In the last 40 years since President
Nixon launched the ‘War Against Cancer’, we have achieved a lot in the terms of
understanding the biology of variety of cancers but when it comes to cure let
us evaluate our successes. After worth of several billions of dollars of
research where are we? Let us first
understand the parameters that define ‘cure’ in biomedical terminology. The
National Cancer Institute (NCI) defines ‘cure’ as “to heal or restore health”.
Many people mistake “5‑year disease‑free survival rates” - an end point used in many clinical
trials, as cure rates. Although 5‑year disease‑free survival is a quick end point that can easily be
measured as a parameter of success of a therapeutic agent, an ideal definition
of cure would be when the annual death rate of post‑treatment cancer patients is the same as the normal
population adjusted for the same age, in other words, when the cancer does not
come back and people die due to some other reason in while they are cancer-free.
As per above definition of cure, what we have been able to achieve is indeed a “significant increase in the ‘disease-free survival’ for majority of cancers” which is not a small feat by any measures. However, it is still far behind the original goal of finding a complete cure when Nixon declared the “war on cancer” in 1971. Just one government organization, NCI, has spent approximately $90 billion on research and treatment during in these 40 years, let alone other government funding agencies and pharmaceutical industry. Despite our best efforts, truth of the matter is that approximately a third of patients diagnosed with cancer in high‑income countries, let alone third world countries like India, will not be ‘cured’ and will ultimately succumb to complications caused by cancer.
As per above definition of cure, what we have been able to achieve is indeed a “significant increase in the ‘disease-free survival’ for majority of cancers” which is not a small feat by any measures. However, it is still far behind the original goal of finding a complete cure when Nixon declared the “war on cancer” in 1971. Just one government organization, NCI, has spent approximately $90 billion on research and treatment during in these 40 years, let alone other government funding agencies and pharmaceutical industry. Despite our best efforts, truth of the matter is that approximately a third of patients diagnosed with cancer in high‑income countries, let alone third world countries like India, will not be ‘cured’ and will ultimately succumb to complications caused by cancer.
So what we could and should do about it? ………While continuous research and development efforts to develop new therapeutic modalities to treat cancer must go on, it is equally, if not more, important to understand the immediate needs of the cancer patients that can help improve the quality of their remaining lives. We should start talking about living with cancer as the “new normal.” Legendary Cancer Biologist and Nobel Laureate Dr. Harold Varmus, also Director of NCI, recently suggested including a new and probably more realistic goal in the field of cancer research, “making cancer a disease you can live with and go to work with.” He went on to say, “We have many, many patients with lethal cancers who are actually feeling pretty good and are working full time and enjoying their families. As long as their symptoms can be kept under control by radiotherapy and drugs that control symptoms and other modalities, we’re doing right by our patients.”
Sounds reasonably good! Well, people live with diabetes, cardiac disease, many genetic conditions, so why can’t they live with cancer and resume their normal lives as with other diseases? Yes they can, but to ensure this happens in the life of every cancer patient, one of the most important aspects of cancer management is palliative care which has to play a very critical role in here, unfortunately which is most ignored and underdeveloped field so far. For those who are new to this, palliative care (from Latin palliare, to cloak) is medical care provided by a team of physicians, nurses and social workers that specializes in the relief of the pain, symptoms and stress of a serious illness such as cancer. While in recent years, medical researchers and healthcare providers in the west have recognized the importance of this growing field of medicine and already have started focusing in this direction, copycats counterparts in developing countries such as in India are still busy wasting their scarce resources in repeating basic research in cancer biology, in which they are anyways 50 years behind the international level.
Immediate development of basic
infrastructure to support palliative care facilities for cancer patients should
certainly be top priority for government healthcare agencies in India, where
these patients are anyways deprived of basic care for their disease because of
lack of dedicated cancer hospitals, oncologists, and new generation targeted (personalized)
therapies to treat their cancers. It is quite understandable that governments
in developing countries too busy struggling with corruption, bureaucracy, and
lack of basic infrastructure to fight seasonal flu, and malaria, can’t provide
their citizens the luxury of cancer treatments, but what they could do easily is
to ensure the rest of the life of a cancer patient goes smoothly and without
pain. The paradoxes of a so-called ‘growing economic power’ India can well be noticed
by pathetic state of cancer care in following example. In my native place
Lucknow, a vibrant mid-size city of 2.4 million people, located in North India,
you can easily pick-up a juicy cheeseburger at McDonald, famous single malt
whiskey Glenfiddich at any hour of
the day from hundred odd joints, but if you have a family member/friend
suffering from unbearable cancer pain, and looking for morphine, you have only
one medical store/pharmacy in the whole city, and you are indeed lucky if you
find this shop open at the hour of need and morphine is available there at that
time. No doubt, cancer patients in India deserve a more peaceful and painless last
days of their lives, and a dignified death which can only be ensured in palliative
care centers (currently nonexistent) especially designed to meet the needs of
terminally ill cancer patients.
To understand the increasing role of palliative
care in cancer management even in best places on earth, please read this
article which explains needs, current status, and future directions of this new
discipline in oncology:
No comments:
Post a Comment