We need a ‘moonshot’ for Cancer

Recently Joe Biden made an emotional appeal for ‘Moonshot’ (the famous declaration by JFK that America should put a man on the moon) for Cancer. President Obama endorsed this by asking for 1 billion dollars to fund cancer research.

JFK, in his Rice stadium speech, did not talk about small things but instead spoke about big dreams. He said “We will put man on the moon in this century”. This obviously led to the creation of the US space program; a focused endeavor laced with excitement and supported by funding.

Yes, Cancer certainly needs a ‘moonshot’ at this time. It was Nixon who provided an impetus for cancer research by declaring “War on Cancer” in 1971. With 100 million dollars in funding, the National Cancer Institute was established. It is nearly 45 years since that dramatic announcement.

Where are we now?

As I look back on the last 30 years of cancer, I reminisce my journey in the medical field of cancer. I joined as a young passionate and enthusiastic surgical resident in 1982. 34 years later, Cancer is still an unsolved and serious problem affecting humankind and we really need to find solutions. In the last 30 years, there have been series of excitements and disappointments on the management of cancer.   I, in my own capacity, fine-tuned my surgical skills, to be able to perform complex surgeries with ease and safety. However there seems to be a sense of despondency among the community and the people: “Why, after billions of dollars of research funding, are we unable to find a cure for cancer?”

I recollect that there were 3 waves of hope showing a lot of promise but soon after faded out. One was a wave of ‘simple blood tests’ called ‘tumor markers’. The promise was that a simple blood test would be sufficient to detect the cancer. But it was soon found that there were too many false positives and today it’s no longer advisable to use for detection.

Second came the wave of chemotherapy. While chemotherapy did have dramatic success in Blood Cancers, the same was not seen in solid Tumors. The responses were limited and partial. There were also significant amounts of side effects and toxicities. Many patients would say that they would rather undergo surgery than chemotherapy.

The third and current wave is targeted therapy using certain monoclonal antibodies, which is supposed to attack cancer specific targets. While there is a lot of excitement, the clinical effectiveness remains a matter of investigation and the treatment is far from affordable.

So where do we see cancer solutions?

As Joe Biden has said, all the research work is going on in silos with very little sharing of information. Scientists are basically suspicious and I feel that the following would be possible solutions for cancer treatment:

  • We need a completely radical, out-of-the box mindset. The current therapies of chemotherapy and targeted therapies at best give a few weeks to a month’s response. Not only do we need doctors and scientists, we need the whole army of physicists, chemists, mathematical modelers and computer scientists on board.

 

  • An open source Cancer research consortium: Imagine that by a universal health mandate that there is an open source research consortium funded internationally wherein all the information from all the different labs in the world is pooled. This is the kind of effort that eventually led to unraveling the genome through the human genome project. Why can’t a multinational effort of such magnitude and scale evolve to put together the information for the best minds to act upon?

 

  • Today, the best current solution in my opinion lies in early detection and appropriate treatment. For me, solid tumors particularly in the gastrointestinal tract, if detected early can be treated with good surgery and lead to long time survival; unparalleled in comparison to other forms of treatment.

How do we  detect the cancer early, is the big question?

Yes, there are challenges with this but the following story very aptly gives us not only the problems but also the solutions for cancer treatment.

In this story I will be putting some notes as to what is really important and how a particular action changed the course of life for Jayaben.

 

Jayaben, a counsellor by profession, is a middle-aged lady from Gujarat. For about 4 months she had been having bleeding and discomfort while passing stools. She had been to a couple of doctors who assured her that it is nothing but piles or fissures and she was then treated accordingly. Jayaben was not satisfied, as her symptoms were not relieved. After nearly 4 months she said ‘enough is enough’ and got a colonoscopy done.

Note : Symptoms are always there. Many times there is negligence on the part of the patients and also on the part of the physician to suspect something more serious. You know your body best and if there is something that is not going right insist on further investigations to make sure that you are completely clear.

On the colonoscopy she was detected to have cancer of the large intestine. At the time her immediate reaction was “how much time do I have? I have small children” and obviously she was worried. It is very natural for any mother to be worried about her children rather than her own life and obviously for anyone, ‘how much of time is left?’ is an important question. She was also worried about the fact that if she had undergone surgery, should would have to carry a permanent bag because some patients with rectal cancer do have a bag. These were her fundamental fears. But in the matter of 2-3 days, she pushed aside her fears and decided that there is absolutely no meaning in getting worried. “I need to get the best medical advice in this situation” she affirmed.

Note : Do not be in denial and make sure that you do seek good medical care once the diagnosis is made. Access to information will lead you to good medical care. Make sure that your first treatment is properly done. This is the best chance for you.

She underwent a combination of radiotherapy and chemotherapy and subsequently surgery. Throughout she only had one feeling, ‘Yes, I am fighting it out for myself and my family and everything will be all right at the end’.

 

Note: There certainly are huge emotional burdens not only for you but also for your family. But once you get past the initial shock, you should forget it like a bad dream and get on with life.

Today Jayaben is not only helping out many patients through funds but also through counselling and urging them to lead meaningful lives.

While we wait for the moonshot for cancer, I think we must start off with simple things like early diagnosis and good treatment. I am completely convinced that early diagnosis is the corner stone in cancer treatment all over the world but especially in a resource poor country like India. When diagnosed early you have excellent options of treatment.

Today, on World Cancer day my one true wish is that no one should be afflicted with any illness (not just cancer).

Best wishes

Dr J

 

Is Cancer contagious???

A retired army officer came to me and he was diagnosed as having tumours in the liver and needed chemotherapy. He had two sons, a software engineer in Australia and another a banker in London.  One of his sons brought him to me.  I explained everything and planned chemotherapy which he wanted to take in Delhi.  The son wanted to talk to me alone and sent his father out.  He then asked me, “Should I isolate my father to protect my son who is fond of his grandfather and wants to play with him.  When I suggested this to my father, he was not very happy and so also my mother.”  I stared with disbelief that such an educated, well placed person should be asking such an ignorant question.

Let me tell you categorically that cancer is not contagious.  As explained in my earlier blogs, it is just the body’s own cells going abnormal and going out of control.  It would be criminal for the family to deny the patient love and affection needed  most at that time.  I was firm on explaining to the son that he can go back to Australia and leave his mother and father together to cope up and share and support each other.

In fact, cancer is possibly safer than other disease like multi drug resistant TB and many others that have limited treatment.  There are only specific diseases like Hepatitis B & C which can be transmitted to others in the family and produce viral infections to the liver which may lead to cancer.

Millions of healthcare professionals across the world involved in cancer care would be a population with high risk and nothing happens to them.  This is one of the biggest myths and please be assured that cancer is not contagious.

 

A True Hero says ‘Chemotherapy is NOT painful at all’

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I have never seen a young man who is so positive in his outlook and say ‘I will hit the word ‘C’ from my life with this precious bat autographed by Sachin Tendulkar”.

Ashish has been a role model for many young men.  He has especially asked me to write to dispel the myth and notion that Chemotherapy is painful and difficult.  He is a smiling young man who has gone through radiotherapy, surgery and again chemotherapy and even now remains absolutely positive. In fact, during our campaign on ‘Salute Sachin’, Ashish single handedly could mobilize nearly ten lakhs for children with cancer. He is a ‘true Hero’.

It is not about mobilization of funds, it is about outlook towards therapy.  Chemotherapy, as the name indicates, is using drugs for killing cancer cells.  The single important characteristic that differentiates cancer cell from normal cell is that cancer cell divides at a higher rate than normal cell. Most of these drugs target these cells taht are dividing faster.  Unfortunately, these agents are not very specific.  That means they are going to attack all those cells which divide rapidly in the body.  That’s the reason that any growing tissue eg. hair which constantly grows get affected and one of the disturbing side effects of chemotherapy is hair loss.

It is also a misnomer that chemotherapy is one single drug for therapy.  In chemotherapy there are multiple different drugs, nearly 100 of them, given in combinations.  Some of them may have hair loss as a predominant side effect and some of them don’t. .  What is surprising is hair loss is also temporary and those patients who lose their hair, their hair regrows thick, stunning and curly hair giving a new and much younger look.

Chemotherapy also affects the cells of the bone marrow that are also constantly dividing and that is the reason that why patients on chemotherapy have lower blood counts and are slightly more prone for infections. But it is certainly not necessary unless the blood counts are really low for them to be isolated in any form.  Yes, there are some precautions to be taken, like general hygiene as far as the eating habits and clean water is concerned. Apart from this there are really no major alterations in life style. Children and adults need not go around with masks as is commonly photographed.

I always encourage my patients to be as normal as possible.  Ashish was working for 6-8 hours even during therapy. Many take their treatment and go to work.  I think, being occupied is the best antidote for all the side effects of chemotherapy.  In fact, one of my patients was smiling as we started therapy and I said to her “Most of the people are apprehensive and why do you seem to be happy about it?”  She said, “Doc, I am convinced that this is going to help me and all the side effects are going to vanish”.  It is all in the mind that if you think of the side effects, you are likely to have side effects.  Modern medication is excellent for reducing nausea which is one of the distressing side effects and loss of taste.  These side effects are very temporary.

Please DON’T listen to unsolicited advice from ’well wishers’ who will tell you horror stories. Don’t believe them. Millions have benefited and so will you.

There is nothing to be worried about chemotherapy. So, be active, be normal even during therapy and that is the best way to beat the big ‘C’.

Exercise and cancer

Who needs Lance Armstrong when we have so many heroes ?

Exercise helps during cancer treatment

 

Last week I wrote about Suresh.  He was thrilled when he came to see me and said, “I always wanted to do the half-marathon before the disease hit me and now after the treatment I will run the half-marathon”.  He completed the half-marathon without a hitch and to me he is one of the real heroes! 

During his treatment, I found him reading Lance Armstrong’s book ‘Its not about the bike: my journey back to life”’.  Incidentally Lance Armstrong also had the similar disease.  I felt so terrible that Lance  let down so many people who looked up to him as a motivation during their fight against cancer.  I think that was definitely criminal.  Unfortunately  sports heroes letting down their fans is happening now. But patients feel so let down when their role model is a fraud.

Yuvraj had a similar problem and wrote about his success story. He is currently hero-worshipped by all.  Rightly so and he too read  the Armstrong’s book. There are many Heroes amongst us – just ordinary people with extraordinary courage.   Many  like Suresh who believe that they can kick the disease and continue to exercise and be physically fit. 

Let me tell you that physical fitness is one of the most important needs for effective treatment.  It is clear that a strong body can resist and fight the disease and also tolerate drugs that are necessary.  For all those who are on treatment or off treatment, do not forget to exercise.  That is your biggest single weapon against the big C. 

When do you start exercising?

If you are a fitness enthusiast like Suresh- DON’T stop. Keep exercise to at least 20-30 min of walk even during chemotherapy. Even aerobics with less intensity are fine. It relieves your stress and take your mind away from thinking about side effects.

What if you have not exercised regularly?

Its advisable to start walking at least 10 min three times a day. Yoga and meditation would help and I definitely encourage you to “keep fit”.

What about yoga?

It has been shown in many studies that yoga reduces the anxiety. Let me tell you that it is the anxiety about therapy that is worse than therapy. I have seen less literate patients take therapy without blinking.

I am attaching the NCCN guidelines for exercise during treatment, which are useful

Exercise, Exercise and Exercise and reduce your weight. This is particularly true for breast cancer where excessive fat can predispose. 

Exercise reduces the cancer risk.  More about it next time.

References:

exercise-during-cancer-treatment

http://www.nccn.com/component/content/article/61-symptoms/90-exercise-during-cancer-treatment.html