A mood and message of reassurance at the Cancer Institute in Chennai.
ON June 10, it was a carnival atmosphere on the five-acre campus of the Cancer Institute in Chennai. Children, women and men, young and old, were singing, laughing and cracking jokes in a manner only they could. Not surprising, for they had, in a sense, come back from a terminal stage. The 45-year-old Institute was celebrating Cancer Survivors' Day.
For the 500 survivors it was a celebration of the fresh lease of life they had got, thanks to the efforts of the dedicated team of doctors, nurses, counsellors and volunteers and also the advanced diagnostic and technological services. The message was clear: "Cancer is curable and there is life after being afflicted by the scourge." In Chennai alone there are over 2,000 cancer survivors who have been relapse-free for five years after the completion of treatment.
There was a time when cancer was seen as a terminal disease. But thanks to sustained research and development efforts in pharmacology and diagnostic and interventional advances, the disease can now be cured in most cases. The Cancer Institute has achieved a 75 per cent cure rate, including in the case of paediatric leukemia. Says Dr. V. Shanta, Executive Director of the Institute: "There can be a 100 per cent cure rate if the scourge is detected and treated early."
There has been a significant increase in the incidence of the disease - the number of patients has doubled in the last decade. The incidence is higher among women. According to the Institute's research director, Dr. T. Rajkumar, about 10 lakh people are affected by the disease every year, in nearly half the cases because of tobacco use. Tobacco use leads to oral (mouth), pharynx (throat), larynx (voice box), oesophagus (food passage) and lung cancers. It is estimated that the elimination of tobacco use can reduce the occurrence of oral cancer alone from 29 per cent to 4 per cent. The Institute's doctors examine hundreds of people every day as out-patients; at least 25 of them are new cases.
Awarness and information are the key to early detection and cure. This is where the media have an important role to play. Realising the tremendous influence of cinema and television on the masses, the Institute had prominent film artists address the gathering on Survivors' Day. Says Dr. Shanta: "Popular and familiar faces from the big and small screen can play a crucial role in creating awareness and dispelling common myths about cancer." A.V.M. Saravanan, one of the most prolific cinema producers in the South, was the chief guest on June 10. He said that none of his films or television productions would show an artist smoking. "This is a promise," he said.
A major problem is the negative projection of cancer by the media. Says Dr. Shanta: "The media always portray a person as dying of cancer; they seldom show the survivors. This should stop." R. Parthasarathy, whose wife Seethalakshmi survived cancer in 1995 and has since been relapse-free, says: "Apart from the medical intervention, which is world-class, the confidence, care and emotional support given by the dedicated team of doctors and volunteers is remarkable. This positive approach is what films should be projecting."
Radhakrishnan, another survivor, emphasised the need to break the myths and project mainly five points: Cancer is not a terminal disease; it is not contagious; courage is the basis for cure; cured cancer patients need no medicine for survival; and, periodical follow-up until the stipulated period is crucial for a patient to be totally free from the disease and its effects.
There has been a significant rise in the cure rate - it was about 30 per cent five years ago. The treatment module - prolonged, intensive treatment for six months, much of that time spent in the hospital, followed by a maintenance phase of one and a half years - has given most patients a fresh lease of life. The multi-disciplinary team-work emphasised by the Institute has made a remarkable difference to the cure rate.
Earlier the only forms of treatment were radiation, chemotherapy and surgery. However, medical oncology, a systematic form of treatment that includes use of drugs and intra-operational radiation and 3-D conformal therapy, has changed all that. According to Dr. Ravi Kannan, Professor of Surgical Oncology at the Cancer Institute, the latest trend is optimisation of treatment for identified low-risk groups, avoiding unnecessary intervention.
Multimodal therapy has led to a significant level of development in the matter of organ conservation. For instance, osteosarcoma or bone sarcoma, for which amputation was earlier the only treatment (with a survival rate of 10 to 15 per cent in the 1970s), can now be cured with limb preservation and with a survival rate of 75 per cent. Other major interventions done in the Institute are breast, laryngeal and bladder conservation and anal-sphincter preservation.
The Cancer Institute's surgery programmes to salvage limbs and the head and the neck, or operations done inside the brain, are the only organised and active ones done in the country. The bone marrow and paediatric oncology departments are among the best in the country. At the state-of-the-art facility, which includes a well-equipped molecular biology laboratory, targeted and monoclonal antibodies are developed as the Institute expects laboratory fabrications to become crucial for cancer treatment. Hence, the crux of cancer treatment is balanced treatment and sensitive supportive care.
The emphasis is especially on sensitive support. The Institute has an emotional support group, Sanctuary. With 10 volunteers working with the patients and their families in the last 10 years, Sanctuary plays a crucial role in the patient's path to recovery. Says Ranga Kumar, who has been with Sanctuary since its inception: "It is a protracted journey for the patients and their families - confusion, disbelief, grief and anger. Only then begins the treatment, which is also a long-drawn-out process - chemotherapy, radiation, surgery and medicines."
Three cured patients, who are now part of Sanctuary, infuse tremendous confidence in the patients. Its volunteers meet almost everyone in the outpatient department and visit the wards every day. Besides organising programmes such as bhajans and discourses, they also conduct group therapy in the general ward and counsel individuals recommended by doctors.
Sanctuary's work with cancer-affected children is also significant. At any given time, there are about 40 children in the Institute, away from their families, schools and friends. Sanctuary works with the children, identifying their talent in various areas such as arts and craft, music, mime, mathematics, science, acting and writing. It conducts workshops for the children. With toys and art materials spread all around, it hardly looks like the paediatric ward of a cancer hospital. Sanctuary ensures that the children are not traumatised by the disease. It also organises outreach programmes in schools and colleges to educate students about the dangers of tobacco use, especially smoking, and teaching them to identify symptoms, especially of breast cancer.
Since many cancer patients suffer from depression and even have suicidal tendencies, it is very important to be sensitive to their problems. Says Ranga Kumar: "The patients need good listeners. It is lethal to tell them 'do not worry, everything is all right' as the patients know, as much as we do, that this is not true. Saying this only closes all communication channels to the patients." Sanctuary has developed an effective training module for counselling cancer patients, most of them poor and vulnerable. Says Gita Das, a cancer survivor who was in the hospital for over a year: "More than the treatment, it was the love, affection, comforting words and the sensitivity shown by the Institute's staff that gave me courage and saw me through the stressful and anxious period."
The Institute's basic concern while treating a patient is not whether he or she can pay for it but whether he or she needs it. Cancer treatment is often protracted and expensive. However, at the Institute, about 20 per cent of the patients are treated free of cost and they are also provided free accommodation and food during the treatment period. About half of the patients are provided treatment at highly subsidised rates. On an average it costs up to Rs.6 lakhs to treat a patient. Delli Rao, suffering from leukaemia since 1987, says the Institute would have spent Rs.4 to Rs.5 lakhs on his treatment. "I have been put on the danger list 36 times and have had 56 blood transfusions since 1987-88," he says. As one who earned Rs.600 a month working for a garment exporting unit, Delli Rao could hardly have afforded the treatment. "I owe my life to Dr.Shanta," he says.
The Institute gets no financial aid from the government. Says Dr. Shanta: "Every day is an emotional strain on us. Patients plead with us to treat them free. It is a very difficult decision. But we never refuse anyone who can be treated." For this, the Institute needs to create a corpus fund of Rs.6 crores, which it has been trying to put together for the last five years. "Industrial houses and philanthropists should come forward to help patients conquer cancer, which is curable," says Dr.Shanta.
The Cancer Institute lives up to its motto: "With humanity and in wisdom." Says Dr. Shanta: "When the sick approach the gates of the Institute, weak in body and spirit, and full of fear, there is only one response, you have to become part of them." This spirit is amply reflected in the dedicated team of doctors and paramedical staff, for whom each patient is a commitment, for life.
