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Reports |
World No Tobacco Day was observed with the organization of ENT camps, a colouring competition for street children and a workshop on tobacco cessation. A report follows. First held in 1988 and observed annually on 31st May World No Tobacco Day (WNTD) is the premier global event established to call attention to the detrimental effect of tobacco use on public health and to initiate steps to reduce individual tobacco-dependence. The Tobacco Free Initiative proposed that WNTD 2004 focus on tobacco and poverty. The direct relationship between tobacco and death and disease is well documented. Less attention is given to the ways in which tobacco increases poverty. Tobacco is the fourth most common risk factor for disease worldwide. The economic costs of tobacco use are equally devastating. What starts as a choice becomes an expensive necessity diverting meager funds which should have gone for nutrition, education and savings. A 1994 report said that tobacco use resulted in an annual global net loss of US$ 200 thousand million, a third of this loss being in developing countries. In India, the problem is tragically highlighted in rampant tobacco addiction in very young street children who are attracted initially because tobacco chewing helps to stave off hunger pangs. In the past CPAA has found children as young as 8 years old exhibiting signs of tobacco addiction, leucoplakia and submucosal fibrosis, an inability to open their mouth more than one finger. Keeping in mind this year's theme, CPAA organized a colouring competition for 125 street children at Cirkus Cirkus. Film star Arshad Warsi was on hand to present the winners with their prizes and also to urge them to avoid tobacco addiction. Many thanks to Unity Charitable Trust, who presented the gifts to the children. 11 ENT camps were held for various groups like Air India Cabin Crew, Naigaon Police, Arthur Road and Byculla Jail inmates, at the Mantralaya etc. in Mumbai, screening individuals for early signs of oral cancer due to tobacco abuse. On May 31st a free ENT Cancer Screening camp was conducted at Hutatma Chowk for the general public. Details are given under Departmental reports below. Over 50 doctors attended a "Tobacco Control and Cessation" workshop for General Practitioners at the Ambassador Hotel on 30th May. The programme included talks and a role play session. Dr. P. C. Gupta of Tata Institute of Fundamental Research spoke on "Role of GP's in Tobacco Control". Dr. Shastri from Preventive Oncology department of Tata Memorial Hospital spoke about "Cessation." Dr. Sultan Pradhan, Head of Surgery, Prince Ali Khan Hospital spoke on "Pre-cancerous Signs & Symptoms related to Tobacco." Counselors from the "Tobacco Cessation" clinic of Tata Memorial Hospital enacted a typical session. The NGO "Umang" performed a Street play. Ms. Shoba John from Path Canada, facilitated the workshop which was greatly appreciated by the participants.
Visit to Queensland Cancer Fund, Australia by Anita Peter Ms. Anita Peter, General Manager, CIP was awarded the UICC's APCASOT fellowship to study the methodology utilized to combat tobacco issues and cancer screening at the Queensland Cancer fund, Australia and incorporate them in CPAA. She was one of two persons chosen from among applications worldwide and visited Brisbane for ten days during May. The programme helped her to gain insights into the activities conducted by the Queensland Cancer fund such as the Helpline, Fundraising, Quitline, Public Affairs, Patients Series, Information and Medical Support System. She visited breast and cervical screening centres, palliative care hospitals, lodges, hospitals and treatment centers at the head office and regional offices. The visit helped her to appreciate the work in Australia and also giving her the opportunity to discuss similar programmes by CPAA. Talk on Surgery by Dr. Mehul Bhansali As a part of our efforts to update our knowledge on cancer related subjects, Dr. Mehul Bhansali, oncosurgeon at Jaslok, Cama and Albless and St. George Hospitals, was invited to address a group of CPAA employees and volunteers from different NGOs and hospitals at Pikale Nursing Home, Mahim. While newer treatment options are constantly being introduced, such as laser surgery, immunotherapy and gene therapy, surgery remains the best treatment for cancer. For Head and Neck cases, for example, it provides a 40% success rate, to which other modalities such as radiation and chemotherapy can add only 20% and 10 % respectively. If detected early, surgery can provide cure in 90% of cases irrespective of site. Modern treatment has become more and more effective. While prognosis used to be measured in terms of 5-year survival rates in the past, the effectiveness of today's treatment modalities, early detection and better awareness ensure better survival rates. Examples have been seen where cases relapsed after 23 years, were retreated and continue to do well. Tumour evaluation typically begins with a clinical examination. Biopsy histology, study of locoregional spread, metastatic workup follow before the treatment modality can be determined. Dr. Bhansali emphasized the importance of proper evaluation procedures. Too often symptoms can be confused with tuberculosis or lymphoma causing delays in treatment. Histological proof from a reputed pathologist is a must. Most doctors insist that tests should be conducted by or that previous blocks and slides be seen by reputed pathologists. Study of locoregional spread gives insight into tumour biology, i.e. whether it is aggressive (fast growing) or not. Typically tumours in the voice box are slow growing where as tongue cancers progress very fast. Not all patients need sophisticated tests such as bone scan to check metastatic spread unless symptoms demand it. However, in some cases such as stomach cancer, these tests are mandatory since ascites or liver metastasis can render cases inoperable. The cost of incomplete surgery is 75% of a complete surgery, so it is unfair to the patient if such investigations are not done and the patient proves to be inoperable in the theatre. Finally the doctor must decide the level of success possible-whether it will be curative or palliative. Size and staging for different cancers can give different prognosis. For example a stage IV cancer of the buccal mucosa can be operated where as a breast cancer may be palliative. Even so, surgery is indicated if only to relieve unbearable symptoms such as removal of obstruction in stomach cancer to stop vomiting. A tracheostomy may be indicated to relieve breathing difficulty. Dr. Bhansali went on to explain the TNM system of staging, which is derived from clinical examination/CT scan or surgical pathology. The first number, T1-4 indicates the extent of the primary tumour. T1 tumour size less than 2 cm; T2 size 2-4 cm; T3 a larger size and T4 indicates involvement of neighbouring organs. N indicates involvement of lymph nodes. N0 indicates no involvement; N1 shows one node +ve and N2 indicates multiple node involvement or node size greater than 6 cm. M relates to presence of distant metastasis. 90% of patients show no signs of metastasis on primary presentation, except cancer of the pancreas and prostate. A lower stage indicates favourable tumour biology. It has been seen empirically that involvement of even one lymph node reduces survival rates by 50% for similar size tumour. Typically, a Stage I cancer has 5- year survival rate of 80-90%; stage II-60-70%; Stage III-20-40% and Stage IV-10%. In the US, breast cancer is often detected at Stage 0-a cse of a mammography showing microcalcification and prostate cancer below T1 reflected in a high PSA test result. In India, patients are still detected at Stage III and IV. Dr. Bhansali then described the treatment of some cancers. In the case of Head and Neck cancer, the site can be the buccal mucosa, hard palate, tonsils, floor, lips, but 90% of cases involve the back of the tongue which is the most difficult to detect since it cannot be seen easily. Patients only notice a problem when the tongue is fixed, they cannot swallow or there is continuous salivation. In all H&N cases, reconstruction, involving the participation of a plastic surgeon, comprises an essential adjuvant to surgery. Radiation treatment is also indicated. In the case of cancer of the larynx further rehabilitation is required in the form of prostheses to enable the patient to speak. The patient can choose between learning oesophageal speech, using a provox box or electrolarynx. The pros and cons were discussed. Cervical cancer has been largely eradicated in the west due to the success of the Pap smear test which detects the cancer at an early stage. WHO recommends screening at first sexual activity, then after 2 years and twice subsequently at intervals of 5 years. In India, unfortunately, women do not get themselves tested and so they still present with late stage cancers. A randomized trial (Milan Group) has shown that treatment results are similar for radiation and surgery. Each patient must decide which option best suits her. Radiation is less invasive, but time consuming and can result in dry vagina so a younger, sexually active lady may prefer surgery. In an obese woman or one with a medical condition such as a heart problem, surgery may be impossible. Cancer of the ovary is diagnosed by clinical examination, CT scan of the abdomen; pelvis, X-ray chest and the tumour marker test CA 125. Many women have conditions such as cysts and fibroids which are usually hormone related. Only 405% of ovarian conditions turn out to be cancerous. Stage I or II i.e. tumour is within the pelvis, is treated by primary surgery followed by chemotherapy. Surgery involves removal of ovaries, omentum and lymph nodes. Stage III or IV may require debulking followed by chemo or anterior chemo followed by surgery. The incidence of Ca ovary seems to be increasing and may be related to changing lifestyles including food with higher levels of chemicals or cholesterol rich diet. Detection is difficult. Stage I is only found accidentally, for example when the patient presents for another problem such a cyst or a benign growth. Even 8cm sized tumours are practically asymptomatic. CPAA and all the volunteers from different organizations would like to thank Dr. Bhansali for sparing the time to make an excellent and informative presentation. Prevention
and Early Detection
25 camps and OPDs were held during the month of April and 15 during May. Camps were held at GIC, Churchgate; Rotary Club of Deonar, Inner Wheel Club, Andheri; Rashtriya Chemical Fertilizer, Chembur; Stree Mukti Sanghatana, Ghatkopar; Hope Foundation, Vile Parle and BEST, Colaba and Dadar (2 each). A total of 653 people, 162 males and 491 females were screened in the camps and clinics in April and 438 people, 97 males and 199 females in May. 451 people were advised follow up. 13 OPDs and clinics were held during April and 11 during May. 192 males and 367 females were screened. 155 people were advised follow up. Two persons were detected with cancer during April. A 44-year-old lady, with breast cancer is undergoing chemotherapy. A 35-year-old man was detected with cancer of the left buccal mucosa. Both are undergoing treatment at Tata Memorial Hospital.
The Smt. Lila Kishanchand Shahani Clinical Diagnostic Centre screened 291 persons during April and 250 persons during May. 1102 tests were performed, out of which 822 were pathology tests. 160 sonography, 77 x-ray and 28 mammography investigations were carried out. 15 ECGs were performed.
During April 191 people were examined, of whom 17 had come for the first check-up and 174 for renewal check up. Rs. 1,48,949 was disbursed towards the 7 claims settled. During May 177 people were examined, out of whom 29 had come for the first check-up and 150 for renewal check-up. Rs. 1,17,801 was disbursed against the 3 claims made. 206 claims have been settled to date. Two policyholders were detected with cancer during the two months. A 75-year-old lady was diagnosed with chronic obstructive pulmonary disease with ampullary cancer and is being treated at Sunjeevan Hospital, Thane. A 53-year-old lady with breast cancer is undergoing treatment at Breach Candy Hospital. Both were registered in 1997. [Top] Patient Care
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PATIENT CARE AND REHABILITATION (SUMMARY) |
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|
|
Oct |
Nov |
Dec |
Jan |
Feb
|
Mar
|
Apr
|
May
|
|
Total
no. of patients aided |
720 |
861 |
917 |
1048 |
1129
|
1151
|
851
|
1175
|
|
Ambulance
service availed |
726 |
438 |
801 |
650 |
507
|
735
|
646
|
5
|
|
Visits
(hospital + home) |
5 |
8 |
813 |
8 |
6
|
6
|
80
|
29
|
|
Total
aid given (Rs lakhs) |
2.46 |
2.63 |
3.69 |
2.49 |
2.42
|
2.34
|
2.79
|
2.52
|
|
Medicine
(Rs lakhs) |
2.23 |
2.02 |
2.26 |
2.10 |
2.40
|
2.10
|
2.39
|
2.21
|
|
Patient
stipend (Rs lakhs) |
2.49 |
2.09 |
1.92 |
1.91 |
1.70
|
2.08
|
1.74
|
1.97
|
851
patients and 1175 patients were aided, counseled and given guidance at
our locations in Mumbai-Smt. Panadevi Dalmia Cancer Management Centre;
at Nair Hospital Radiation Centre; Cama & Albless, Wadia and Tata Memorial
Hospitals; and at Bharat Sevashram Sangh in April and May respectively.
Over 850 patients availed of ambulance facilities, including 126 patients
who availed of the stretcher service for long distances. 170 packets of
biscuits and 150 boxes of Complan and Feredol were distributed. 109 home
and institutional visits were made. 15 of our patients expired.
At Tata Memorial Hospital: Room No. 189, Golden Jubilee Block
Palliative
Care Unit at Tata Memorial Hospital
Mrunal Marathe counseled 31 patients, 21 males and 10 females during the months of April and May. 9 cases of head and neck, 9 of cancer of the abdomen, 5 cases of leukemia and 8 other cases were seen.
Out of these there were as many as 7 cases of liver cancer related to long-term alcoholism. Unfortunately, in spite of witnessing the pain of their fathers battle against cancer, the habit was carried on to the next generation and fathers were unable to convince their sons to give up this dangerous habit.
At Bai Jerbai Wadia Hospital for Children
19
new patients were registered during the month of April and 15 patients
during May. 1127 patients attended follow up of whom 907 patients are
undergoing chemotherapy. 70 patients were counseled and given guidance
and Vinaya Chacko visited 15 patients in their wards. 12 group meetings
were held. 60 patients were given packets of Complan and 75 packets of
biscuits were distributed.
87 patients were counseled and given guidance by Iva Athavia during April and 71 patients during May. 143 ward visits were made. 55 patients were provided guidance regarding alternative therapy. 8 terminally ill patients were referred to Shanti Avedana Ashram. 78 persons attended group meetings on diet and hygiene. Rs. 25,875 was donated towards radiation, medicines and special financial aid. 160 biscuit boxes, 17 packets of nutritional supplements and 10 boxes of clothes were distributed.
Nair Hospital (Radiation Department)
111 patients were counseled and given guidance at the Counseling Cell at Nair Hospital Radiation Department by Iva Athavia during April and May. 50 ward visits were made. 7 terminally ill patients were referred to Shanti Avedana Ashram. 35 patients were given information about alternative forms of medicines. Rs. 51,438 was donated towards treatment in the two months. 10 kgs sugar, dal and rice and 30 packets of Complan were distributed. The Rotary Club of Mumbai Seaface donated a PC and printer during April and Ms. Veena Doeosthale arranged for a Boyle Pulse Oxymeter and ECG machine through a Rs. 2.5 lakh donation from Larsen and Toubro. Many thanks to our donors.
Counseling at Bharat Sevashram Sangh
Iva Athavia counsels patients at Bharat Sevashram Sangh, Vashi every Friday evening. 151 patients were counseled and guided during April and May. 45 group meetings on radiation, diet and hygiene were organised. 21 patients were given information regarding alternative treatment. From this month Mr. and Mrs. Patnaik have joined CPAA in counseling efforts at Bharat Sevashram. The couple visits the center every Friday and provides valuable information on therapeutic exercises and financial assistance. Their grand daughter, Pallavi Das, also supported their efforts by performing on stage for the patients at an informal concert. CPAA joins in praising their selfless efforts.
The Rehabilitation Centre adopted 5 new patients during April and 9 new patients during May. 110 patients and their family members were given assistance. 7 cases of mastectomy were attended and breast prostheses were provided. 95 patients were given rations worth over Rs. 20,000. Rs. 22,885 was spent on teachers' salaries, for patient education and vocational training. Rs. 2.27 lakhs were spent on patients' wages and Rs. 72,024 was spent on welfare activities, conveyance and diet supplements during the two months.
Many thanks to Mrs. Kalindi Philips who donated mangoes from her farm for the Rehabilitation center employees!
Cancer Patients
Aid Association Monthly Review is compiled by Dr. Shubha Maudgal and printed
by Mr. Suresh Mishra at Saraswati Printing Press
Please
write in with your comments to: Smt. Panadevi Dalmia Cancer Management
Centre, Anand Niketan, King George V Memorial,
Dr. E. Moses Road, Mahalaxmi, Mumbai-400 011
Phone: 24924000, 24928775, Fax: 24973599,
Email: webmaster@cpaaindia.org
Famed
Bollywood actor, Vivek Oberoi has been working with CPAA as a brand ambassador,
promoting tobacco control and creating awareness about it's down sides
and talking to people about their rights under the new laws in India for
the past two years. His contribution towards this cause has won him this
year's World Health Organisation's Special Director-General's award, for
leadership in Global Tobacco Control 2004, and in recognition of outstanding
contribution to tobacco control. The award function was held at the Hyatt
on 10th June.