By Dr. Caleb Harris
World Cancer Day, February 4th, 2024
The editor of this daily, through her article (Importance of debate in Khasi society, ST dt.26.01.24) rued that rather than waste our energy arguing on the languages in the state anthem, we ought to look at the real issues confronting Khasi society. Some of the issues, according to her, are growing poverty, increasing school drop-outs and rising drug-dependency in the states. While I totally agree with her point of view, I feel that she has missed one of the most important issues plaguing the Khasi society – high cancer rates.
I wish to substantiate my claim with the fact that while poverty, illiteracy and drug-dependency are important issues which need to be addressed, none of these are directly responsible for the death of our people. As per data from the National Cancer Registry Program (NCRP) Report released in 2020, East Khasi Hills has the second highest number of cancer patients in India, with 228 males per lakh population being afflicted by cancer. To give another perspective, one in four men below the age of 74 in East Khasi Hills is likely to develop cancer. This results in the death of 95 men per lakh of population, as compared to 22 deaths per lakh of men in Delhi. It is important to note that the proportion of patients who die due to cancer in Meghalaya is almost thrice that in Delhi.
One of the reasons attributable to the higher death seen in the cancer patients of Meghalaya (as compared to other regions) is the type of cancers prevalent here. Meghalaya tops the country in the rates of esophageal (food pipe) cancer, with ten times the national average of this particular cancer. Esophageal cancer is deadly, with hardly one-fifth of the patients living to see the fifth anniversary of the cancer diagnosis, despite the best treatment possible.
The treatment for esophageal cancer is multidisciplinary, meaning that the patient may need a combination of surgery, radiotherapy and chemotherapy for achieving best chances for cure. While it is heartening that we can offer such treatment for our patients here, we are at times overwhelmed with the number of patients who seek such treatment. Besides, most of the patients come at a late stage. It is important to understand the symptoms of this cancer. Difficulty or pain in swallowing, especially in a person who uses kwai (betel nut), tobacco or alcohol, is a symptom which should not be overlooked. If a patient with esophageal cancer comes at this stage, in some cases only surgery may suffice. However, as commonly happens, patients tend to ignore this and end up being able to take only soft food, followed by a stage when it is impossible to take anything but liquids. At this stage, patients will invariably need multidisciplinary treatment.
After a battery of tests, patients are subject to around five weeks of radiation therapy along with chemotherapy(injections) after which they are taken up for surgery. During surgery, the entire esophagus (food pipe) is removed and the stomach is fashioned into a tube which replaces the esophagus. While this was traditionally performed through a big incision on the chest (thoracotomy), we are able to do this through thoracoscopic(key-hole) surgery at NEIGRIHMS, resulting in much lesser pain and early recovery. The patient must modify his lifestyle, by having small, frequent meals in order to live a healthy life. But the lurking danger of a disease recurrence remains.
Sadly, many patients come at a stage when they are unable to even swallow their saliva, carrying a spittoon around and many others with a communication between the food pipe and the wind pipe, resulting in constant cough. At this stage, surgery is usually not possible, and the patient may be administered only chemotherapy to keep the disease at bay. We can insert a metal tube(stent) to open the blocked segment but even this may be temporary in many patients as the disease may grow into the stent. Its evident that if patients present early, the treatment may be simpler, with the patient’s chances of ‘cure’ being higher.
One must remember that all these treatments are intensive, affecting the patient nutritionally, emotionally and financially. While some patients are highly motivated, many tend to get depressed and a few even stop the treatment, not wanting to undergo the stress associated with treatment. The financial stress is felt by not just the patient but the entire family. At NEIGRIHMS, thanks to being a government institution and the insurance schemes available, we do not turn away any patients due to lack of finances, but there is the burden of loss of livelihood for the patient and caregivers, apart from the expenditure on travel, food, accommodation, etc. If the patient is the breadwinner of the family, one can imagine the impact on the economy of the family, and with so many families being affected, the economy of the state is affected too.
It is easy to gauge that if a patient is detected early, lesser treatment may be required and hence the cost of treatment would be low, with better outcomes. Wouldn’t it be better if we diagnose the cancer before the onset of symptoms? This approach is called screening, which has been established for cancers of the breast, oral cavity, uterine cervix and lung. It is important to note that screening has been found to be effective in ‘high risk population’- those with higher risk than the rest of the population. While higher age is a risk factor for some of these cancers, many others are at risk due to use of tobacco.
Screening is a good strategy to reduce the ill effects of cancer treatment and increase the chances of long-term survival, but the smarter move would be to reduce the risk of cancers by refraining from use of tobacco, kwai (betel nut) and alcohol. According to the NCRP report, 70% of cancers in Meghalaya are associated with the use of tobacco, meaning that if tobacco is not used, we may have only one-third of the cancer patients we currently see.
World cancer day, observed on February 4th annually, is an initiative of the Union for International Cancer Control (UICC). The theme for the past three years has been ‘Closing the gap in cancer care’. The last year of this campaign is all about bringing attention to a higher level—literally. We need to raise our voices to engage our leaders. Now that we have knowledge and a united community by our side, we are ready to shake the very foundations of injustice—to become lifelong advocates fully equipped to push for lasting change. Together, we will make sure our leaders know that we demand a commitment to prioritising cancer, to creating innovative strategies designed to confront inequity and to investing our resources to achieve a just and cancer-free world.
We need more voices debating on what needs to be done to reduce the burden of cancer in Meghalaya, and that cancer care services are available to all citizens of the state. It needs to start with an effort to prevent cancer by ensuring awareness regarding tobacco, betel nut and alcohol, in addition to strict enforcement of anti-tobacco laws. This is probably the most important topic to be discussed by society. The pressure groups need to take this up too, as this is an important effort in saving the jaidbynriew.
Dr. Caleb Harris is M.Ch.(Surgical Oncology) Additional Professor, Surgical Oncology, NEIGRIHMS (Views expressed are personal. Email: [email protected]