Thursday, December 13, 2012

Dr. Ajai Kumar's take on Cancer Care


The next speaker was Dr. Ajai Kumar, an oncologist who single handed had revolutionized cancer care, cancer management and cancer treatment in our country. With an astounding experience of 35 years in the field of oncology, there was no other better person to give his views on management of cancer.
He spoke about the way cancer is addressed in our society which has added fuel to already burning fear about cancer. Any negative happening or bad incidences are referred to as cancer, for e.g. corruption is referred to as cancer of society, which creates an image of cancer to be something to be dreaded in the mind of the people. Such term should be avoided by the media, so that the word cancer stops sending fear among the masses. It is important to redefine the terminology used in regard to cancer.
Treating cancer the right way, the first time, is a philosophy that can change the face of cancer care in India according to Dr. Ajai Kumar.    
He narrated an incident that had taken place in Chicago in way back 1975 when he was an enthusiastic young doctor. His first patient, a woman with breast cancer named Phyllis, was scared and shocked with her diagnosis which said she was terminally ill. Though hesitant initially, the Doctor initiated talks and slowly she started opening up to him. She asked the question finally, “I am terminal?”  There is no definite meaning for the word terminal, as it defined by how a person lives his/her life rather than by how long they live.
The patient wanted to do many things in her life before she died. The doctor encouraged her to get treatment and then go ahead and do whatever she wanted to do. The treatment began in 1978 and she went on to live for eight more years. She did every physical activity and other things on her bucket list before she finally succumbed to illness.   Dr. Ajai Kumar recalled the days in sentimental tone, “in 1986 I came to India on a short visit. When I returned it was on a Sunday. She was waiting for my return, so I went to meet her. The cancer had taken its toll on her body and she was weak. She thanked me for the 8 years of life, in which she had done all she wanted. She died the same night,”
No matter how much of philosophy a person reads, dealing with survivor is the true lesson of life that no philosophy can teach them. He also spoke about the Cobalt units which are used in treatment of cancer. He spoke about the advantages of Linear Accelerator over the cobalt therapy. With development of Linear Accelerators the Cobalt treatment has been phased out in most part of the world. Cobalt does not focus on the tumor or cancerous tissue, but will possibly cause damage to healthy tissue around the cancer growth. In Linear Accelerator, more focus can be obtained and the radiation that can spill over on the normal tissues is to the minimum bearable extent.
Though he stressed on early detection, he said it was easier said than done. How are we going to screen 1.2 billion people for cancer, to detect it early? He stressed upon the early detection of recurrence of cancer too, which has been one of the highest killer.
He again stressed on the wrong terminology used even by doctors when referring to people going through cancer treatment. Words like survivors, palliative care, terminally ill, advanced stage etc tells the patient that their days are numbered. Even at the stage 4, there are different levels in the progression of cancer. All cannot be grouped into single unit. For people who are dealing with heart disease, diabetes, asthma etc, which does not have a cure, yet no one refers to as survivors, under palliative care of terminal kind of terminology. When no one says a victim of diabetes or asthma, why say ‘cancer victim’ was the question asked by Dr. Ajai Kumar. Redefining cancer in terms and make it a chronic disease was the goal to be perceived and achieved by all the medical practitioners.
Cancer is no more a deadly disease. Nearly 80% of Breast Cancer survivors are living for more than 6 years. The amazing feat has been achieved by right treatment the first time. This also proves less financial burden on the patient in the long run.
Patients nowadays have access to internet where they can search for guidance and treatment options. Unlike most of the doctors who are for organ removal, Dr. Ajai Kumar stands out with his views where he considers removal of an organ is unethical. In fact he goes on to explain that conservation of breast in breast cancer cases is easier, when compared to going for total radical mastectomy. The fear of organ removal makes many people hesitate to approach the doctors for treatment. Breast is an important part of women and her sensuality. Does anyone bother how her life, especially her married and sexual life is affected after removal of breast? The concern for such a sensitive topic coming from an experienced oncologist was very touching.
Pain management is easy to achieve, quality of life is not that easy. The need of the hour is to concentrate on providing a good quality of life to patients after they have been through cancer. Many people associate cancer with pain and fear the pain. Pain is not a big issue, as it can always be controlled with pain killers, quality of life cannot be corrected with a pill. Dr. Ajai Kumar stressed that we cannot take away the good quality of life a person has every right to enjoy just because he/she has cancer.
Cancer is not a stigma or dangerous monster which attacks to kill, but just a lifestyle disease. It should be treated as such, without using excessive terminology like victims and survivors. The fear of cancer should be overcome. People hide the fact that they have cancer fearing their daughter will not get married.
Sometimes it should be considered whether it is really worth taking the treatment, because cancer treatment itself can be harsh on the patient. Sometimes the Cancer centers are nothing more than waiting for death centers where people just wait for their turn to die. Many doctors consider cobalt to sufficient in treating cancer, when better treatment cannot be afforded in a poor country like India.
He pointed out that despite advancements in radiation oncology, Cobalt therapy still remains the mode of treatment for the poor people in India. Its wider use in developing countries like India, among the poor patients warrants for its production, though it is phased out in the developed world. “It’s unfair to deny such facilities for the poor. But certainly we need effective treatment models. For instance, Linear Accelerator may not be a new thing. Old models are in use. What we have done is to create an independent treatment centre and allow everyone to access it,” said Dr. Ajai Kumar very passionately.
Dr Ajai Kumar talked about the decision of bringing in Linear Accelerator to BIO and bringing in the mode of treatment models that enabled everyone to go for a sophisticated treatment.
With advancement of treatment, it has been possible treat more tumor and less normal tissue. The target of therapies is only cancer cells. The right treatment with right technology is controlling cancer without many side effects. While Cobalt therapy can still be used in palliative care, he feels advanced therapy is imperative in cases of definitive cure.
Financial burden of cancer treatment is another topic, which usually doctors do not like to discuss, but Dr. Ajai Kumar even ventured into that area. So how are the hospitals going to treat everyone, even the ones who do have any enough money to afford the treatment? He brought a good solution for the complicated in the form of capacity utilization. The screening like PET would be made available at lesser cost or free at late hours. Those who can afford it can approach the hospitals at the convenient time like 11 a.m. whereas those who cannot afford it can approach the hospital at 11 p.m.
In this regard, Dr. Ajai Kumar has taken steps at the HCG to treat all patients that approach the hospital for treatment, without sending back anyone disappointed neither is the patient deprived of the quality of treatment due to financial constraints. Various methods have been adopted by the hospital like giving concessions on ward, nursing charges to make the treatment affordable and within the reach of every person.
With tie ups with pharmaceutical companies, the hospital has been able to provide free medicines to the patients. Also relief comes in form of EMI payments, for those who cannot afford to pay at one go.
All the achievements have been done without any grant or support from the government. That is something that needs a big applause.
Though people complain about financial burden of treating cancer, the doctor pointed out that India has the cheapest treatment option available to people. Even in Africa the expense is almost 3 times higher than in India.
The failure of the government is what that has let the medical professionals down in our country. Countries like S.A and Vietnam have changed their policies of health care and shown great improvement.
Cancer care should be available to everyone. If the cancer hospitals are located only in few cities, how will the people in the rural area afford treatment? As the standard treatment may last for more than 6 months, the poor farmers may have to sell farms to get treated at places far away from their homes. Even when they survive and go back home, poverty and burden of earning livelihood itself can kill them. Providing cancer care hospitals near to their homes can help them continue with their work and life when they are being treated. The target goal should be to provide accessible, affordable and high quality treatment to every person of the country.
Treatment of cancer cannot be standardized. There are different types of patients who will require treatments according to their diagnosis, personal health condition and other conditions. 5 patients who were diagnosed with Breast Cancer were given different treatments as they had different needs. Individual, tailor made models of treatment for every patient is what proves to be effective in the long run.
Gone are the days of mastectomy, colostomy and amputations, as doctors now resort to remove only what they have to, not the whole organ. Dr. Ajai Kumar again stressed on the fact that it is easy to remove only the cancerous tumor, than removal of whole breast.  He showed the audience details about the limp salvage surgery performed on a young patient through the replacement of fibula. With proper intervention, it was possible to give the young patient a good quality of life.
Decision about the treating patients cannot be made in haste. There is no way a doctor can decide what the patient needs in 5 minutes. The doctor has to look at the reports, the pathology test results, general health of the patient before deciding what can be done to manage cancer in the best possible way. No cancer is going to grow overnight, and he stressed that there is no need to hurry up with the treatment without thinking over it properly. There is no hurry to remove the stomach, as was mentioned to one of the patients who approached him from Chennai, nor is there any emergency to remove the breast assured the doctor who had such vast experience on the subject. The proper plan of treatment to be executed can make a world of difference to the quality of life of the patient.
A doctor himself, he went on to question why the doctors discriminate between the patients and their family members. Will a doctor recommend the same treatment to his wife or sister that he had recommended to his patient? This was something very perplexing and bothering as it questioned the ethics and principles of the medical profession itself. The patient trusts the doctor totally, when they do not guide them properly, than it is the biggest disservice they are doing to their profession.
There is no cure for cancer, but every patient can live with the disease symptom free. Cancer can be treated like any other chronic disease.
He also talked about the efficiency of the Indian doctors. The finance minister of Tanzania had once visited India for treatment. When asked why he had chosen India over all the developed nations, he said when he visited the developed nations, all the efficient doctors working in those hospitals were from India, so he decided why not go to their homeland itself for treatment and came over here.
He also explained in detail about the advantages of Digital Mammography, laser capture micro-dissection (LCM), PET Scan, CT scan, FDG procedure where fludeoxyglucose is injected into a patient to aquire images of the distribution of FDG around the body. The images are later assessed by a nuclear medicine physician or radiologist to provide diagnoses cancer. He also went ahead to explain the advantages doctors have now with MRI,PET and other advanced types of screening procedures which assist them in treatment.
Technologically it is now possible to predict occurrence of cancer through the BRCA1 and BRCA2 genes.BRCA1 and BRCA2 are human genes that belong to a class of genes known as tumor suppressors the mutation of which has been linked to hereditary breast and ovarian cancer.
Prevention is better than cure. It is good to eat healthy food and follow a healthy lifestyle to prevent cancer as much as possible. People who eat out cannot have healthy diet. He even joked about the waiter who told him he will put only pure butter on the dosa when asked not to use too much of oil. Unfortunately, tasty food is not always healthy food. The incidences of Breast Cancer being less among the rural women indicate that it is a lifestyle disease that can be controlled.
Prevention should be the primary goal in cancer management, where as screening and treatment can take secondary place. Smoking contributes to high incidences of cancer. Dividing the types of cancer and categorizing them on demographics will help in prevention of cancer to a great extent.
Pesticides have been contributing to incidences of cancer. He narrated a incidence when he had visited farmers growing cauliflowers, who had dipped the vegetables in the pesticides to get rid of the worms. There has been nearly 40 % increase in cases of cancer due to herbicide and pesticide used by the agriculturists. Carbonated drinks another promoters of illness and cancer.
People who carry on their lives with positive attitude usually remain healthy. Even if illness cannot be cured by will power it will help in overcoming any kind of disease to a great extent. Chronic stress promotes tumor growth and Angiogenesis in the mouse models which were experimented upon. He also explained how yoga and alternative treatments can help in success of cancer management in a better way by increasing the tolerance of the body to the medicines.
The most amazing part of the presentation came when he spoke about the how mind can master the body. For the first time I was listening to a medical professional who talking about alternative therapies in treatment. Everyone says be positive, but for the person going through cancer being positive is not easy. Understanding the psychology of cancer was very important.  If was not important to just add years to life but important to add life to years.  With all the advancement in medical technology, we have not even touched the surface of cancer care. There are other fields to be explored and brought together to create a perfect solution to management of cancer.
The presentation of Dr. Ajai Kumar ended with a big applause given to an oncologist who was unbiased in his speech, going ahead to even promote other therapies and process in treating cancer. 

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