Rebuilding trust on cancer care in Bangladesh

Faridur Rahman Khan

What is the current situation of cancer in Bangladesh?

There is no official record available to verify the overall current situation of cancer in Bangladesh; however the data collected by GLOBOCAN shows the current situation of cancer in this region, especially India, Bangladesh and Nepal is quite terrifying. The statistics show, globally 1 in 10 men and 1 in 8 women will be afflicted with cancer by the time they turn 70. However, statistics in Bangladesh show 1 in 6 men and 1 in 8 women get afflicted with cancer in the same time period. 

In Bangladesh, with an average life expectancy of 72 years, we need to make provisions and be prepared to tackle this disease taking this data into account. Unfortunately, there is no adequate timely data available in Bangladesh which can help us plan and move forward. If we could systemise cancer data properly in a national registry, we could have had the true picture of this ailment to set treatment protocols accordingly. 

I also believe we need to create awareness among the common people of the country that quality cancer drugs are manufactured in Bangladesh and are also being exported abroad; so now for many cancers there is no need to go abroad for medicines. For the cancer drugs which are not manufactured here and need to be imported, the government can help by making the import of these medications little easier with flexible registration and shipping formalities. This will only serve the interest of the patients and not for profit of businessmen or hospitals. Authorities concerned should also consider providing fast track release of spare parts of life-saving equipment, as these can aid in rapid diagnosis and treatment.

The weakest spot of cancer management in Bangladesh now is lack of an advanced molecular diagnostic laboratory with immunohistochemistry of cancer histopathology. Government needs to initiate this with strong research wing to back it up. Without a prompt and correct diagnosis, confused cancer patients keep on visiting centers home and abroad and eventually their diagnosis and treatment get delayed. Most of them come to us at a late stage when we cannot give them the curative treatment; we end up giving them palliative treatment at their terminal stage. We can get proper diagnosis and unique results, distinctive to our local context, if a proper molecular histopathology laboratory is launched in the country.

I believe, it's the responsibility of the medical community to create a sense of confidence and faith amongst our country people about the available convenient quality treatment that we have to treat cancer patients in their own homeland where they can have the comfort of presence of their family members.

What are the unique facilities that United Hospital offers for cancer treatment?

After United Hospital was launched in 2007, we prioritised on specialised treatments mostly in heart, kidney and cancer care. Cancer treatment around the world is now based on Nuclear Medicine specialty. The best and most detailed method of diagnosing cancer presence and spread is by nuclear PET CT scan, thereby enabling doctors to act quickly to set a technical course of action. For PET CT scan one needs a tracer called FDG (fluorodeoxyglucose) which is produced in Medical Cyclotron. United Hospital invested around BDT 100 crore to install the first and only Medical Cyclotron in 2011 and has been serving the country for the last seven years producing FDG, not only for itself but also for other six centers i.e. NINMAS, INMP at Savar and Dhaka Medical College Hospital, Medinova, CMH, Apollo. We feel immensely proud when in international forums it is publicly acknowledged that Cyclotron is available in Bangladesh as United Hospital represents Bangladesh, having the lone Cyclotron of the country.

We are at par in radiation treatment with renowned hospitals worldwide. United Hospital is the only hospital of the country having the latest True Beam radiation technology that offers integrated imaging, beam delivery and motion management resulting in improved precision and speed of treatment reducing radiation time and increasing radiation safety. We can provide radiation with Respiratory Gating which is significant for lung and breast cancer treatment, since these tumors are always on the move due to breathing movements. Respiratory Gating synchronises this momentum by using measurements of the patient's breathing cycle to accurately identify the region in which the tumors will move, thereby giving precise radiation there killing the cancer cells while keeping the good tissues intact. We further offer precise & accurate IMRT, IGRT & Rapid Arc (VMAT) therapy. We do SRS (stereotactic radiosurgery) for inoperable deep brain tumours without the need to open up the skull or damaging brain matter and also SBRT (stereotactic body radiation therapy) for liver cancers. All these unique modern facilities enable us to provide more accurate, safe and convenient radiation therapy for cancer patients.

United Hospital also has a unique PET based treatment planning system (TPS), from where cancer patients' radiation treatment plan is devised by correct identification of the exact location and accurate measurement of tumor or cancer. Since the country is lacking qualified radiation technologists and physicists, with United Hospital's TPS, we have the facility to provide on-line guidance to other radiation centers to provide accurate radiation for their patients.

How do you think, our people can be made more aware of cancer and its prevention?

The government, along with private stakeholders, need to strengthen the movement to raise awareness about preventive measures, like vaccines for cervical cancer, lifestyle modifications, smoking restrictions, which can keep cancer at bay. We also need to raise awareness about environmental pollution. Regular basic screenings can help prevent or at least diagnose the presence of cancer at an early stage.

Coordinated efforts need to be taken by people from all walks of life, be it the community and religious leaders, teachers, doctors and other members of the society, to remove the myths concerning cancer. People still believe that cancer is contagious, whereas it can only prove to be contagious when the cancer afflicted organ is transplanted in another healthy patient. Then there is a misconception that only smokers will have lung cancer. Whereas, though active smokers are much more at risk of getting lung cancer, a non-smoker can also have it. 

Please tell us how we can strengthen palliative care ensuring family & friend support, mental & social support for cancer patients.

Cancer patients at terminal stage are at risk of suffering unbearable pain. Palliative care gives them relief of symptoms like reducing pain, easing breathing discomforts, assisting sleep etc thereby giving them as much comfort as possible. Physical medication is still very much a part of palliative care, contrary to the misconception that palliative care is only about consoling patients or offering mental support.

The biggest strength for palliative care comes from patients' family and friends. While hospitals in Bangladesh are commonly providing palliative care of different degree, I believe nursing homes, specifically dedicated for palliative care, should be established, so that terminal cancer patients get the best possible care and focused attention. Apart from family support, trained dedicated nursing and counseling is imperative. We should also encourage a culture of voluntary social worker care-providers from the community for patients on palliative therapy.

How can the private sector hospitals play a role in providing affordable facilities for the marginalised population?

Cancer treatment unfortunately is very expensive, considering the investments made for this. However, in order to provide affordable cancer care, a regimented team effort is essential which would need to be accountable. We at United Hospital are ready to extend our full cooperation for public-private partnership if the government establishes such a platform.

United Hospital currently is offering PET CT scan at only BDT 50,000 along with discounted radiation package upholding highest quality standards for financially disadvantaged cancer patients under a special scheme offering up to 50% discounted rates. This package starts from BDT 70,000 which patients can start availing with only a deposit of BDT 10,000. These rates are the lowest among all the private cancer care centers of the country. We want to ensure that no cancer sufferer leaves our premises without treatment and that they can continue and complete their treatment.