BY ARUNABHA SENGUPTA
Cancer afflicts individuals but in coping with cancer the community as whole stands to trial. The disease itself is diverse and appears in different forms. With many answers still not forthcoming, naturally there are surmises and myths and it is understandable why people purr sue “miraculous cures” and cheer every new initiative to provide “comprehensive cancer treatment”. From a concerned society’s point of view, though, comprehensive care must mean much more.
The Indian case
The Centre for Disease Prevention and Control, USA, defines comprehensive cancer control as “an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention (primary prevention), early detection (secondary prevention), treatment, rehabilitation and palliation”. Effective cancer care incorporates all the above through a continuum of services and also addresses end of-life issues. WHO and other experts believe that only a National programme, that includes all major cancers, all population groups, and all geographic regions and works through a meaningful collaboration between multiple agencies can achieve that. In designing national cancer control programme, WHO recommends three levels of action according to the socio-economic scenarios prevailing in different countries. For countries with low resources, it recommends prevention through health education and pain relief through low cost easily available technology. For economics in transition and developed economics it recommends screening programmes and treatment strategies for major cancers.
India presents a mixed bag. Amidst large-scale poverty, illiteracy, and lack of basic of basic facilities, there exists a health infrastructure extending down to block levels and a growing middle class demanding treatment by western standards. Started in 1975 the National Cancer Control Programme put emphasis on health education which included a vigorous anti tobacco campaign for primary prevention of cancer and identified three major cancers, namely oral, cervical, and breast for propriety areas fro screening and early detection. The International agency of research in Cancer which helps in data collection through cancer registry programmes in India estimates that these three cancers caused 157,411 deaths in India in 2000.
There is now solid evidence that such an approach can yield results. Stomach cancer rates the world over have declined. Mass screening has reduced mortality from cervical cancer. Both cancer incidence and mortality, among US whites have decreased following the anti-tobacco campaign and other public health’ measures despite a growing and ageing population. That the same is not evident in the USA among blacks due to lack of health education and improper social justice is a confirmation of the basic tenets of comprehensive cancer control. For providing basic cancer care across the country, NCCP in India has installed modern ‘radiotherapy equipments in all government medical college hospitals. It also gives handsome’ recurring grants to each of the 17 regional cancer research and treatment centres to lead mass based activities regionally.
Cancer Control Protocols
Yet, what makes a cancer control program robust is the whole hearted participation by state government, professionals, NGOs, and voluntary agencies. To incorporate these elements the National Cancer Control Board in India urged the setting up of state level cancer Control boards and asked them to take up district wise awareness and early detection projects and allocated a total grant of Rs 55 lakhs for each district. Recognised voluntary societies got up to Rs 5 lakhs a year for awareness and early detection programmes and charitable hospitals can get financial assistance of Rs I crore to buy radiotherapy equipment from NCCP. Traditionally in India voluntary work has always played a major role in cancer care. The RCC in he eastern region itself started work as an NGO way back in 1951 and was sustained for many years through voluntary work. The other major cancer centre in this region at Thakurpukur, which, in fact caters to more patients, has provided, therapies and other care for nearly one lakh patients in last 20 years.
According to IARC estimates,813,595 new cancer cases and cancer deaths occurred in India in 2000 making the disease already a major killer in India. Decline in communicable diseases, a demographic shift to older age’ population groups, imbibing of western life style hazards by urban population and environmental pollution will further increase the burden. Besides the numbers the burden of cancer Puts intolerable pressure on mental and economic resources of the community and it is unlikely that a Wonder drug or vaccine will solve the problem in the near future. WHO thus advises NCCPS to use available funds judicially and to set guidelines and standards for big treatment centres. If we analyse the data further in-2000, 590000 patients developed cancer of colon breast, stomach larynx. oral, genitourinary organs, and head and neck region. Expertise available in all metropolises in India can treat these diseases with comparable results. Prognosis for aggressive cancers of lung, liver and pancreas are uniformly poor all over the world and treatment, whether done in Kolkata, Mumbai, or New York, does not make much difference. Where resources are limited, WHO des not recommend elaborate treatment strategies for these cancers but wants good palliative care to be in place. On the other extreme, for hematological, neurological, bone, sarcomas and some other types of cancers, treatment results differ widely between advanced and standard oncological set-ups. Successes, of reputed western centres with prodigious facilities have never been emulated elsewhere. It is wrong to prescribe their protocol in our community settings and selected empowered centres should carry the burden of these cancers.
The community, therefore, has a right to ‘expect an accountable and beneficial system for comprehensive cancer care to be in place and be sustained by all stake holders. If governments, health professionals, and NGOs, which often pursue private passions and agendas, pull in different directions, it ‘falls through. In ‘West ‘Bengal, in spite ‘of much good work, the situation looks dismal because there is no unified voice.
There is ne ‘active cancer society, in this state, nor is-much heard about the state cancer control board. According to the IARC estimate there would be about 56000 new cases in West Bengal each year and the figure will continue to rise in each year, Less than one-fourth of these patients get treatment through recognised oncological set ups (including the patients who go out of state).
It is possible that many die undiagnosed even more fail to gain access to proper facilities, and some seek solace in alternative method altogether. Total lack of palliative care and unjustified high value remedies cause more frustrations drive people to alternative medicine and there is always someone selling a miracle cure nearby. Despite being found ineffective by repeated scientific studies, some of them have captured public imagination with obstinate endurance.
Thus more than one cancer care centre ‘under one roof’ or a ‘one stop facility’ what the society needs is a beneficial collaboration amongst the interested parties. The heads that should worry must lean together.
Magic and Medicine
Surgery Sans masks
Unknown and unseen fears.
cancer prevent technology