Oncologists urged to prescribe cost effective economically priced cancer therapy

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 Oncologists urged to prescribe cost effective 
economically priced cancer therapy

By practicing rational prescribing we can treat more patients
which will also ensure judicious use of limited
resources -  Dr. Shahid Hameed

PAEC needs to be commended for establishing numerous
centers helping cancer patients - Prof. S.H. Manzoor Zaidi

KARACHI: Dr. Shahid Hameed a noted clinical oncologist who is currently working in United States has urged the Pakistani oncologists to prescribe cost effective economically priced cancer drugs. By doing so we can treat a much large number of patients rather than spending huge sums of money on few expensive cancer drugs. This is something which we can do ourselves and don’t have to wait for the government. Dr.Shahid Hameed who has served for almost twenty years at Shaukat Khanum Cancer Hospital Lahore before returning to United States was delivering Prof. Shamsuz Zaman Memorial lecture during the inaugural session of the Pakistan Society of Clinical Oncology conference held at the College of Physicians & Surgeons Pakistan recently.

Speaking on improving oncology services in Pakistan Dr. Shahid Hameed said that there has been lot of improvement in cancer care in Pakistan but still there was lot of room for improvement. According to reports there were fourteenmillion new cases of cancer in the world during 2012 and eight million cancer deaths in that year. Almost 50% of new cancer cases are diagnosed in Asia and South Asia. It is estimated that by 2030 there will be twenty eight million new cancer cases and thirteen million cancer deaths of which 70% will be in middle or low income countries. The top ten cancers includes lung cancer and breast cancer. Besides treating these patients we can do something else as well to prevent it to reduce this number. Smoking is involved in sixteen types of cancer. Smoking accounts for one fifth of all cancer deaths. It is more prevalent in male.  Lung cancer accounts for one in five cancer related deaths in the world.

Continuing Dr. Shahid Hameed said that many common cancers are due to infections like Hepatitis B and Hepatitis C. Regular physical activity and dietary factors can decrease the cancer risk. In Pakistan it is estimated that there are 115 new cancer patients per hundred thousand population as per 2008 figures. We spend too little on health services.Our life span is about 65 years as compared to 78 years in United States. Breast cancer, lip and oral cavity and cancer of the cervix are much more prevalent. Most of these patients present in an advanced stage of cancer when almost 80% of them are not curable. The problem is multifactorial. Most of these cancer patients are poor. There are about one hundred twenty five oncologists in Pakistan and fifteen hundred in India. Majority of the Atomic EnergyCenters are taking care of the cancer patients while few are also treated at teaching hospitals.  About one hundred fifty thousand new cancer cases are diagnosed in Pakistan every year. Radiotherapy facilities are mostly available at PAEC centers. We have about twenty foreign qualified oncologists, fifty five with FCPS degrees while about fifty oncologists have acquired MCPS or DMRD or MSc qualifications.  We, Dr. Shahid Hameed stated, have to do much more work. We need at least two hundred radiotherapy machines in Pakistan. At present less than 50% of patients diagnosed with cancer can have access to cancer treatment facilities.

Solution to the above problems, Dr. Shahid Hameed remarked lies in streamlining our healthcare system.  We need to take effective measures to reduce exposure to cancer. Vaccination can be an effective intervention.  We also need to reduce stigma associated with cancer. We must provide universal access to screening facilities and also ensure availability of pain control medications besides improving education and training.

Pakistan had a National Cancer Action Plan formulated in 2002 which might be lying in somebody’s office. We need to start registration of cancer patients. At present we have cancer Registry in Karachi and a Cancer registry in Punjab but we need to have a national cancer registry. We do not have any screening programme. Early diagnosis ensures that most of the cancers are curable. We have to be careful in spending our resources. WHO recommends resource sparing treatment but we waste money on purchase of few expensive cancer drugs rather than opting for cost effective economically priced cancer drugs. Over the years we have failed to promote research culture. Technology, Dr. Shahid Hameed opined, means nothing without proper infrastructure and trained staff.

CPSP, Dr. Shahid Hameed said was doing a commendable job of training people in medical, surgical, pediatric oncology but we need to bring this training in line with the modern times. I personally, he stated, was notin favour of MCPS, MSc or DMRD as two years period was not enough to train a clinical oncologist. We need to take some urgent actions which include establishing a National Cancer Registry, ensuring vaccination of all people against Hepatitis B and Hepatitis C, legislation against tobacco, create awareness through media, ensure availability of pain killers to provide pain relief to cancer patients, he added. Later he was presented a Gold Medal by Dr.Areesha Zaman wife of late Dr. Shamsuz Zaman.

The second memorial lecture was delivered by Prof. Lubna Baig Dean of Institute of Public Health at Jinnah Sindh Medical University. She talked about the importance of cancer registry. Dr. Lubna Baig was of the view that research culture is developing in Pakistan. There are some barriers but there is a way forward. She highlighted the importance of judicious use of data since evidence based medicine is important. Systemic Reviews and Meta-Analysis can provide lot of useful data. According to reports cancer deaths in United Stated, she said, has dropped. Currently 1.3 million people with cancer are surviving in United States.

In Pakistan, cancer treatment facilities are now available but we need highlevel of awareness among public as well as physicians. In Pakistan poverty indicators are not improving. For cancer registry we need reliable data. We need to develop cancer training programme in cancer registry and epidemiology.  We also need to provide support to cancer patients and their families. SKMT has developed a cancer registry while Dr. Bhurgri had started a cancer registry in Karachi. There are fifteen collaborating centers which show that 5521 new cancer cases are diagnosed in Punjab every year. Advanced countries have every type of cancer registry. For this we need collaboration of epidemiologists, pathologists, oncologists. Some of the barriers which Prof. Lubna Baig mentioned included  lack of public and physicians awareness, lack of trust and trained personnel, basic denominators, identity of individuals and follow up of patients. She also talked about intellectual property rights, confidentiality and security. It is important that we provide basic facilities for cancer care for which we need to work with the government which should own this programme.

Earlier Prof. S.H. Manzoor Zaidi who was the Guest of Honours on this occasion in his speech said that he along with late Prof. Munir Siddiqui and others established the Pakistan Society of Clinical Oncology at Hyderabad many years ago. Over the years we have treated patients effectively. Cost of treatment is too high and a large number of patients cannot afford it. Research costs a lot and since cost of cancer therapy is too high, we cannot deliver right treatment to the right patients in time. Our members are making efforts which are indeed commendable as they were working under lot of odds. Prof. Manzoor Zaidi commended the efforts of Pakistan Atomic Energy Commission which has established numerous centers which are providing treatment to cancer patients. At present almost 80% of cancer patients are receiving treatment at PAEC centers. Cancer unit was established at JPMC in 1960 which was the first such centers. At present twenty such centers are functioning in the country providing treatment facilities to cancer patients.

Dr. Syed Jameel Akhtar Member PAEC in his speech on the occasion said that problems in SAARC region are mostly due to small health allocations.  At present almost 80-85% of cancer patients are being treated at eighteen PAEC centers all over Pakistan. Cancer is the third largest killer in the world. By working together we can control cancer, prevent and provide rehabilitation services. He laid emphasis on close collaboration between the SAARC countries. Sharing cancer burden is possible. SAARC countries should share their expertise and safe environment is the key to prevention of cancer. We supply isotopes for diagnosis and treatment and if need be we can provide it to other countries in SAARC region as will, he added.