Friday, November 23, 2012
MANAGING CANCER DURING TREATMENT AND BEYOND
From : National Seminar On Cancer Management
The paper MANAGING CANCER DURING TREATMENT AND BEYOND was presented by Dr. Niti Raizada Narang MD., DNB., DM., ECM, Consultant Medical Oncologist, Fortis Hospitals, Bangalore.
Dr Niti Narang has done Hematology & Stem Cell Transplant Fellowship, Hammersmith, London. She is a Gold Medalist, President of India Awardee.
Doctor Nidhi started her presentation with guidance in managing cancer during treatment and beyond.
Cancer is preventable, curable and treatable was her take on the dreaded disease.
She talked about the conventional cancer treatment which consisted of Surgery, Chemotherapy and radiation.
Treatment of cancer is a systematic therapy which should be followed step by step by both the doctor and patient to win the battle. In our country the diagnosis often happens late, so the treatment is starts late too. According to Dr. Niti “Over 70 per cent of the cases report for diagnostic and treatment services in advanced stages of the disease, resulting in poor survival and high mortality rates. The disease is associated with a lot of fear and stigma in the country. But what is worth emphasizing is that now with improving treatment modalities, ‘cancer survivorship’ has increased and so issues like fertility preservation are being brought to the forefront”
Breast cancer forms the most important part of cancer research and the treatment is done through systematic therapy, where the medical professionals are adding newer targeted agents or immunotherapy, chemo-therapy and hormonal therapy, every few months.
Breast cancer has overtaken cervical cancer as the most prevalent cancer among women in urban India. One out of 22 women develops breast cancer and this figure is increasing gradually in our country which could progress to match to match western figures of 1 in 8 women if proper preventive measures are not taken.
Some of the cancers are curable by chemotherapy while others are not. Some of the cancers are known to respond to chemotherapy and be cured even when in advanced stages like
· Testicular cancer
· Ovarian germ cell tumors
· High grade non Hodgkin’s lymphoma (B cell and T cell)
· Gestational choriocarcinoma
· Hodgkin Lymphoma
The difference between chemo curable cancers and chemo resistant cancers is, chemo curable cancer started from cells that are designed to die whereas the chemo resistant cancer develops in a cell that is meant to live a long time and be resistant to death (e.g. a nerve cell).
Chemotherapy needs to be handled with care as is has many side effects of depending on the type of and the amount given. Anticipating and managing side effects can help to minimize them and provide the best possible experience for the person receiving chemotherapy. The side effects can be severe or mild depending on the patient and his/her reaction to chemotherapy.
Since anticancer drugs are made to kill growing cells, they also affect normal, fast-growing cells such as blood cells forming in the bone marrow and cells in the digestive tract, reproductive system, and hair follicles. Some anticancer drugs may affect cells of vital organs, such as the heart, kidney, bladder, lungs, and nervous system.
Dr. Niti also touched upon topics like the ‘objectives of systematic treatment, the settings of systematic treatment and the principles of therapy’. The main goals of a cancer diagnosis and treatment programme are to cure or considerably prolong the life of patients and to ensure the best possible quality of life to cancer survivors.
Dr. Niti also spoke extensively about the evolution of monoclonal antibody therapy for curing cancer. Today besides lymphoma, breast cancer is the disease for which monoclonal antibody therapy is best established. Trastuzumab is the first monoclonal antibody which has already entered routine clinical use in breast cancer treatment. A number of novel monoclonal antibodies are currently in development for breast cancer and other diseases.
The next topic was about organ conservation in cancer treatment. The conservation of organs is vital for better quality of life for the patient.
Today it is the era of Hematopoietic Stem Cell treatment for cancer. Effort is now focused on identifying cancer stem cells in various hematopoietic malignancies, and defining the cells of origin such that the stepwise accumulation of genetic/epigenetic events necessary for cancer stem cell development can be delineated. A detailed understanding of these processes could lead to development of therapeutics that more effectively treat hematopoietic malignancies and potentially other cancers.
From there on Dr. Niti touched the psycho-social part of cancer survival as to what the patient feels during diagnosis and treatment; how cancer affects the relationships, pattern of blaming and other such problems which are part of cancer.
The bonding between physician and patient adds new meaning to personalized medicine, especially in the treatment of cancer. Personalized medicine in the ‘war against cancer’ started with the era of biological markers. There were ‘magic bullets’ or targeted drugs to target important biological markers on tumor cells that came to be known as immunotherapy and helped reduce the side effects of conventional chemotherapy. Today, however, it is not just the medicine but also the physician-patient relationship that needs to be personalized. A physician has to figure out ‘what, how and when to convey’ and ‘How to help fight the patient fight his own mind’ to treat the patient effectively.
The personalized treatment and physician-patient partnership is of no less importance than the actual medicine, especially in case of cancer where an oncologist must play multiple roles of physician, psychologist, mentor and friend.
The oncologists realize that cancer is not just a battle against the disease but more importantly a patient’s war against guilt, fear, suffering and agony. They have to realize that breaking this news does not merely cause a magical disappearance of all happiness in a patient; it is more profound devastation in terms of unplanned events in a person’s life: thoughts of child’s marriage or education and fear of the unknown to name a few. The misery is compounded with repeated diagnostic investigations and frequent clinic or hospital visits for treatment.
The role of clinician is to be supportive of the patient by listening and caring for them. Truth telling is one of the tough times for the doctors. It is big decision when to say there is no hope.
At this juncture what is of utmost importance is the confidence imparted by the physician through ‘open communication’. With this the battle is redefined... Battle is about joys, sorrows, rewards and challenges of caring for people with cancer.
Oncology is not just a science but an art, a philosophy of human relations and understanding of human experience to a very serious ailment. There is no ‘blunting of emotions’. There is always a flood of emotion when you see a new patient and understand his/her circumstances. The important thing to remember is that this relationship is ‘forever’, from diagnosis to treatment to surviving cancer.
Cancer is not the end but the beginning of a different journey; advances in oncology have truly given life wherever possible. It starts with ‘never lose hope and faith’; then comes ‘telling the truth’. The relationship has to go beyond ‘the physician knows best’ attitude and enter a partnership in care, treatment planning and delivery.
In this era of overflow of information, it is very important to add meaning to the information that the patient or his/her family want to share and comprehend.
Coping with cancer should be done through support groups where patients who are in same boat can be there for each other with better understanding of their situations.
Paper presented by Dr. Niti
Oncology is not just a science but an art, a philosophy of human relations and understanding of human experience to a very serious ailment. For a doctor, there is no 'blunting of emotions over time. There is always a flood of emotion when you see a new patient and understand his/her circumstances. The important thing to remember is that the relationship between doctor and patient is 'forever ' - from diagnosis to treatment to surviving cancer. Cancer is not the end but the beginning of a different journey. Advances in oncology have truly given life wherever possible. Managing cancer starts with 'never lose hope and faith'; and then comes 'telling the truth'. The relationship has to go beyond 'the physician knows best' attitude and enter a partnership in care, treatment planning and treatment delivery. Therefore today in the 'Era of Personalized Medicine', it is not just the medicine but also the physician-patient relationship that needs to be personalized.