Procedural delays threaten to make life-saving treatment unaffordable for many
Every year around 200,000 patients are diagnosed with cancer in Pakistan, the most prevalent kind being breast cancer which makes up an estimated 20 percent of all cases, followed by bladder and cervix/uteri.
Speaking at a seminar, titled ‘I am and I will,’ held at Sir Ganga Ram Hospital recently, Dr Shamsa Humayun, the head of Gynaecology Department, spoke extensively about how incidence of preventable cancers is on the rise. The reasons she cited included insufficient proactive preventive measures and a general lack of knowledge regarding prevention, early detection and treatment routes.
“Cervical cancer is easily preventable; however, most people do not know this,” The practising gynaecologist explained that many patients come to them at an advanced stage of the disease. “Most women reach the hospital too late,” lamented the doctor.
Nearly all cases of cervical cancer are caused by a sexually transmitted disease (STD) called the human papillomavirus or HPV. There are over a hundred types of HPV, of which fourteen are high-risk type for cancer. Dr Shamsa told the audience that “type 16 and 18 HPV can cause pre-cancerous lesions that can progress to invasive cervical cancer if left untreated.” There are ways of preventing disease onset through vaccination and screening, but both are difficult to access in Pakistan.
HPV vaccination is readily available in high-income countries, and there are programs in place to ensure that women as young as 12 years old are vaccinated effectively. Interestingly, Rwanda, an east African low-income country, may just become the first in the world to wipe-out cervical cancer. Since 2013 the country has made cervical cancer prevention a priority health concern.
“The HPV vaccine was withdrawn from the Pakistani market by medical companies,” says Dr Humayun. The doctor blames a lack of awareness drives for current unavailability of vaccination. “With no primary prevention methods in place, we look to secondary options, but screening and testing costs are high, making them equally difficult to access,” adds the gynaecologist.
According to Dr Humayun, “cervical cancer is a public health emergency and must be treated as such.”
The target of the seminar organised by SGRH’s Oncology Department was to counter misinformation, stigma and a fatalistic attitude resulting from a cancer diagnosis. Dr Usman Noor, an expert, said, “there needs to be a holistic approach towards treatment. Establishing a connection with your patients is the first step.” Dr Noor spoke passionately about the impact of keeping a positive mindset on receiving a cancer diagnosis, which is only possible through family and healthcare practitioners’ support.
With only a few dedicated oncology departments in government hospitals across the country in major cities, patients face many challenges. Dr Saif ur Rehman, a leading oncologist who recently transferred from Bahawalpur to SGRH Lahore, is acutely aware of the problems emerging from inadequate infrastructural facilities in government hospitals. “There are no beds available for cancer patients at SGRH.” Other hospitals, including Mayo and Jinnah, have proper wards, but the ever-increasing number of patients coming from all over the Punjab is continuously putting pressure on the healthcare system. “We have requested the hospital authorities to build a proper ward with enough beds to cater to most patients who come to us for treatment,” the oncologist says.
The added financial cost of cancer treatment can have long-term economic implications for a low/ middle income household.
Cancer treatment can be very hard. From diagnosis to treatment, the route can be long and expensive. Government hospitals are there to make the process easier by cutting down the cost of treatment. “We have a surgical department and can also provide medical support through injectable and oral chemotherapy to patients,” said Dr Aneela Dewan, a medical officer at SGRH.
The treatment plan of two patients diagnosed with the same type of cancer could vary depending on their age at the time of the diagnosis, the stage of their disease, side-effects of the treatment and possible quality of life post-treatment. Not all patients need chemotherapy; some may require radiation or other targetted therapies. “A patient needing radiation is referred to another hospital as we do not have the facility here,” added Dr Dewan.
To design a department for radiotherapy is not a simple task. “There are many factors to consider when building a radiology unit. From wall-thickness to installing proper insulation, there are several engineering and design-related details to take into account,” added the MO.
Often patients who come to the government hospitals for cancer treatment belong to low/ middle income households. The cost of surgical procedures is often bearable; however, a post-surgery treatment session could cost anywhere between Rs 12,000 and Rs 20,000. Most patients cannot afford the price of treatment. Such cases are forwarded to Bait-ul-Mal and the Chief Minister’s Zakat fund. In recent years, the process of getting financial support through the two funds has become incredibly challenging.
Shamim Bibi, 60, was diagnosed with breast cancer in 2020. Every few weeks, she travels to Lahore from her hometown in Gujranwala for a chemotherapy session at SGRH. “My sons are bearing the cost of my treatment, as my husband is unwell and cannot work,” Shamim tells TNS.
The doctors at SGRH had referred Shamim’s case to Bait-ul-Mal, considering her financial situation. It took almost a year for the first cheque to come through. In the meantime, her children have been bearing the burden of treatment. “The first cheque they approved is for Rs 78,000. It took us many visits to get the approval. They would not let us enter Bait-ul-Mal offices, citing the pandemic as reason,” Shamim remembered.
A meeting of all provincial heads of Oncology Departments is regularly held at SGRH. The doctors’ present estimate budgets they require for patient treatment through Bait-ul-Mal and the dedicated Zakat fund. The meeting has had to be postponed several times due to the ongoing pandemic. “We have not been able to get together in the last quarter. However, as the situation improves, we will have the meeting while following the SOPs,” said Dr Saif ur Rehman.
Cancer takes a huge toll on a person’s physical health. It can also affect their mental well-being. The added financial cost of cancer treatment can have long-term economic implications for a low/ middle income household. Facilitating Oncology Departments in government hospitals is crucial. The government should also aim to build more Oncology Departments in hospitals across the country so that patients do not have to travel long distances every time. Moreover, investing in timely prevention awareness campaigns needs to be on the agenda.
The writer is a staff member