Address at the Sri Ramakrishna Institute of Oncology and Research, Coimbatore

Cancer Treatment: Challenges

I am indeed delighted to participate in the dedication ceremony of Sri Ramakrishna Institute of Oncology and Research. I greet the organizers, distinguished doctors, guests and dedicated nursing and paramedical staff on this important occasion. I appreciate the missionary spirit and dedication of the institute team in providing high quality and compassionate medical services and care to all sections of our society.

Insights into Life

I would like to share a few experiences of people and their pain and possible solution. Last year, I was at the Centre for Cellular & Molecular Biology at Hyderabad. I met hundreds of young scientists working on the genetic origin and manifestation of diseases, particularly Cancer. The young scholars very enthusiastically shared with me their knowledge of molecular biology and cellular research. They told me about the information encrypted on the DNA in the cell nucleus and how both problems and solutions to the human lives reside on the software that nature has embedded in each life it creates. In a way, these young minds were dealing with the questions that were so far confined in the domain of sages and philosophers.

Cancer, unlike many other diseases that come from the external factors, like infections, life styles and other environmental and physiological stressors, primarily emanates from within the cell. The life software embedded in the DNA material gets mutated and starts growing in a way that is not in-line with the surrounding cells. Many times when immune systems are impaired, life turns against itself. The tragedy becomes unfathomable when it happens too early.

Sometime back, I met one gentleman whose 6-year-old grand child was on periodic blood transfusion for Thallesemia. The permanent solution, doctors told me was a bone marrow transplant. The bone marrow of the child was not matching even between siblings and the parents. Unmatched bone marrow transplant is not done in India, I was told, and even in the West it is undertaken only in experimental situations. I met the child who was unaware of the time bomb that was ticking inside him. I prayed for him, for that was the only thing I could do. Today, standing before this gathering of cancer experts, I think I must share with you my concern for these patients who live under the shadow of uncertain life. What can we do to strengthen the doctors? capabilities in such a situation? Research on stem cell holds great promise. May be clinicians getting involved in this research will lead to breakthrough. We have a shortage of Bone Marrow Transplant facilities. Then there are emotional issues. When a person is diagnosed with cancer, in addition to the treatment, psychological support is needed in a big way. This support should be in the form of counseling and spiritual strengthening. Patient should be advised not to despair and retreat from the normal life. Courage to carry on with the life should be reinforced by persons living around. It is seen that properly supported by their families and friends, many cancer patients have discovered their inner selves while valiantly facing onslaught of the disease.

Affordable & Accessible Therapeutics

Treatment of cancer is very often multi-pronged involving unique combinations of radiation, chemotherapy and surgery. Genetic diagnosis can help to take good decisions while charting the course of therapy. On the drug side, instead of looking for agents that kill dividing cells, researchers are now looking for agents that encourage cell to get destroyed. Inside a growing tumor, the blood supply can be made to run short suffocating the deformed cells. Many drugs, called angiogenic agents, are now being used. However most of these drugs are imported and are very expensive. Industry-hospital-research institution consortia need to be established to develop affordable indigenous products.

Optimization of Chemotherapy

Chemotherapy is often hazardous. It ends up destroying healthy cells in the vicinity and in the metabolic path of the targeted cancerous ones. A firm in Pune has developed algorithms describing interaction between normal cells, malignant cells and nutrients. The algorithms also take into account the pharmaco-kinetics of the drug. Together with inputs on patient?s age, height and weight and the type and volume of the tumor, the mathematical model can design an optimal drug schedule, minimizing the side effects. The type and volume of tumor can be automatically deduced by a combination of imaging and laboratory investigations. PET scans offer powerful techniques in this area. This is a good example of how advances in many disciplines of science such as Biomedical engineering, Image processing, control systems, mathematical modeling and pharmacology are helping in the development of better and effective treatment for cancer patients.

Palliative Care

Palliative care, also called comfort care, is primarily directed at providing relief to a terminally ill person through symptom management and pain management. In situations where the cure is foregone conclusion, availability of comfort and preservation of minimum essential quality of life remains an issue. We have to evolve well-rounded palliative care programs to address mental health and spiritual needs.

Palliative care is best delivered in home settings. Community participation is therefore fundamental in organizing palliative care services. We have very stringent narcotics laws, which have to be reviewed in making available required chemicals to the palliative care networks. I understand many otherwise committed and well meant organisations are shying away due to this fear.

Networking of institutions

There are a number of hospitals providing cancer treatment in different cities of the country. It will be useful to network these cancer treatment centers enabling exchange of experiences among specialists leading to the delivery of best possible treatment. This type of interaction will also generate confidence among medical community to undertake treatment of complex cancer cases. During one of my visits I found that cancer centers have immunologists, physiologists and psychologists working together. This model could be followed by this institute to provide psychological support to the patients facilitating faster recovery.

Conclusion

Availability of comprehensive cancer centres like Sri Ramakrishna Institute of Oncology and Research is a significant step forward in dealing with the most challenging healthcare problem of this region. However, we need an active connectivity of general practitioners with this centre to make a major impact in terms of reaching the needy as well as helping them out. The mission of offering the best available patient care, the most sophisticated education to physicians and patients and be the leader in the cancer research is indeed a very challenging task. This mission demands highest of the human capabilities in intelligence, innovation and perseverance.

It is also equally important that the general public is educated about the healthcare risks of exposure to carcinogenic agents as a result of life-styles and habits. To this end, education of children on this subject should begin as early as in the primary schools so that children do not get initiated into bad habits and thus remain immune from the impact of such disease. Let our new generation enjoy health and prosperity and do not succumb to the needless waste of human life. Cancer cure and cancer research are indeed twin challenges to the medico and health-care community. Challenge transforms into mission of pain removal and thereby provides useful life that is close to the God.

I inaugurate the following facilities of Sri Ramakrishna Institute:

- the women cancer screening project

- the Cancer alleviation and rehabilitation

- the 64 multi-slice CT Scan.

May God bless you.