The role of the physician is only One percent, the institution adds another 10 % the remaining 89 % of the possibility of cure of a cancer affected lies with him / her, their family and friends and the resources they can generate for the treatment
– Dr. Ramanathan Jayaraman MD ,Hematologist & hemato -oncologist , Mg. trustee ,Vasantha Memorial Trust & Cancer centre
The final hours of cricket match, at times late hours of the night, would witness a unique scene at my residence. We would be placed at the edge of our seats hoping the team we cheer wins and sometimes it would be otherwise and dejected we would rush to shut the television off and just we as we proceed to do so, my grandma would rush from nowhere and insist that we keep the television on and she watch the prize distribution ceremony . “it gives me immense pleasure to see people winning prizes, whomsoever it may be “and she would pull the pull the TV remote from us and watch the ceremony till the very end.
She didn’t know what the game was or who was playing but it was sheer delight for her to watch people winning trophies. Imagine the joy she would have had, had she known the game or the teams or have been player or a coach. It would be zillion times more. This “zillion times joy “we perceive when we are a team player in the game of cancer affected and he / she is steered to victory. The mere sight of the cancer victors assembled on the stage levitates all us – patients, their family, the care givers, the donors and everyone involved – to a plane of unimaginable heights. We from Vasantha memorial trust celebrate the Cancer Victors’ day in the second weekend of February every year at Mumbai & Chennai and that day our joys are unbound!
In India where cancer is as high as 3 in a 100 , 80% plus patients plus come in advanced stages to the treatment centers and cure becomes impossible . Of the remaining 20 %, only a quarter get optimum treatment. The average cure rate of all cancers put together is around 40 %. In effect 2 % of people affected by cancer get cured today.
During graduation and postgraduation I have only seen patients dying of cancer and that includes my mother. In 1992, I started my independent practice and it took me 8 years to pronounce somebody completely cured out cancer. Then onwards there was no looking back the score rapidly increased to several hundreds, so much so that we have to restrict the number of cancer victors attending the event held in February
A cancer affected undergoes treatment for periods ranging from 6 months to 3 years and after that he / she is followed up for 4 – 5 years depending on the cancer and at the end of this period if no obvious cancer is found in the body through several tests , he / she is pronounced “ Cancer Victor aka Cancer survivor” . The change in the adage requires a lot of things, some of them are as follows:
- Early detection: this is the key factor. To give an example, breast cancer when detected in stages one or two , the cure rate is above 90% , when it reaches stage 3 it is 50% or less and stage 4 it is zero ! If breast cancer has to be picked at or before stage 2 , then the lady has to be aware of the disease , know breast self-exam or undergo annual mammograms What I want to convey with this example is people at large should have good awareness about cancer and that is the most crucial factor in getting cure
- Correct & Complete Diagnosis. This is foremost as the entire course of treatment depends on this. Historically we knew only the name of the cancer but today we can get its entire horoscope. Cancers have subtypes and there is subtle change in therapy for each of these. The ferocity of the disease is now known & appropriate steps are taken to tame the terror striker and eliminate him. Big & established labs have established a network throughout the country and even the smallest practitioner can avail of their facility.
- Disclosure of Diagnosis: A significant need that is many times not permitted by the family. It is the patient’s right to know what he has and more important than that is when the patient knows, he gears himself for the fight and is not disheartened by the minor hitches in health that occur during treatment. Patients above the age of 10 should know the diagnosis and the first disclosure should be made by the treating physician.
- Resilience of Patients: Resilience is the property by which a substance returns to its original after being forcibly deformed. Cancer affected should desire the same. Wanting for a second life and a better one. This happens when there is a positive attitude and a strong urge to fight.
- Treatment decision: Traditionally treatment was decided by the doctor and religiously followed by the patient. He or his family had no say in the therapy plan. This is called paternalistic approach. The other extreme is a consumer like approach. Put up all the options for treatment before the patient and his family and ask them to choose. Both these are not right. What is correct is “Shared decision making”. The treating physician has to learn the patient’s requirements fully and select the appropriate course of the therapy. Patient is fully involved, monitors his own progress and cooperates better with the physician and his therapy.
- Economic considerations. Once the shared approach is embarked upon the economics is considered well. The physician needs to spell out the costs before commencing a particular line of treatment. And the patient and his family should indicate their budget clearly. It would be even better if it starts with the suspicion of diagnosis. Many a times a battery of tests is ordered and entire cash reserve of the patient is depleted. What does he do for treatment then ?
- Care during chemotherapy: The drugs used in the treatment of cancer are like mini bombs and proper precautions need to be taken if collateral damages have to be avoided. Secondly these drugs reduce the body’s immune system making them prone to infections. Some of the drugs cause of lot of vomiting. Fortunately, there are such good drugs today that vomiting almost never happens. But for the remaining we have to take several measures and the major aspect is in educating the patients on personal hygiene , the cleanliness of food etc. And of course, there are boosters available today to prevent blood counts from falling to low levels and preventing them to be prone to infections
- Adequacy of Treatment: Completion of therapy is a must. Many patients chose to cease therapy as soon as they feel better or are in remission for reasons of their own. This can lead to relapse and relapsed cancer is several times stronger than the earlier one and surviving that is difficult
- Follow up: Most patients are followed by at 3 monthly or more frequently intervals for a period of 4 -5 years depending on the type of cancer. This is to pick up an early relapse and take care of complications of the given treatment. By this both the quality & quantity of life are improved.
- Need for community involvement. Time and again it has been said that cancer is a disease of the community and the entire community as to get into the act for survivorship. Firstly, it is to eliminate the stigma associated with the disease. The affected person should no longer feel shy disclosing the diagnosis. He should be made to feel that he is wanted in the society. Cancer is a disease of the elderly and many make a decision that he has lived enough, let him die and not treat him adequately. This is not correct. Second problem what children and youth face after surviving cancer are career and marriage opportunities. The former is easier but the latter tough. When it comes to young women it is even worse. A few are sterile after treatment and a few have sparse hair and the same is true for the general population. Why outcast them then! Today there are facilities to store sperms and ova before commencing treatment and the patients should ask for these facilities. Much like the individual the community plays a part in making an affected a survivor and a survivor, a normal human!
The above measures are some of the many that we or other institutions taking care of cancer patients adopt. The role of the physician is only One percent, the institution adds another 10 % the remaining 89 % of the possibility of cure of a cancer affected lies with him / her, their family and friends and the resources they can generate for the treatment. Like I said before when the community gets involved cancer definitely becomes curable and I could give relate hundreds of such success stories from my experience alone. Finally, I would like to bring to your notice that sixty percent of cancers seen in India are preventable and if we only spared a few minutes to learn these measures a big chunk of cancers can be totally eliminated