Decentralising cancer treatment

The World Cancer Day was observed on February 4 in Bangladesh along with the rest of the world. Created in 2000, World Cancer Day is a global initiative led by the Union for International Cancer Control (UICC) to face one of our most significant challenges. Cancer treatment is improving day by day in our country. National Institute of Cancer Research and Hospital (NICRH) was initially established with 50 beds. Gradually the number was increased to 300, and now it has 500 beds. Starting with the Radiotherapy and Radiation oncology department, the institute later included surgical oncology, medical oncology, gynaecological oncology, paediatric oncology and haematological oncology departments. Moreover, a few departments are available to diagnose cancer cases.

Due to some limitations, we are unable to provide desired standard of treatment to a huge portion of cancer patients. Though some private hospitals have developed their treatment facilities like abroad, treatment expense is beyond the capability of the poor people. As a result, most people rely on the National Institute of Cancer Research and Hospital (NICRH) which is situated at Mohakhali in Dhaka. For this reason, every day, most cancer patients from different parts of the country gather to try their luck in this hospital. A large number of affluent cancer patients go abroad to get themselves treated. Our cancer patients go to England, Singapore, Malaysia, Thailand, etc. Many cancer patients go to India and sell their property to meet the treatment expenses. A portion of cancer patients take their treatment from private sectors. But a huge number of them are too poor to go abroad or get treatment from private sectors. Their only hope lies in National Institute of Cancer Research and Hospital (NICRH). It is difficult to provide standard cancer treatment protocol and cancer care service to this vast population by a single cancer institute. Now it is imperative to establish some centres out of Dhaka. So, decentralization of cancer care service is a demand of the time.

We give treatment to cancer populations but are unaware about prevention and palliative approach. We lack a proper screening process, motivation, and building awareness among the rural, even most urban people. To develop appropriate cancer care services, all fundamentals are equally important, and they should be established by any means. Oral examination for early diagnosis of oral and tongue cancers, VIA test for early diagnosis of cervical cancer must be ensured. Routine breasts examination for early diagnosis of breast cancer and other screening procedure can help early diagnosis of cancer and helpful for proper standard treatment. Our cancer screening process is limited to the VIA test though proper awareness among the female of reproductive ages is not satisfactory. Other screening processes are not visualized. Routine steps should be taken in Upazila and district level for primary prevention. We can diagnose and plan for standard treatment protocol by routine and proper screening. Early diagnosis and adequate treatment can reduce the mortality rate. Palliative care should be developed.

We have failed to achieve our goals due to

1. National cancer prevention process is not incorporated into the national cancer screening programme

2. Lack of proper training and monitoring

3. Failure to start social screening from the hospital screening process

4. Failure to create awareness among the people to participate screening programme and make them understand that screening programme is not harmful/ painful

5. Failure to incorporate different local organisations to create awareness

6. Failure to spread the screening programme to the whole country

Different programmes have been arranged in recent years and these discussed the faults of the screening process and took plans for improvement of this process.

We should take the following steps to achieve our goal

1. Mass screening process throughout the country should be undertaken

2. The screening process should be easy, available, and reliable

3. Social screening process should be initiated

4. Creating mass awareness about cancer and cancer screening process among the general population

5. Decentralisation of cancer care services

It’s great news for Bangladeshis that the government is launching specialized units at medical colleges of eight divisional cities for cancer, kidney and heart disease patients. Each year, many such patients go abroad, most commonly to India. After getting stabilized, patients of different categories will avail treatment in their own country instead of going overseas. Thus we can prevent foreign currency from going out of the country.

A study carried out in 2012 by a group of faculty and students of Pharmacy Department of Jahangirnagar University, Bangladesh revealed that 8.2 per cent of total studied patients suffered from leukaemia and among male 3.8 per cent, among female 3.2 per cent suffered from lymphoma. Studies showed leukaemia and lymphoma comprised of more than 11 per cent of all cancer patients. Among all blood cancers, leukaemia and lymphoma were more than 11 per cent and if other blood cancers had been included on that study, the percentage would rise further. This study was carried out in 2012, and now we are in 2022, so it easy to say total blood cancer patients have increased further along with other cancers. These cancer patients are treated by Haematology and Haemato-oncology departments. It is very unfortunate that the Haematological oncology portion was not included in the specialized units of divisional medical colleges of eight cities. As a result, many patients failed to get this specialized treatment. Paediatric oncology portion was included in Paediatric Haematology and Oncology subject thus Haemato-oncology portion from Haematology and Haemato-oncology subjects should be included this specialized units in divisional medical colleges of eight cities.

The writer is an Haemoto-oncologist. He can be contacted at marufhasan4954@gmail.com