LAHORE     -   Cancer is one of the oldest diseases in human history, a burden that we have been trying to manage formany gen­erations. The earliest evidence of can­cer can be found in Egypt, dating back to 3000 BC but it was not until 1900s that the field of oncology started devel­oping and people began to raise a voice to unite against cancer.Over time, high-income countries have had their share of failures and successes against cancer and they have come a long way in shap­ing the history of cancer treatment. On the other hand, in addition to the prob­lems faced by the high-incomecoun­tries, cancer in the low- and middle in­come countries face a different array of problems—making an already complex disease even more challenging. 

DISEASE PREVALENCE

According to the World Health Or­ganization (WHO), the toll of cancer is greater in low- and middle-income countries, where people develop chronic diseases “at younger ages, suf­fer longer – often with preventable complications – and die sooner than those in high-income countries.” Ac­cording to an estimate, by 2040, the global burden is expected to grow to 27.5 million new cancer cases and 16.3 million cancer deaths. In Pakistan, it is estimated that there are around 180,000 new cases in a year and over 117,000 deaths from cancer.The mag­nitude of the problem demands that we make afocused and dedicated effort to fight cancer in LMICs. 

CHALLENGES IN LOW- AND MIDDLE-INCOME COUNTRIES

One of the major barriers for cancer patients in poverty stricken region­sis theproblem of “access” —they do not have enough funds to see a doctor because either reaching a hospital re­quires travel expenses or they cannot afford the costs of diagnostic tests and doctors fee; leading to late diagnosis of the disease, causing avoidable loss of life. Due to a lack of awareness and stigma, they are more likely to ignore certain signs and symptoms until it is too late. Moreover, cancer patients from underserved areas often do not have access to nutritious food leading to malnourishment, which makes can­cer treatments, such as chemotherapy, difficult to tolerate. Having your chanc­es limited due to your economic back­ground adds to the tragedy of suffering from cancer. Lastly, a crucial aspect of battling any disease, especially can­cer, is the patient’s fighting spirit and mental well-being. The burden of pov­erty adds to the burden of disease and weighs down on the patient and their family psychologically.

SKMCH&RC EASING THE BURDEN OF CANCER

In Pakistan, the Shaukat Khanum Me­morial Cancer Hospital and Research Centre (SKMCH&RC), Lahore, opened in 1994 as the nation’s first specialist cancer hospital.The Hospital’s mis­sion statement reflects remarkable foresight—itsums up how it hopes to address the above discussed issues: “To act as a model institution to al­leviate the suffering of patients with cancer through the application of mod­ern methods of curative and palliative therapy irrespective of their ability to pay, the education of health care pro­fessionals and the public and perform research into the causes and treatment of cancer”.Over the past twenty-eight years, SKMCH&RC has continued to provide quality treatment to under­privileged cancer patients—over 75% of whom receive financially support­ed treatment each year. TheShaukat Khanum healthcare system admits patients for treatment based on clini­cal guidelines, irrespective of their socio-economic background.It has established walk-in clinics providing cancer-screening facilities in Lahore, Peshawar, and Karachito allow easy ac­cess to cancer patientsand to fast-track cancer diagnosis.If patients are unable to cover the cost of treatment, and ma­jority of cancer patients in our country form this group, they are assessed for financial support and are provided the care they deserve, free of charge.

Prevention and early detection are important tools as part of any strategy to effectively fight cancer. SKMCH&RCconductscancer awareness campaigns for various types of cancers, focusing on commonest cancers that are preventable or have a high cure rate if detected early, namely tobacco-use related cancers and breast cancer. The Hospital organises awareness sessions in colleges and poster competitions in schools to raise cancer awareness amongst youth at an early age.

PROVIDING EQUITABLE ACCESS TO HOLISTIC CARE

Cancer management requires a ho­listic and multi-disciplinary approach. Equity demands that we make efforts to provide not only similar treatment to all patients but also provide them what they need to achieve similar outcomes of treatment. For example, the problem of malnourishment is massive and can affect cancer treat­ment outcomes. The Hospital works to help such patients who have been admitted to the Hospital by provid­ing them meals as advised by nutri­tionists, irrespective of the patients’ paying power.For patients who are eligible for hundred percent finan­cial support, their food expenses are fully covered during hospital admis­sion. Lastly, SKMCH&RC has ancillary health care section that is dedicated to help the psychological wellbeing of patients.