Cancer Crisis

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While the number of cancer patient has phenomenally increased, the management system within the health sector is sluggish in adopting the new system of detection, and management reports Saima Bashir

One area in which the response is disproportionate the actual crisis in Kashmir is cancer. While the numbers are huge, the care is too small and limited. Right now, Kashmir has more than 7000 people fighting cancer.

In Kashmir’sRegional Cancer Centre (RCC) at SKIMS, Soura and other hospitals, the basic diagnostic and treatment facilities are lacking. Many patients go outside the state for expert opinion or treatment, or both because diagnostic tools like PET scan and other auxiliary support and management systems are missing.

Outside J&K, experts are moving to PET-MRI and in Kashmir, the basic PET is missing.PET- scan is an Rs 30crore project. This project, according to previous SKIMS director Dr Showkat Zargar was started six years ago with a Singapore based company as PublicPrivate Entrepreneurship (PPE). But the company backed out at the last stage.

After a wait of so many years, the PET scan machine has finally reached now at SKIMS and will be inaugurated on December 05. Meanwhile, the construction of State Cancer Institute, started by Dr Showkat Zargar, is also going to start next year and is expected to cater the maximum number of cancer patients.

Ghulam  Rasool Bhat is a cancer patient from Bandipora. Every year, he has to go to Delhi twice for the PET-scan. “It costs me more than Rs 80,000,” Bhat said. “Had PET-scan been available locally, I would have saved this money for the further treatment. I had to sell my land for this.”

“PET-scan will be beneficial for the doctors as well as for the patients,” Dr Tanveer Ahmad Rather serves SKIMS in Nuclear Medicine department, said. “Till it starts, we are continuing our job without any problem using CT-SCAN.”

Dr Zargar said getting the PET-SCAN machine is not an issue. “There is one more project called as cyclotron worth Rs 12 crore which needed to be installed for the production of medicines for PET-scan,” Zargar said. “It also needs pet technicians, radioisotope technologists and medical physicists who will be trained from the nuclear medicine departments.”

Cancer management has gone highly technology driven outside J&K. Now technologies like IMRT and IGRT, high precision radiotherapy and radiosurgery are in vogue. But in Kashmir,  primitive cobalt unit and brachytherapy are the ultimate cancer management technologies available. The Cobalt unit of SMHS, however, was not functional as it was severely damaged by the September 2014 floods and they used to refer their patients to SKIMS.

After remaining dysfunctional for almost three years, DrSonaullahKutchey, head of radiation oncology at SMHS, said they have revived the machine on October 28, 2017, and are expecting patients from November 20.

Despite having more than 7000 cancer patients, Kashmir has only 13 certified Oncologist in SKIMS and only 10 in SMHS. It does not make an adequate proportion between the patients and the doctors.

Insiders in the medical fraternity said that J&K is yet to be part of the cancer registry, a programme that Central Government had launched earlier. The National Cancer Registry programme had approached  SKIMS many times in the past to establish this but there has not been any follow-up.

Currently, the data is mostly generated by the medical records department of the hospital which can have duplications and lack details. Admitting the importance of the Registry, Director SKIMS said that this can be done once the government orders for this and all the hospitals including the GMC Jammu must be part of it.

Cancer care does not only mean medical treatment. It requires comprehensive care including Psycho-oncology, nutritional and social support, and legal help.

Psycho-oncology pertains to the psychological and social aspect of cancer. Cancer and many other serious sicknesses impact the patients psychological and social health and behavioural factors. This stream of response addresses those impulses and changes at all stages of the disease. Unfortunately, J&K lacks a specialisation of psycho-oncology.

Currently, patients needing counselling are sent to General Psychiatry department where they have to stand in queue for hours like other patients without given any special priority.

Dr Arshid who has worked in one of the leading cancer centres in Delhi said the research suggests that three out of every five cancer patients suffer from psychological distress warranting intervention. It also brings social and emotional distress to the families of cancer patients. Keeping this in mind cancer centres must have psycho-oncology help within the reach of these patients.

Besides, there is also no separate well-established branch of nutritionist or dietician available for cancer patients either in SKIMS or in SMHS.

“In future, we will try to establish separate branches of psycho-oncology and nutritionists exclusively for cancer patients,” Dr Showkat Zargar said. “However, even now cancer patients are being given priority for counselling.”

Kashmir also lacks paediatric oncology. In SKIMS and SMHS the general oncologists perform the treatment of children as well as adults.

“We have started paediatric nephrology, paediatric radiology, paediatric haematology, paediatric ophthalmology and have kept paediatric oncology in the pipeline,” Dr Shafaqat Khan, former medical superintendent at GB Panth hospital for children said.“We will soon start a cancer branch for children here.”

Zareefa a cancer patient from Odur Baramulla is suffering from Breast Cancer. She said her husband is suffering from Asthma and could not afford her medicines and she did not get any legal help.

Cancer Research forms the integral part of cancer management. It refers to basic science, clinical research and translational research. While basic statistics about new admissions is made available to the public domain, there has not been any research that will offer an idea about the survival rate in different forms of cancer in Kashmir. “The file is closed at the RCC once the patient does not report for six months,” one insider said. “They are presumed dead even though there is a possibility that they might have survived.” Some patients who skip going to RCC and directly fly out might have survived but at RCC they are presumed dead. This is despite the fact that all the files carry the phone numbers of the patients registered with the RCC.

Dr Khalid Majid Fazil, Prof in Bio Technology at the University of Kashmir says, “The research should not only be done for the purpose of publication.” He said there are problems of funding in this kind of research.

Another researcher Prof NA Dar opines researches are always useful for public. He says, “Research should be done in every type of cancer. For this the infrastructure, funds and other allied facilities are required.”

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