late stages. Cancer is not perceived as a major health priority. It is distressing to observe that there is no widely recognized voice for cancer in the country. We now need to address the issue of improving our voice. When we compare the change in death rate from cancer with other public health problems we see only a slight fall in deaths from cancer compared with major changes in and near elimination of other public health problems. It would be inadequate for us to continue on as is. In the past a blame game had promoted the generation of self preservational defensive strategies not cancer patient care solutions. Surgeons placed major emphasis on surgery. Medical oncologists and radiation oncologists devised their own system of management.
The divergent resources proved detrimental to the patients. It is a strategic paradox that at a time when surgical technology has increased at a staggering rate, the surgeons skill has not rewarded him with the same respect they used to command because simultaneous advances in the field of medicine were not appreciated by him to use various non-invasive means of treating what previously were surgical diseases. Meanwhile growing awareness that physiological and psychological healing are intertwined suggests that the surgical care might perhaps benefit from a multidisciplinary team approach stretching beyond subspecialities. The physician who manages cancer cases in their institution vary from institution to institution. Concurrent with the challenges to cancer care system, the availability of high quality cost effective multidisciplinary care is adversely affected by mismatch in supply and demand. The non-availability of oncologists has restricted the hospitals to care of cancer patients. Cancer care is on the verge of collapse because of dangerous overcrowding and inability to treat patients in a safe, timely and efficient manner.
If we have to move forward with the concept of propagating cancer as a curable disease if detected in early stage and treated properly we will confront some issues which will help us to introspect and analyze our present understanding and modification required for better deal to cancer patients irrespective of their socio-economic status. We have to create public perception that cancer occurs in all socioeconomic groups. The disease can be prevented and that economic and social return on the investment made in prevention is high. By education of community we can markedly reduce the incidence of cancer and even detect cases in early stage when complete cure is possible. Apart from declaring cancer as a notifiable disease, we should ensure its aggressive representation in National Rural Health Mission and Sarva Shiksha Abhiyan programme to include cancer awareness as one topic for promotion. As awareness increases from the primary health worker to primary health centre doctor a witch hunting may start. The case will report to us initially in advanced stage disease followed by reporting in premalignant or early curable stages when treatment will be less expensive. Education and specialized training of nurses to interact with community for accepting screening procedures to prevent and to early detection of cancer.
India is the world capital of cancer. But unfortunately uniform follow up data and guidelines of treatment protocols from different centres of treatment of different ethnic groups within our country are unavoidable. Our conscience is built upon our observations over the years and follow up datas. If we have failed in organizing follow up studies, we cannot build either conscience or confidence to move further with our own research.
We have to ensure that the future generation of oncologists are provided with opportunities to study and ask explanations for established protocols of treatment, comment on the issues such as outcome measures and patient safety because they and their patients are the ones who stand to benefit or lose. A new cancer care centre is required to promote clinical and basic research and tumour board meeting. The doctors at undergraduate or postgraduate level must be sensitized to management of cancer to avoid disastrous consequences.
The administrative direction to private educational institutions to provide free education to the children derived from low socio-economic group of population should provide sufficient ground to the authorities to declare free cancer care services to the poor population in corporate/private hospitals. As a part of their social responsibility to the society and to diminish the load on defunct or underutilized public sector the private sector must be encouraged. We should not boast of modern methods of treatment while admitting that 80 percent of cancer treatment centers in India are deprived of basic infrastructure for a comprehensive cancer treatment centre. We must focus on more realistic issues regarding patient treatment compliance or affordability. For all of us it matters to improve the quality and longevity of cancer patient which depend on so many factors. Some issues are within our reach to manage while some problems are difficult to manage and not in our control. Had we started to take care of manageable issues in time we would not have been in the present state.
We should have looked forward to early detection campaign, multimodal management of cancer, improving compliance of treatment, declaring cancer as a notifiable disease, the equitable affordable treatment for all, prevention of waiting lists for cancer patients in institutions, improving manpower and infrastructure in institutions, creation of good cancer treatment centres, Consequently understanding the concept of palliative care and creating infrastructure for palliative care and finally continuing medical education programmes for the oncologists to keep them informed about the latest evidences in the therapeutics. This is necessary in smaller towns where knowledge of oncology is not being shared and the erratic approach of management of cancer remains uncontrolled and the quality of life and survival rate of patient diminish remarkably. Let us not lose sight of the fact that with declaration of cancer as a notifiable disease the oncology departments will have to be upgraded and tumor boards will be constituted in all medical colleges. The additional burden of patients has to be shared by corporate sector by introducing the concept of the “Chambal valley justice.”
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