JK’s callous admin yet to make SCI operational; patients suffer    

By Nazir Ganaie

With cancer emerging as a major health threat across the world, Kashmir is witnessing a surge in the number of cases in the past few years with lung cancer topping the list.

Every year there’s a marked increase in the number of cancer patients registered in the Valley’s premier tertiary care institute, SKIMS, where an increasing number of cancer patients, especially from poor backgrounds, continue to pour in for treatment. Sounding alarm bells, leading oncologists caution that cancer has become the number one killer disease in Kashmir. They believe there is a need for doing more, and better cancer awareness, and providing latest treatment facilities to ease the suffering of rising cancer patients in the Valley.

According to the official data available at Regional Cancer Centre, Sher-e-Kashmir Institute of Medical Sciences, Soura, the number of registered patients has shown an alarming surge during the past few years with more than 1700 people having died due to cancer in Kashmir.

It says that since January 2014 there were 12,091 patients who were detected with cancer in various state hospitals. In 2013, 6300 patients were detected with the killer disease. In 2016, 4800 cancer patients have been registered at SKIMS.

The data revealed that the number of registered patients has jumped from 2097 in 2007 to 4800 in 2016 which is expected to go much higher. The centre witnesses a heavy rush with nearly 40,000 older cases that doctors call follow-ups, visiting it for various kinds of therapies. The data available with the SKIMS centre reveals that cancer patients registered for 2007 were 2097, in 2008 the number was 2465, and in 2009, it was 2968. However, the patient influx recorded a sharp decline in 2010 at 2623 only but in 2011 it went up again to 3057. Even as cancer cases in far-flung areas go unreported, the 2010 decline has been attributed to the unrest in the Valley that year. Official data stated that there were 144 deaths due to prostate cancer in Jammu Kashmir during 2011 and the number surged to 154 in 2012, 164 in 2013 and 174 in 2014.  The rise in the number of cancer cases could be attributed to a larger number of ageing population, unhealthy lifestyles, and use of various forms of tobacco and related products, unhealthy diet and in most cases, the non-availability of better diagnostic facilities.

According to official figures, cancer cases in 2017 were recorded as 5731 which is 87 percent higher than the cases recorded 7 years ago in 2011 when 3057 such cases were witnessed.

In an alarming scenario, Jammu Kashmir has witnessed an unprecedented 87 percent rise in cancer cases during the last 7 years, government figures reveal.

As government on the floor of the house has admitted that there is rise in cancer cases, the official figures further corroborate year-on-year increase in detection of dreadful disease in the state.

The government officials have admitted that cancer cases are on rise in Kashmir.  “Tobacco is one of the major risk factors for majority of cancers and is probably leading to increase in the number of patients. Poor personal hygiene, unsanitary living conditions and low immunity are related with few cancers like cancer of the cervix. 

“The consumption of adulterated food, fruits and vegetables laden with pesticides and environmental pollutions are also a major risk factor,” the official document reveals. “Many cancers like breast and colon are increasing due to change in lifestyle, late age at first childbirth, obesity, fatty diet lower in fibre, increase consumption of red meat and sedentary contribution to it.”

The minister for health had stated that radiotherapy treatment was being delivered free of cost as per government policy.

Poor patients, falling under the income group of less than Rs 20,000 per month, are given financial assistance under the cancer treatment management fund, he said.

He had stated PET-CT facility has been made operational from January 7 and so far 20 procedures have been done with effect from January 15.

According to experts, the top 10 cancers afflicting the Valley are lung cancer, oesophagus (cancer of food pipe), stomach, colon (large intestine cancers), breast, brain, Non-Hodgkin’s Lymphoma, gastro-oesophageal, junction cancer (cancer between the stomach and food pipe), ovary and skin cancers.

Leading oncologist and Director, Regional Cancer Centre, SKIMS, Dr Muhammad Maqbool Lone said that the situation in Kashmir was becoming alarming every day a with the highest number of lung cancers in the country found in the people of Kashmir.

“Situation is changing as far as the deadly disease cancer is concerned. The diseases are alarmingly on the surge. There are patients hailing from every part of Kashmir including the far-flung areas which are diagnosed with such a terminal disease,” Dr Lone said.

He said that the lung cancer, which for few years back was not witnessed in that alarming number, has surpassed the oesophagus cancers across Kashmir valley.

Expressing serious concern, experts said the cancer mortality rate among Kashmiris had increased due to some leading behavioural and dietary risks, including high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and lack of regular check-up.

They claimed the changing lifestyle and food habits among the Valleyites had caused a surge in all the cancers, especially in oesophagus, colon and breast cancers.

“Yes, there is an alarming increase in cancers in Kashmir,” director, RCC, and Head Department of Radiation Oncology, Dr Muhammad Maqbool Lone said.

The centre maintains records of patients.

He said the patients had been coming from all parts of the state, including Ladakh, Doda, Kishtwar, Bhaderwah and even from Jammu.

“We receive a particular type of cases relatively different from those in rest of India because of geographic, socio-economic and religious factors. Tobacco use is the leading cancer risk factor at the global level causing 71 percent of lung cancer death. In Kashmir, the situation is very grim with the highest number of lung cancer cases, which is increasing alarmingly,” he said.

However, Dr Lone said, Islam provided for some inherent practices which go a long way in minimizing chances of cancer.

He made particular mention of circumcision and the ablution ahead of mandatory prayers, something which has been acknowledged at the global level through scientific research.

Pertinently cancer is a generic term for a large group of diseases that can affect any part of the body. Other terms used are malignant tumours and neoplasm. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, which invade adjoining parts of the body and spread to other organs. This process is referred to as metastasis, a major cause of cancer death.

The experts attributed the rise in cancer cases to intake of spicy food, changing dietary habits and consumption of bulk of contaminated food items available in the market.

“There is massive adulteration in mass consumption food items which kills people slowly. We have seen an increasing number of patients complaining of food poisoning, gastric troubles and other problems. Any delay in detection of cancer can prove fatal,” noted gastroenterologist and former SKIMS Director, SKIMS, Dr Showkat Ahmad Zargar said.  “Lung, stomach, liver, colon and breast cancer cause most cancer deaths every year in the world. The situation in Kashmir is no different,” he said.

The experts said that early check-ups and adoption of preventive strategies can reduce the risk. Acquisition of knowledge about its causes and intervention to prevent and manage the disease is the need of the hour. Evidence-based strategies for cancer prevention and early detection and management of the disease can go a long way in reducing the incidence of the dreaded disease.

“Many cancers have a high chance of cure if detected early and treated adequately,” said leading oncologist and head Radiation and Oncology Centre, SMHS, Dr Sanaullah Kuchay, adding that cancer deaths could be prevented by modifying or avoiding key risk factors, including tobacco use, obesity, unhealthy diet with low fruit and vegetable intake, lack of physical activity alcohol use, sexually-transmitted HIV-infection, urban air pollution and indoor smoke from household use of solid fuels. 

“Vaccinate against human papillomavirus (HPV) and hepatitis B virus (HBV), reduce exposure to sunlight, early detection. Cancer mortality can be reduced if cases are detected and treated early,” he said.

Doctors Association Kashmir recently demanded a complete ban on import, manufacturing, transportation and sale of all forms of tobacco in Kashmir

“These things can make this disease more fatal in Kashmir. Whenever a patient develops any symptom, he should immediately report to the hospital,” said Dr Nissar ul Hassan, President, Doctors Association Kashmir.

“J&K is emerging as the smoking capital of north India and cigarette smoking is almost double the nationwide prevalence of 5.7 percent J&K has 12 percent cigarette smokers, 3.8 percentbidi smokers and 8 percent smokeless (chewable) tobacco users. Tobacco is a risk for heart attacks, strokes, COPD, cancers, hypertension and peripheral vascular disease,” he said. “The rise of cancers in Kashmir from 1448 cases in 2009 to 1768 cases in 2014 has been due to high rates of smoking in children and young adults. According to a study conducted at SKIMS smoking-related cancers like lung cancers have a high incidence in the valley. International agency for research on cancers concluded in 2014, that involuntary smoking is carcinogenic to humans.”

However, according to experts, a massive awareness campaign is needed for early detection of symptoms (for cancer types such as cervical, breast colorectal and oral) to get them diagnosed and treated early before the disease enters an advanced stage. They alleged early diagnosis programs were particularly relevant in low-resource settings where the majority of patients were diagnosed very late.

 “Screening and cancer detection camps are seldom organized in far off areas. Research is the worst hit; doctors don’t get time while the authorities never emphasize the need and, in the process, quality patient-care gets affected,” said a senior professor of Oncology at SKIMS, wishing anonymity.

He accused the Directorate of Health Services of virtually doing nothing to create awareness about cancer among the people or to provide for some preliminary diagnostic facilities at various healthcare institutions.

As per reports, cancer cases have shot up across India with 11.18 lakh people suffering from the disease in 2014 as compared to 10.28 lakh in 2011 – a rise of 9 percent in the last four year. Surveys have shown that breast cancer has upstaged cervical cancer as the most common and biggest killer of women, whereas lung and oral cancer are the most common types of cancers among men.

World Cancer Day, organized by the Union for International Cancer Control (UICC) and celebrated each year on 4 February, is an opportunity to rally the international community to end the injustice of preventable suffering from cancer.

WHO has provided guidance on how to address the global cancer burden through comprehensive cancer control, founded on global coordination and strong health systems.

Meanwhile, the much-hyped State Cancer Institute (SCI) at Sher-I-Kashmir Institute of Medical Sciences (SKIMS) is yet to be made operational. 

Officials at SKIMS said that the procurement of major equipment is under process and they have informed the government about the manpower creation for the state-of-art facility.

They said SCI would be operational by September this year.

Director SKIMS, Dr Omar Javid Shah said that that the administration was trying to procure important equipment for SCI including cardiac cath lab which has been approved by the Governing Body.

“For the creation of manpower, we have prepared a proposal, which is in the final stage which will be sent to the government shortly and will discuss it in governing body,” he said.

The director said that the civil construction of the cancer institute is almost over and it will be made operational by September, which will be a relief for patients.

“There is some pending mechanical and electrical work which is taken on priority and it will be finished with three months,” he said. 

Dr Omar said cancer institute will bring the whole cancer treatment under one roof and there will be focused attention from all angles from diagnosis, treatment, post-treatment and managing ill patients.  

In November last year, the state government had said that the SCI would be completed by April (2019) but the claims have fallen flat hitting patient care.

Prof Muhammad Maqbool Lone said they have already missed a deadline claiming that construction of SCI had been productive and hailed by the government compared to other cancer institutes in India.

“Our progress is satisfactory in the form of construction and procurement of equipment. By September we will be shifting to the new building,” he said.

Lone said to procure a linear accelerator, used for external beam radiation treatments for patients with cancer, they were facing some problems.

The establishment of SCI was proposed by the previous UPA-II government in 2013, which is likely to replace the existing Regional Cancer Centre (RCC) at the premier Institute.

Nazir Ganaie is a Srinagar-based journalist. He has covered health, art and culture, and environment for several media outlets. His father lost his battle to dreaded cancer in 2014.

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