HEAD & NECK CANCER PART-11
(All the articles published in past are available at www.shyamhemoncclinic.com/blog/)
Question: Thank you Chiragbhai for explaining role of chemotherapy before and after surgery or radiotherapy; treatment of nasopharynx cancer; role of repeat radiotherapy; and palliative chemotherapy.
You mentioned that a number of patients are not in condition even for palliative chemotherapy. They have already been declared untreatable by surgeon and radiation oncologist. What happens to these patients? What is their survival? How should they be managed?
Ans: Excellent questions. Something not asked by doctors, not taught in medical college, very little emphasis in our textbooks. But very important for the patient and family.
WHAT DO YOU DO WHEN ALL TREATMENT WRITTEN IN ALL TEXTBOOKS HAS FAILED OR IS FAILING?
How long do you keep on “trying”? and what happens to the “suffering” while you are trying and waiting for something to work? Should these patients keep on suffering till something works OR till life ends?
This question is applicable to all cancers, and even non cancer diseases. Proportion of patients who need answers to these questions varies by the disease. For example, only few patients will end up in this condition, where cure rates are very high such as Hodgkin lymphoma, skin cancers…Same questions also apply to debilitating cases of stroke, kidney failure, end stage lung disease like severe emphysema or congestive heart failure or advance rheumatoid arthritis…
Fortunately, there is a branch of medicine, still unknown to most our readers, known as PALLIATIVE CARE. In USA, similar to other degrees, one can also get formally trained and obtain MD degree in palliative care. And take care of all of the above noted situations and more…
Que: Wow! That is so nice to hear. Where do these doctors practice?
Ans: There are large centers in developed countries to take care of such patients, known as HOSPICE CENTER OR PALLIATIVE CARE CENTERS. Apart from that, these doctors are frequently involved in care of other hospitalized patients, outpatient care, home care etc. Large bulk is cancer patients, but also cardiac, neuro, lung, kidney are a substantial number.
Coming back to your earlier questions, today in India, most such patients are left to suffer until death, as treating oncologists and family doctors both are not trained, nor aware of existing facilities for palliative care. Families are asked to take patient home and “seva karo”. Depending on the stage and other factors, patient may live in this condition for few weeks to several months to even few years. Suffering that they go through, leaves very deep scars in family and friend’s minds also. All life they also silently suffer, feel guilty, and spread the negative message that cancer means extreme suffering.
GOOD NEWS is palliative care movement is gaining momentum in India. Kerala has hundreds of such centers, very evolved and providing India centric care, lead by Dr Rajagopal. Gujarat has few centers now. GCRI, Ahmedabad has been running a center in vasna for many years and now they have even started formal training, lead by Dr Geetaben Joshi.
We run a center known as KARUNALAY, run by Shyam Oncology Foundation. Interested readers can visit our website www.shyamoncologyfoundation.org for more details of what happens at the center. Broadly, we take care of their physical, psychological, social, spiritual suffering. There are fairly clearly laid down scientific principles of palliative care. This is not JUST TENDER LOVING CARE, where you just “be nice” to a dying person, or “keep them sedated” so they don’t feel anything. At admission, proper history, examination and assessment of their issues is done by a team, led by Dr Bhavish Khara, who has been with us since inception, that is over 3 years, and has been managing these patients with wonderful knowledge and compassion. It is amazing what specific knowledge, counseling and compassion can do, how it can transform a patient from extreme pain and worry into a happy and smiling person. And leave family members with sense of satisfaction that they did the right thing for their loved one. Medical care includes issues like pain management, wound care, nutrition etc. I would urge all doctors to visit our website, see a video about what palliative care means, read testimonials of patients and family members, and preferably visit the center once personally. This 10 bed center is run in the premises of Thakershy Charitable Trust Hospital, near Shivranjani, Ahmedabad, with their very active support. Center also provides outpatient care and home care for patients who don’t want hospitalization. AND THE BEST NEWS FOR MANY WOULD BE THAT ALL THIS CARE IS PROVIDED COMPLETELY FREE OF COST, NOT EVEN REGISTRATION FEE. Outpatient, inpatient, home care all are FREE. For inpatients, this includes not just medical care, but also food, accommodation, clothes, counseling, entertainment etc and free accommodation and food for one relative as well.
November 8th 2015.
Dr. Chirag A. Shah