Tuesday, June 25, 2024

Case ‘load’ of overwhelmed oncologists

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As per the cancer registry data, it is estimated that there will be about 800,000 new cancer cases in our country every year — alarming is the only emotion we can express right now. With a predominantly clinical approach to managing cancer, the relentless onslaught of cases not only causes distress to increase numbers of patients and caregivers but also puts oncologists and the healthcare system under inordinate stress!

“There are many reasons that this consideration is important, especially in a country with a ratio of one medical oncologist per 3000 new patients a year. For one, we cannot afford long consultations with such caseloads, even though longer consultation times are proven to lead to better health outcomes. Further, burnout is experienced by 20%-70% of practicing oncologists worldwide, leading to medical errors, professional misconduct, or leaving medical practice altogether. Reducing the caseload will improve the capacity of the healthcare system to deliver quality care, yielding more positive patient outcomes. This can be achieved by the twin approaches of prevention and palliation,” enlightened Dr. Vishal Rao, Group Director for Head & Neck Surgical Oncology and Robotic Surgery at HCG Cancer Centre.

Up to 50% of cancer cases are preventable, though avoiding cancer altogether is tricky because we are all exposed to the ever-growing list of carcinogens to some degree. We can however take measures appropriate to our risk profiles.

For example, Dr. Rajesh Kumar Reddy, an Uro Oncologist at AINU shared something serious about urological cancers: “Theme of the close the care gap campaign is to address the inequities in cancer care is continued this year. Cancers found in the urinary and male reproductive organs are one of the most common tumors encountered in clinical practice. Risk factors of cancer development can be broadly divided into biological factors and lifestyle-related factors like consumption of tobacco products and alcohol, obesity, and dietary factors. Then there is environmental exposure and occupational risk factors like many chemicals, radioactive materials, and asbestos. The deadliest is the infectious cause which is the Human Papillomavirus! Early detection of cancer significantly increases the chances of successful treatment. Some signs of cancer include lumps or swellings, sores that fail to heal, blood in the urine, unexplained loss of weight, and loss of appetite. However, for all practical purposes most of the cancers, genito-urinary cancers, in particular, are silent in the initial stages. These can only be detected with regular health screenings by means of lab tests or imaging. With the advent of recent technologies in medical care, cancer cure has become a possible entity for localised cancers. Robotic surgeries revolutionised urological cancer care over the past decade! Surgical robot featuring endo-wrist technology and 3D vision enables surgeons to perform surgical dissection with great precision. The advantages are minimal blood loss and fewer chances of injuring surrounding organs. A clear-cut benefit is seen for prostate cancer surgeries where nerve preservation is possible to preserve urinary continence as well as potency. The earlier the better is the final take-home message. This enables urologists to perform minimally invasive, organ-preserving surgeries with curative intent.”

Meanwhile, Dr. Vishal shared, “The real struggle lies in managing the social determinants of health outside of individual control. Life today is hurried and intense, with crowded living conditions, increasing pollution, financial pressures, uncontrolled consumption, sensationalising media playing up threats around us, and so on. We need to introspect and collaborate as a society to reduce these triggers. Palliation enters the picture when the disease has taken root. Treatment protocols include chemotherapy, immunotherapy, radiation, or surgical measures. Each is accompanied by a host of side effects such as nausea, gastrointestinal distress, fatigue, anxiety, and depression. But patients and caregivers experience pain and discomfort well before this point. Cancer is so feared that even the idea of undergoing tests to diagnose it can be deeply unsettling! Without external support, they can only look to the already overburdened oncologist to take them through the entire process, from screening to treatment and after.”

He continued, “The crucial significance of palliation cannot be understated. Early initiation of palliative care has been proven to reduce depression and anxiety because of its holistic, empathetic approach. Patients are also empowered on the clinical front because palliative care professionals ensure they are well-informed of the appropriate use of different medical treatments, can identify their own preferences, and are mentally prepared for possible outcomes. Everyone stands to gain when oncologists’ caseloads are reduced through prevention and palliation. Systemic efforts are necessary to build awareness of prevention, and the capacity to provide palliative care. At the same time, each individual must do what is necessary for their particular positions, starting from the person taking adequate healthy measures to avoid meeting an oncologist, all the way to someone living a fulfilling and pain-free life during and after treatment. Altogether, it would result in better health outcomes across the board.”

On the other hand, Dr. Madhu Devarasetty, senior consultant surgical oncologist and minimal invasive surgeon at KIMS Hospitals, stressed that the revolution in cancer care with technological advancements must reach village level too where cancer care needs to be streamlined. “This can be addressed by establishing more centers at the district level and recruiting more specialists. Organising more screening camps, promoting awareness through social media, and enriching knowledge through websites will help this society to know more about cancer. It’s very important to know that most cancers are curable if they are detected early in breast cancer, thyroid cancer, colorectal cancer, etc. Awareness in society and standardisation of treatment will enable to close of the care gap,” he added.
Seconding Dr Dr. Madhu Devarasetty, Dr Srinath Bharadwaj, consultant oncologist, Apollo Hospitals, Jubilee Hills, listed five major scientific milestones which have made a huge impact in care for cancer in the past decade.

This is definitely one of the path breaking discoveries in the past decade. Tumors grow in our body by evading / misleading our immune system. This therapy brings back the cancer under the radar of our immune System and increases the effectiveness of other therapies in turn providing longer periods of remission. Significant impact has been seen in many cancers especially Lung cancer.

Next generation sequencing:
Massive Parallel Sequencing of tumor DNA / RNA to detect specific mutations in the genome which could have been the cause of his / her cancer. Once a mutation is detected, we also get to know if this is hereditary and if is there is any drug which can target this mutation. This makes Cancer treatments more personalized. BRCA gene testing in breast and ovarian cancers, EGFR, ALK, Ros testing in lung cancers, MSI testing in colonic and many other cancers are examples.

Targeted therapies:
These medicines are a direct consequence of our ability to delineate targets in individual tumors through various molecular teste including Next Generation Sequencing. Most of the targeted therapies come in tablet form which makes administration very easy for the patients and avoids multiple chemotherapy injections.

PROTON therapy:
The therapies previously discussed are either tablets or injections. This therapy is a form of Radiation therapy. Conventional Radiation therapy Consists of Photons generated at Mega voltage to treat cancers. In proton therapy particles called Protons are used instead of photons to improve precision and decrease side effects and Apollo is the first hospital to introduce it in India. This is most useful in treating tumors which are nearby critical organs like brain and spinal cord.

Developments in supportive care:
Array of new Medicines have come up in the last decade which are much more effective in tackling nausea and vomiting associated with chemotherapies. Scalp cooling machines are available which prevent hair loss for patients on chemotherapy. Various interventions from Radiology and Pain Medicine have made treatments more tolerable and the journey of fight against cancer more comfortable than ever before.

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