Cancer care: When evidence is the backbone of informed decision-making

In another decade, we will truly be able to call India developed as far as cancer care is concerned, says Dr Sameer Kaul, Senior Consultant, Surgical Oncology and Robotic Surgery at Apollo Cancer Institute, New Delhi, India. Dr Sameer Kaul is among the busiest oncologists in India. When he’s not with patients, he’s talking to them on the phone. “If America, with all its monies, doesn’t have enough money for standard healthcare, you can imagine where we stand. Affordability is important, but what’s more important is the value that justifies the patient’s time and efforts,” says the Senior Consultant, Surgical Oncology and Robotic Surgery at Apollo Cancer Institute in New Delhi, India. Lauded with numerous awards and prestigious fellowships, Dr Kaul’s abundant passion, commitment and dedication to work comes as no surprise. As the Founder-President of a non- government cancer foundation, the Breast Cancer Patients Benefit Foundation, the tireless maverick also runs a Central Drug Repository that offers subsidised cancer care to the economically underprivileged. In an exclusive, wide-ranging interview with HealthLEADS, Dr Kaul talks about technological advancements, the importance of homogeneous distribution of health services, and the need to strike a balance between work and play. “Oncology could have easily pulled me down, especially after three decades of clinical practice, but I countered that with other things like playing Kashmiri drums,” quips the serial multi-tasker. Edited excerpts from the interview:

What made you choose surgical oncology?

Honestly, my first choice was to become a gynaecologist. Or else, could have taken up cosmetic surgery. However, back then, my father got diagnosed with urinary bladder tumour, for which he underwent nine surgeries. I saw my father grappling with cancer for 14 years. Perhaps, emotionality defeated my choices. Secondly, I always had a passion to do things differently. During that time, oncology wasn’t so big and we didn’t have much infrastructure to treat cancer, especially in Kashmir, where I had grown up. So, considering it to be a new and different subject, I opted for it.

How has the cancer care scenario evolved in India?

The attitude of resignation or giving in to a cancer diagnosis as a near-death situation has changed. Research has also come in a big way and so has evidence, which is the backbone of informed decision-making. We may not be perfect, but we are much better than we were a decade ago. For a long time, we didn’t bother about data. Now, there’s a National Cancer Registry and registries at the state and community levels. We have numbers to show which cancers are prevalent in our country and who is getting them, in terms of age groups and regions. Accordingly, we are able to take informed decisions regarding prevention programmes. Similarly, drug trials are faster and better because of the use of algorithms, artificial intelligence and more importantly, increased connectivity across the globe. We are thus able to save a lot more lives and improve the quality of cancer care.

What are the technological advancements in cancer treatment?

There have been advancements at every level - diagnostics, genomic analysis, molecular labs that identify mutations in various cancers, targeted drugs and immunotherapy. With immunotherapy coming to the fore, you can better coax the immune system to fight cancers more effectively. Cancer treatments have better focus, fewer side effects, and improved quality control. Tyrosine Kinase inhibitors (TKIs) in targeted therapy are a reality for my patients in India today. Similarly, medical gadgets, remote monitoring devices, augmented reality and proton therapy machines are available in our country now.

How would you rate the infrastructure in terms of human resources in the Indian context?

We are inadequate as far as the classic doctor-patient ratio is concerned. We are also inadequate in terms of technical infrastructure, but the situation is improving. Since the Government of India started medical colleges in various districts, we are hoping that things will get better. Currently, we are going through a transition and it’s a matter of another decade before we will truly be able to call ourselves developed as far as oncology care is concerned. That said, our country is large and wide, so homogeneous distribution of services will continue to be the biggest challenge.

Nearly 1 in 28 women are likely to develop breast cancer during their lifetime. How can this risk be reduced?

Breast cancer has overtaken cervical cancer to become the number one cancer in India. Every woman must be aware of the risk factors and know if she is at risk. If there’s a family history, she needs to get screened regularly. Also, if she is obese, or if she already had cancer in one breast, the chances of getting it in the other breast are higher. Other risk factors include ageing as well as marriage and childbirth at a later age. However, if diagnosed early, breast cancer can be treated and cured. Therefore, mammograms and screening programmes are important. When I started my oncology practice, about 85 per cent of breast cancer patients were diagnosed either in stage 3 or stage 4, but now those numbers have come down to 59 per cent. This means we are on the right path to diagnosing cancers early and treating them aggressively.

Could you share some lifestyle recommendations to help prevent cancer?

As far as the etiology of cancer is concerned, lifestyle and history of the disease are important factors. Lifestyle entails what you eat and drink, even if it is tea. For instance, if you consume too much tea, it leads to an excess of tannin and acid, which corrode the inner lining of your gastrointestinal tract and increase the risk of cancer. So having a balanced approach is crucial. I would recommend regular exercise and cutting down on tobacco, alcohol and red meat. Most importantly, listen to your body. If you don’t, you may miss the early symptoms and land up with stage 2 or stage 3 cancer.