Tuesday, November 27, 2012
Dr. Ajai Kumar and Dr. Kumara Swamy views on Cancer Management
The next speaker was Dr.Kumara Swamy who spoke on behalf of Dr. Ajai Kumar who could not attend the seminar due to professional obligations. Dr. Kumara Swamy has worked in the field of Radiation Oncology for over three decades. After serving in the HCG Curie Centre of Oncology as a consultant, heis currently, he is presently serving as a Consultant Radiation Oncologist at HCG where he joined in 2008. H e is expert in the field of External Radiation Therapy Procedures, and is a renowned person in Image Guided Radiation Therapy, Intensity Modulated Radiation Therapy, 3DCRT, Stereotactic Radio-surgery (Cyberknife), Stereotactic Radiation Therapy (SRT) and 2D Simple & Complex Palliative treatments. He is a specialist in operating Cyberknife which is the world’s first non-invasive surgery system, through which he has treated patients with various types of cancer for many years.
He began his presentation with a few words about Dr. Ajai Kumar, the chairman of the HCG, the Health Care Global Enterprises Ltd, and Bangalore. Dr. Ajai Kumar was a professional who worked for the betterment of masses. With a vision of providing high quality cancer care on a pan-India basis to all sections of the society, irrespective of their socio-economic status, he turned into an entrepreneur with the launch of 30-bed Bangalore Institute of Oncology (BIO), the only private cancer hospital in 1989.
Dr. Ajai Kumar is responsible for making the Linear Accelerator with 3D conformal therapy, IMRT, even in remote places of India.
His three mantras to fight cancer are
1. Hit it early
2. Hit it hard
3. The right treatment the first time
Here is the message shared by Dr. Ajai Kumar through his paper.
There has been transition as far as detecting cancers "Early" is concerned. CANCER is often related to end of life in our society, this has stemmed from the fact that we more than often detect cancer very late at an advanced stage in the past compared to the present day scenario. This is also the reason behind the stigma attached to cancer in the society, and the public perception to treat cancer patients as cancer victims. The reason why we are seeing a phenomenal increase in cancer can be attributed to improved cancer surveillance facilitated by technological advancements in diagnostic imaging and pathology apart from other attributable risk factors. With these cancer awareness and surveillance programs we have seen a trend for early detection of cancers in the population. The advent of technology today has seen improvements in diagnostic accuracy. Diagnostic accuracy such as using a digital mammogram / MRI instead of conventional mammograms or ultrasound has helped identify suspicious lesions more accurately than their historical counterparts. Secondly, image guided biopsies have helped reduce false negative rates. Usage of PET CT compared to conventional CT/ Ultrasound of abdomen, pelvis and bone scan to radiologically stage cancer has helped to accurately stage disease and facilitate the right treatment. Use of tumor markers such as Prostate Specific Antigen, CA 19-9, CEA, AFP etc and other immunohistochemical markers have helped us arrive at an accurate pathological diagnosis. Use of high end diagnostics coupled with increasing awareness and education about cancer, effective surveillance and screening program for high risk populations and community, outreach programs in rural areas with telemedicine to aid diagnosis and identification can play a key role in early diagnosis of this disease. Impetus has to be given to early diagnosis to facilitate good cure rates and reduce the cost of the treatment and debility due to disease and treatment. Secondly, cancer directed treatment involves a multimodal therapy that has been tested over the years for varied types of cancers. Surgery, radiotherapy and chemotherapy form the triad of cancer directed treatment. There have been several innovations in how these treatments have been imparted to cancer patients over the years. Surgery has been moving from a more radical approach towards organ preservation, shorter hospital stay, less post operative morbidity and minimally invasive and robotic surgeries. The intent of surgery can be to cure, manage or down stage cancer or symptom control. This is usually the primary treatment of choice in many early stage solid malignancies. Radiation is now more sophisticated with use of electrons, protons etc and high dose is possible to, cancer areas sparing the normal tissue using radio robotic surgeries. Earlier there used to be fewer numbers of chemotherapy drugs but today we have several options of giving 1st, 2nd and 3rd line drugs. Low dose metronomic chemotherapy is also showing some promising results and could be used to treat the cancer as a chronic disease. Other targeted therapies such as those that block angiogenesis, specific molecules that involve in growth or spread of tumor, drugs that interfere with cell growth signaling or tumor blood vessel development, promote the specific death of cancer cells, stimulate the immune system to destroy specific cancer cells, and deliver toxic drugs to cancer cells are also in the treatment cart for cancer patients. Differentials in tumor sensitivity to chemotherapy drugs and chronicity of the disease have ushered in concept of personalized cancer care. The treatment is tailored to suit the patient’s condition and cancer using all these multimodal approaches. It is imperative and important to understand that cancer needs to be treated the right way the first time, and there are no shortcuts available to circumvent the problem as of today. However, the focus of treatment should not be limited to tumor. Today we see a transition from cancer directed treatment that relies purely on tumor killing to treating the person who has cancer. Quality of life is given prime importance in treatment decision making. Quality of life is "not just relief from pain" but implies getting back to normal life or even better life than they had before they were diagnosed and treated for cancer. In holistic sense, it is a social, emotional, physical and spiritual wellbeing. Cancer directed treatment can impose severe hardships and distress inpatients leading them to feel helpless and distraught. Coping with helplessness and hopelessness, being depressed has shown to be related to poor survival and increased risk of relapse and progression compared to those who cope well with positive attitude and fighting spirit. It is in this context that mind body approaches such as prayer, yoga and meditation could be useful. Evidence has shown that other complementary approaches such as Yoga helps in improving mood states, quality of life, immune responses and sleeps and reduces symptoms of distress and fatigue in cancer patients. Evidence base for such therapies that improve quality of life of cancer patients should be encouraged and should be an add-on intervention to conventional treatment. Other complementary approaches such as Ayurveda need extensive research for testing its efficacy as a anti cancer therapy. However it should be noted that 60% of the anticancer drugs in the market today are discovered from folklore claims and one cannot be dismissive but only be cautious of its efficacy. Diet and lifestyle are not only an important risk for causation of cancer but also important as therapeutic modalities. A low fat and low calorie diet and physically active lifestyle has been shown to improve disease free and overall survival in breast cancer survivors who have completed cancer directed treatment. The need of the hour is to see a harmonious integration of all specialties of evidence based treatment to improve quality of life of cancer patients.
Dr. Kumara Swamy went on to explain why it was so important to treat the cancer properly the first time. It is always very difficult to handle a recurrence, than fighting cancer the first time. It is also important to note the individuality of cancer before treating it. When cancer in detected in Stage 1, then the chances of cure are as high as 95%, which starts declining with the progress of cancer. He also stressed on the point that we should avoid using words like victims and survivors which strikes fear in the heart of the people. To remove the fear it was important to treat cancer as any other malady that affects human body.
He noted the importance of keeping pace with the advancement in treating cancer and understanding it thoroughly. The need for multidisciplinary surveillance program for the early detection of cancer is necessary as it goes a long way in saving lives. Prevention and timely screening are two most effective and pre-emptive defense against cancer. Prevention is better than cure- the old adage stands very well for the cancer. By prevention of cancer we include
· the methods involved in forestalling the activities that leads to cancer
· early detection and treatment of pre-cancerous condition
· catch the cancer at the treatable stage when the success is rate is high
· Prevention of new of recurrence of second primary cancers in people who have survived cancer.
By following a proper screening process the cancer is detected when the number of malignant cells is small and highly acquiescent to treatment.
He had information to share about Digital Mammogram, which is fast replacing the standard mammogram in detection of breast cancer. The mammograms record images of the breast on film, whereas the digital mammograms store and analyze the information through the digital computer images. In a digital mammogram though X-rays are used, they are turned into electric signals and stored in a computer in the same way digital cameras take and store pictures. Research has shown that the cancers that are missed on the film in standard mammogram are the type of cancer that proves to be fatal. Catching them by digital mammogram will save numerous lives.
Next he went on to explain the advantages of Targeted Biopsy which ruled out the incidences wrong diagnosis. Through the guidance from digital imaging, the part of the most highly proliferative tumors can be excised for lab test.
Dr. Kumara Swamy was concerned how the hesitancy on the part of the people to spend on diagnosis will eventually incur them huge expenses in form of treatment. He also called upon the medical professionals to screen the high risk population to catch cancer in their early stages. Being assured of organ preservation and functional preservation would encourage more and more people to trust and go ahead with the diagnosis and treatment of cancer. For this, the medical professionals need to be more precise, which will lead to less mutation in the patient. The team should consist of onco plastic surgeon to ensure the mutation caused by cancer or its treatment will be minimized.
During this session more information was imparted on the following:
· Personalized medicines which were administered considering the individuality of the patient and type of cancer, and their effectiveness in battling cancer.
· About the effects of principle stress hormones on cancer cells. Research has shown that stress related psycho-social factors are proportional to survival rate in cancer patients. Principal stress hormones Catecholamines and Glucocorticoids and their effects on tumor growth.
· Stress regulation of Tumor Biology.
· Process of treatment which should not only include relief from pain but also functional preservation of the patient
· How the attitude of the person effects his/her recovery
· Power of Yoga in treating cancer
· Complementary medicines like Ayurveda which can be highly effective since most of chemicals that go into medicines are extracted from herbs and plants.
· Removal of fear through proper assurance, support and counseling.
· Considering cancer as any other chronicle disease
· Changing the expression of palliative care to managing disease. The terms like Terminal, palliative etc tends to take away the whatever remaining strands of hope are left in the patient
· Propagation of philosophy to face the outcome of cancer.
· Productive life even when facing the crisis.
· Critical insurance to ease the financial burden of cancer.
The person who is affected by cancer should not stop on enjoying the little things of life. The need of the hour is to see a harmonious integration of medical facilities which will provide care to all.