Why is cancer the number one cause of death in Pakistan? Although a number of men and women die from cancer, especially colon, prostate, lungs and breast cancer, a cancer diagnosis does not always have to be an automatic death sentence. It is much more treatable if it is caught by doctors at an early stage, and when relatives and friends of the afflicted, and society as a whole, behave positively towards them.
To ensure positive behaviour towards cancer patients, social groups can be formed that may play a vital role in the treatment of the disease. They can fulfil one of the basic psychological needs for survival; a sense of belonging. A feeling of association with a loving social group can motivate cancer patients to persist, to struggle for life, and can also affect their mental health positively.
During my medical practice and visits to the remote areas of Pakistan, especially Bajour, Charsada, Sawabi and Mardan, I have noticed that cancer patients are in miserable conditions, just because they lack hope and social support from their relatives and society. As a paediatrician, I have also seen many cases of leukaemia, brain and renal cancer in infants and children, and seen their parents struggle without any kind of active and systematic support from the people around them. Hence, it is high time that we initiate positive activities and organise social groups in order to support cancer patients and their families.
WHO states that there are four key components to cancer control: cancer prevention, early detection, diagnosis, treatment, and palliation. Developing countries, particularly Pakistan, are facing major challenges in each of these four areas. As we know, cancer mortality varies significantly between the developed, developing, and under developed areas within Pakistan. However, a key challenge when trying to define the scale of the problem of cancer control in the country is the lack of reliable data. In this situation, formation of social support groups will help in collecting the necessary information needed to understand the scope of this problem.
A complex group of diseases like cancer must be tackled on multiple fronts, by multiple partners. We should realise that this problem in the developing world is so huge that at times it is difficult to find the right way to even measure it.
According to the WHO, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, around 70 per cent, or 5.5 million, are now occurring in the developing world. A disease once associated with affluence, now places its heaviest burden on the poor.
For public health, the complexity of cancer control increased enormously following the shift of the disease burden from wealthy, to less affluent countries within the world, and from relatively developed areas of Pakistan, to its under-developed areas. According to the latest WHO statistics, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, around 70 per cent, or 5.5 million, are now occurring in the developing world. A disease once associated with affluence, now places its heaviest burden on the poor.
On average, 70 per cent of cancer patients in rural areas of Pakistan, mainly in Bajour, North & West Waziristan, rural areas of KP, South Punjab, interior Sindh, and Balochistan, are diagnosed at a very late stage of the illness, when treatment is no longer effective. The only possible intervention is palliative care, including pain relief and control. Even this intervention fails to reach more than 50 per cent terminally ill cancer patients every year in Pakistan.
We can also measure the problem in terms of the almost total lack of response ability in the country. There is a lack of preventive measures, public education, screening, and early detection, as well as diagnosis and treatment, whether involving surgery, radiotherapy, or chemotherapy. Generally, in our society, such treatments are usually reserved for those rich enough to seek specialised care abroad.
The demands of long term care for a disease like cancer are simply crippling, and it can become a huge financial burden for the patients, as most of them have to pay for care directly out of their own pockets.
For many years, healthcare in Pakistan, at both the provincial and federal level, has been all about the short term. It has been designed to cope with outbreaks of epidemic and infectious diseases, like dengue, cholera, and hepatitis etc, which leaves our governments without the necessary financial resources, facilities, equipment, technology, infrastructure, staff, or training to cope with chronic care for cancer patients. This situation again demands for the creation of effective and active social support groups.
These groups should have the assistance and active participation of doctors, especially experienced oncologists, as well as psychologists, nutritionists, philanthropists, former cancer patients and other members of society that might want to lend a helping hand to the cancer patients in the country. Surely, well-organised social support will only enhance the quality of life of those afflicted by this terrible disease and give them a reason to fight on.
These social support groups can help fight against cancer on three basic fronts. First is by providing emotional assistance through expressions of love, empathy, and trust; second, by providing instrumental assistance through tangible aid and services; and third, through providing information about the disease, its preventive methods, and potential treatments available.
The writer is a MBBS, MPH, MCPS (Scholar) of the Al-Dar Hospital Madina Munawara, Saudi Arabia
Published in Daily Times, August 10th 2018.