Fighting Cancer
- In
- 10:54 AM, Sep 25, 2016
- Tara Rajendran
There were times I used to carry " The Emperor of All Maladies" secretly in the corridors of surgery ward and voraciously read it. Like what happened with me, that one book changed a lot of people's perceptions. Heartfelt gratitude to Dr. Siddhartha Mukherjee and his 2011s Pulitzer for nonfiction winning riveting biography on cancer which opened a wide vista of oncological world to everyone. From the days of civilization to the story of Germania it leads us to the conscientious work of Dr. Sydney Farber and about a boy Robert Sandler who played unknowingly a momentous role in the development of chemotherapy, an ALL patient who left the word 70 years back. The book itself is dedicated to him and the people who came before and after him.
Cancer is not like hypertension, diabetes mellitus or cardiovascular disease where primary prevention is highly prospected. Regarding non modifiable risk factors like age sex family history ethnicity nothing can be done and will modifiable risk factors like diet, hormonal therapy, higher body mass index can be suspected in a woman who hardly looks like human with muscle wasting? "Screening" is the word which is golden in oncology. Earliest the cancer is diagnosed the five-year survival rate of the patient is increased.
Mahatma Gandhi once told India lies in villages but how much ever we claim that we have come far forward in health agriculture and industrial sectors post-independence yet the national programmes and schemes are not reaching the rural most India. Doctors are helpless when the patients are diagnosed at a stage where cancer cells have reached the plateau stage and stop their autonomous growth where chemotherapy cannot do anything. That may be the reason why our country whenever comes to cancer embark from the word "palliation" which indirectly means just waiting for the death counting days which is the Hippocratic torturing of the patient in a country where euthanasia is not having judicial acceptance.
As per the world health organization(WHO) Breast cancer ranks highest among all cancers in the estimated age standardized incidence and mortality rate in women. According to the latest data from National Cancer Institute(NCI) there is an escalation in the number of new breast cancer cases every year. Our country lacks an authentic account of the exact number of patients with cancer and also do not know how much a single patient spends on cancer right from the time she presents to OPD with symptoms. We are living in the world’s largest democratic country yet patients spend money from their pocket for their health issues where as there are countries on the other hand which realized spending money on screening and early detection spares a lot of national revenue spend on the treatment of the population on the basis of an accurate and authentic number of incidents, prevalence, diagnosed cases, patients currently on treatment, recurrences and much more which is more pragmatic because it earnestly tries to save every life under the country.
Indian citizens hold ration card, voters Id card, aadhaar card, pan card then in the near future national population card also . For registering the aadhaar card four years back I remember waiting hours outside the post office and so does the rest of the population for every identity card and as well almost every one possess all of them.
So it is high time to introduce a comprehensive cancer registry for generating and analyzing and later given for open accessing, the statistics of the oncological morbidities and mortalities which must be embarked from the grass root. This must not exclude the tribal communities in Attappady, Palakkad, in the south to Barak valley in the east. People will definitely take their time out in case needed if hospital registries are insufficient.
The lean patient with whom we commenced the write up is not a fictional character. A Women with advanced stage of infiltrating ductal carcinoma breast metastasized to ribs.only 6% of the cancer cases have a distant metastasis and the 5 year relative survival rate is around 26% according to the latest NCI statistics. Extent of cancer plays a huge role in determining the survival chances. Coming back to our patient again she worked hard and brought up two children and left with few months in her life. her youngest son took all the money she gave it to him for her medicines and went to Delhi with his spouse. when I went to put a cannula for the next bed patient she pulled my shirt from behind with her trembling hands. I cannot explain anyone how busy I was, how stressed I was that day as a doctor. It was just a month since I joined the govt. medical college as the first year surgery post graduate. I was sweating from top to bottom, sleepless nights of work. So I moved on. Next day I went to give her a shot of analgesic, she looked at me in pain. I sat down in front of her. She held my hand on hers and told” tumi amar cheler moto” and i just stood still. She told that I am like her son.
In this durga pooja festival time when the whole 'city of joy' ligts up and give salutations to mother Kali there is this mother who look out of the window in retrospection her life. All she receives are eyes of compassion or rather futility. What to do when doctors cannot do anything? Early detection by screening and cancer awareness programmes after estimating an authentic number are the quintessential of cancer treatment. My salutations to my patient in bearing the pain there deep inside her exists the form of Adiparashakthi in her Shakthiswaroopa; when others look out for Durga ma in sculptures.
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