February 2014

Shift in Population will lead to more Cancer Patients

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More than 23 years of experiences in the field of Medical Oncology and approximately 600 transplants performed for various cancers in India, Dr Vinod Raina, Director Medical Oncology and Hematology, Fortis Memorial Research Institute, Gurgaon, also performed first high dose chemotherapy and peripheral blood stem cell transplant in India. Having considerable research experience, Principal investigator of approximately 50 projects in AIIMS, Dr Raina in an interaction with Ekta Srivastava, ENN

How the scenario has changed since you joined this field and what will happen in next ten years?
I graduated in 1974-75, since that time everything has changed. When I was graduating, there were no CT scanners, ultrasounds, MRI’s, PET scans or molecular diagnostic not even the computers, since then lot has been changed. Technology has taken the medicine into new era of patient outcome and developing new researches. Molecular diagnostic and all will be in advance position after 10 years. Molecular oncology will come into front. Today, problem is that at the under graduate level cancer is not a specific topic but this is the topic or specialty at the post graduate level. At under graduate level they don’t have much information about the cancer. In next 30-40 years cancer is going to be the major killer. This means it is increasing rapidly but mainly in urban areas not in rural areas and we need more cancer specialists in India.

How molecular diagnostics will helps in patient’s outcome?
Molecular diagnostics is growing rapidly. Molecular diagnostic tests detect specific sequences in DNA or RNA that may or may not be associated with dis ease. Clinical applications can be found in at least six general areas: infectious diseases; oncology; pharmacogenomics; genetic disease screening; human leukocyte antigen typing; and coagulation. Molecular diagnostic testing usually generates a profit margin that increases as the testing volume goes up. In general, there is greater clinical demand for tests that produce results in less than one day. The infectious disease applications are among the most common area of clinical interest.

What is the difference between medical oncology and surgical oncology?
Medical oncologist: They are the one who specialize in treating cancer with chemicals or medications like chemotherapy (the use of drugs to kill cancer cells) and work with primary care physicians and other medical specialists. Often, the medical oncologist is the coordinator of the treatment team and keeps track of the various tests results and follow-up exams performed by other specialists. A person with leukemia, lymphoma, or other blood-related cancer may be cared for by a hematologist (a doctor that specializes in the treatment of blood disorders). A hematologist also completes a three-year residency in internal medicine followed by a fellowship in hematology, oncology, or hematology/oncology. Surgical oncologist: One of the main treatments of the cancer is the removal of the particular affected organ and that is done by surgery. This is a doctor who specializes in treating cancer using surgery. Surgical oncologists complete a five-year residency in general surgery and a two-year surgical oncology fellowship. They may choose to specialize even further and devote training to one type of cancer, such as breast or lung cancer.

What is the most challenging part for an oncologist?
Most challenging is the delivery of cancer care. It’s a very long treatment which goes like for eight nine months. Then you have to follow up the patient. The relationship with the patient becomes completely different. It’s not like any other disease. Many cancers have become more like a chronic disease. Cancer is not getting cured though their life is getting prolonged but they are not getting cured (there are some which get cure but not every cancer has got the permanent treatment) There are days when things are not going well such as, when patients you have been following up with have their disease progress and you are in a position where there is nothing much you can do. I think everyone finds that a challenging part of their work. We are hopefully in a position where we can do something to help them. I think that is a good mantra, that you are trying to be there to be helpful to people and improve their situation and you know that you aren’t always in a position to take this away or cure it. But you are in a position where you can give quality time and improve patients’ quality of life. But we do cure them as well, of course. Challenges arise with people who you’ve worked with for a long time, done multiple interventions for them and they’ve improved and then you get to the end of the line and there isn’t much else you can do.

What is the most common misconception people have about medical professionals?
Yes they have many misconceptions. Sometimes they say doctor don’t treat, sometimes they say they over treat, they have scientific mind, and doctors don’t have clear foundation. Problem is that most of the treatment is done by the doctors who are not scientific, who don’t know what they are giving. Patients sometimes along with the chemotherapy are taking medicines and treatments from local hakeems, ayurvedic doctors and vaids, and since they don’t have much publication, we don’t know what these nonscientific doctors are giving to these patients. The biggest frustration is that sometimes when you are not able to cure them, patient starts going to these sadhu-sants, they believe in so much superstition that they will start saying that particular period will be good for the treatment, now we as the medical persons know what is going inside their bodies but we cannot go against their wishes.

Is there a rapid growth in cancer patients in India? Which age group it is affecting the more?
There is a rapid growth. Cancer mainly is the disease of the elderly. There is an increase in number of cancer patients, mainly because of the shift in the population. If you look at the graph of the India more than 50 percent of the population is under the age group of 30 years. But in next twenty years it will not be like that because in next ten years there are more people who will be elderly. So, in addition to the fact that the reach for the treatment is growing , and there will be less younger people and as I told cancer dominates at the age of 60 years mainly, there will be more case of cancer in next 30 -40 years. It doesn’t means that cancer is increasing but there will be more people who will be vulnerable to the cancer. Most of the cancers occur after the age of 60, 80 percent of the cancers occurs at this stage only.

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