Cancer is a global health concern affecting millions of people worldwide. Pakistan is the fifth most populous country in the world and its cancer statistics are no different from the developed world. In Pakistan, cancer is a leading cause of morbidity and mortality, with an estimated cancer incidence of 148,000 cases per year and a cancer-related mortality rate of 96,000 per year. Oncology in Pakistan is a relatively new field that has gained significant attention in recent years due to the increasing burden of cancer and the need for improved cancer care services. In this article, we will explore what is oncology in Pakistan, the challenges and solutions in cancer care, and the current state of cancer diagnosis and treatment.
What is Oncology in Pakistan?
Oncology is a multidisciplinary field of medicine that involves medical oncology, surgical oncology, and radiation oncology. Medical oncologists specialize in the diagnosis and treatment of cancer using chemotherapy, targeted therapies, and immunotherapy. Surgical oncologists specialize in the surgical management of cancer, while radiation oncologists specialize in the use of radiation therapy to treat cancer.
What are the Doctors of Oncology called?
Oncologists are medical professionals devoted to treating cancer. A medical oncologist treats cancer with chemotherapy and medication. A surgeon removes the tumor in its vicinity during an operation. These specialists perform biopsies on tissues whose contents are cancerous. Finally, radiation oncologists treat tumors using radiation. The doctor also treats gynecological, oncological, and gastrointestinal cancers such as cancer of the cervical bone and ovaries. Children’s oncologists treat cancer.
THE CANCER BURDEN IN PAKISTAN
Cancer is a significant burden on Pakistan’s healthcare system, with high morbidity and mortality rates. The leading types of cancer in Pakistan are breast, lung, and colorectal cancers. Lack of awareness about cancer, limited access to quality cancer care, and inadequate infrastructure for cancer management are the major contributing factors to the high burden of cancer in Pakistan. According to the Karachi Cancer Registry, the incidence of breast cancer is on the rise in Pakistan, with approximately 40,000 new cases each year. The registry also reports an increase in colorectal cancer cases.
CURRENT FACILITIES FOR DIAGNOSIS AND TREATMENT
The availability of cancer treatment facilities in Pakistan is limited, and most cancer patients do not have access to adequate cancer and tertiary care hospital. There is a shortage of trained health care professionals, including medical oncologists, radiation oncologists, and surgical oncologists. Most of the health care professionals practicing oncology in Pakistan are middle-tier professionals who lack advanced training and expertise. The majority of patients present to tertiary care hospitals when the disease is advanced, and the cancer is difficult to treat. The diagnosis and management of cancer require specialized skills and expertise, which are often lacking in health care providers in Pakistan.
What are the Doctors of Oncology called?
Doctors who specialize in the diagnosis and treatment of cancer are called oncologists. There are three main types of oncologists: medical oncologists, surgical oncologists, and radiation oncologists.
Medical Oncology
Medical oncologists specialize in the use of drugs to treat cancer. They are responsible for determining the best drug therapy for a patient based on the type and stage of cancer.
Surgical Oncology
Surgical oncologists specialize in clinical oncology, the surgical treatment of cancer. They are responsible for removing tumors and other cancerous tissues from the body.
Radiation Oncology
Radiation oncologists specialize in the use of radiation therapy to treat cancer. They are responsible for determining the appropriate dose of radiation and ensuring that the radiation is delivered to the correct location.
Challenges of Practicing Radiation Oncology in Pakistan
Radiation therapy is an essential component of cancer treatment. However, practicing the radiation treatment and oncology in Pakistan has its challenges. There is a shortage of radiation oncologists, medical physicists, and radiation therapists. The equipment used for radiation therapy is often outdated, and the infrastructure is inadequate. The treatment planning process for radiation therapy requires accurate imaging techniques, such as magnetic resonance imaging (MRI), which is often not available in many cancer centers in Pakistan.
Radiation Therapy and Infrastructure in Pakistan
Radiotherapy can be used for the treatment of lung cancer at any stage as a curative and palliative treatment. It is a therapeutic drug in stage I lung cancer. – Stereotactic ablative radiotherapy. This medication may be helpful in the treatment of stage 2 or III lung cancer in patients suffering from underlying medical co-morbidities that prevent surgery or in nonresectable tumors. Radiation therapy has also traditionally been used for stage 4 lung cancer to treat metastatic cancer. Presently, 26 hospitals across Pakistan offer radiotherapy for lung cancer.
Cancer Care in Pakistan
Cancer care in Pakistan is improving, but there are still many challenges that need to be addressed. According to the National Cancer Registry, there were over 165,000 new cancer cases reported in Pakistan in 2020. Breast cancer is the most common cancer in women, while colorectal cancer is the most common cancer in men.
The cancer burden in Pakistan is high, and the mortality rate is increasing. One of the main challenges in cancer care in Pakistan is the lack of awareness of cancer, which results in delayed diagnosis and treatment. Another challenge is inadequate training in oncology, especially among middle-tier oncology professionals.
Challenges and Solutions
One of the major challenges in cancer care in Pakistan is the lack of access to new therapeutic agents for marginalized patients with cancer. Many cancer drugs are not available in Pakistan, and those that are available are often expensive and out of reach for many patients. To address this challenge, new guidelines need to be developed to ensure that all cancer patients have access to optimal treatment.
Another challenge is the lack of infrastructure development in Pakistan. There are only a few cancer centers in the country, and most of them are located in major cities. This limits access to cancer care for patients in rural areas. To address this challenge, there is a need for the development of new cancer centers and the expansion of existing ones.
In addition to infrastructure development, there is a need for more health services, education, and awareness campaigns to promote cancer screening and prevention. Many people in Pakistan are not aware of the risk factors for cancer and do not undergo regular cancer screenings. Health education can play a vital role in reducing the cancer burden in Pakistan.
Inadequate Training in Oncology
Another significant challenge in the field of oncology in Pakistan is the lack of adequate training for healthcare professionals in this field. Oncology is a highly specialized field that requires a specific set of skills and knowledge to effectively treat patients with cancer. Unfortunately, many healthcare professionals in Pakistan, including doctors, nurses, and other medical staff, lack the necessary training to provide high-quality cancer care.
One of the main reasons for this problem is the lack of a comprehensive oncology curriculum in medical schools in Pakistan. Most private medical schools do not offer specialized training in oncology, leaving healthcare professionals to learn medical oncologist on the job or pursue additional training through expensive and often inaccessible programs.
Moreover, the shortage of trained medical oncologists, radiation oncologists, and surgical oncologists in the country exacerbates this problem. The few specialists are available are concentrated in urban areas, leaving rural areas and smaller cities with a severe shortage of oncology professionals.
To address this issue, medical education institutions in Pakistan must prioritize oncology training and offer specialized courses to heal thcare professionals. The government can also invest in training programs and workshops to increase the number of trained oncology professionals in the country. This will not only improve cancer care but also provide job opportunities for healthcare professionals interested in specializing in oncology.
Radiation Therapy and Infrastructure in Pakistan
Radiation therapy is one of the mainstays of cancer treatment and an essential component of radiation oncology infrastructure in Pakistan. Unfortunately, the infrastructure for radiation therapy is limited, and there is a shortage of radiation oncologists and medical physicists. In addition, the majority of radiation oncology infrastructure is located in urban areas, leaving patients in rural areas with limited access to radiation therapy.
To address this issue, the government has taken steps to increase the number of radiation oncologists and medical physicists by establishing radiation oncologist training programs and medical schools that offer an oncology curriculum. In addition, several private sector hospitals have also invested in radiation therapy facilities.
Systemic Therapy for Advanced-Stage Disease
Systemic therapy, such as chemotherapy, targeted therapies, and immunotherapy, plays a crucial role in the treatment of advanced-stage cancer. However, access to these therapies is limited in Pakistan, primarily due to their high cost. As a result, only a small percentage of cancer patients in Pakistan receive targeted therapies, which can significantly improve their chances of survival.
To address this issue, the government and private sector have taken steps to increase access to targeted therapies. For example, the government has introduced a cancer drug program that provides essential cancer drugs at subsidized rates. In addition, several private sector hospitals have established oncology centers that offer clinical trials of targeted therapies.
Cancer Screening and Prevention
Cancer screening and prevention are critical aspects of cancer control in Pakistan. Despite the high burden of cancer, there are currently no national cancer screening programs in the country. Lack of awareness about cancer prevention and screening, limited access to healthcare services, and cultural and social barriers contribute to low screening rates.
Breast cancer screening is an essential component of breast cancer control in Pakistan. Early detection of breast cancer can improve the chances of survival and reduce the need for aggressive treatment. However, breast cancer screening rates in Pakistan are low due to a lack of awareness about the importance of screening and limited access to screening services.
Colorectal cancer is another cancer that can be prevented through regular screening. However, colorectal cancer screening rates in Pakistan are very low. The lack of awareness about colorectal cancer, cultural and social barriers, and limited access to healthcare services are significant factors contributing to low screening rates.
To improve cancer screening rates in Pakistan, there is a need for public health campaigns to increase awareness about the importance of cancer screening and prevention. Additionally, healthcare providers should be trained on cancer screening guidelines and how to promote cancer prevention behaviors among their patients.
CURRENT FACILITIES FOR DIAGNOSIS AND TREATMENT
Cancer diagnosis and treatment in Pakistan rely heavily on clinical services provided by tertiary care hospitals, such as the King Edward Medical University and the Punjab Cancer Registry. These hospitals provide cancer care, including diagnosis, treatment, and palliative care services. However, due to the limited number of hospitals that offer cancer care services, patients often face long waiting times, and there is a lack of coordination between hospitals.
In addition to clinical services, cancer care in Pakistan also relies on research centers, such as the Karachi Cancer Registry, which provides data on cancer incidence and risk factors. However, there is a need for more cancer registries in Pakistan to help understand the burden of cancer and develop effective cancer control strategies.
Infrastructure Development
Infrastructure development is critical in improving cancer care in Pakistan. This includes the development of cancer centers, the establishment of cancer registries, the training of healthcare professionals in oncology, and the provision of adequate equipment for cancer diagnosis and treatment.
The government and private sector should invest in the development of cancer centers that provide quality cancer care to patients. The establishment of cancer registries is also critical to providing accurate data on oncology facts and the incidence and prevalence of cancer in the country. The training of healthcare professionals in oncology should also be a priority, particularly in rural areas where there is a shortage of trained professionals. Finally, the provision of adequate equipment for cancer diagnosis and treatment is critical in improving the quality of cancer care in the country.
Lack of Awareness of Cancer
Lack of awareness of cancer is a major problem in Pakistan. Many people don’t know about cancer and its symptoms. Therefore, they don’t seek medical help until it’s too late. Additionally, there is a lack of awareness of the importance of cancer screening, which can lead to late-stage diagnosis and poorer treatment outcomes.
The lack of awareness is not only limited to the general public but also among healthcare professionals. Many healthcare providers, especially those in rural areas, are not trained in cancer diagnosis and treatment. As a result, they may not be able to identify cancer in its early stages, which is crucial for successful treatment.
To address this issue, there is a need for more awareness campaigns, especially in rural areas, to educate the public about cancer, its risk factors, and the importance of early diagnosis. Healthcare professionals should also receive adequate training in cancer diagnosis and treatment.
Moreover, government agencies and non-governmental organizations (NGOs) should work together to improve cancer education and awareness programs. This can be done through the use of various media, including television, radio, and social media.
Efforts should also be made to increase the number of cancer screening and prevention programs in the country. This can be achieved by setting up mobile clinics and screening centers in rural areas where access to healthcare is limited.
Health Education
To improve the infrastructure of oncology in Pakistan, there is a need to establish new cancer centers and upgrade the existing ones. The government should allocate more funds to the healthcare sector to support the construction and development of new cancer centers. Additionally, public-private partnerships can be established to provide quality cancer care services.
Medical physicists play an essential role in radiation therapy, and there is a need to train more medical physicists in Pakistan. This would help improve the quality of radiation therapy and ensure that patients receive optimal radiation treatment throughout.
Challenges in Access to New Therapeutic Agents: Marginalized Patients With Cancer in Pakistan and the Need for New Guidelines
Despite advances in cancer treatment, access to new therapeutic agents remains a challenge for many cancer patients in Pakistan, particularly those who are marginalized. Due to poverty, lack of education, and limited access to other health care services, many patients are unable to receive optimal treatment for their cancer. This results in poor outcomes and increased mortality rates for advanced disease.
There is a need for new guidelines and policies to improve access to new therapeutic agents for cancer patients in Pakistan. This requires cooperation between the government, health care providers, and pharmaceutical companies to make new drugs and treatments available to all patients regardless of their socioeconomic status.
In addition, there is a need to increase awareness and education about cancer prevention, screening, and treatment options among marginalized communities. This can be achieved through targeted health promotion campaigns and outreach programs that provide information and resources to those who may not have access to traditional healthcare services.
Overall, improving access to new therapeutic agents and increasing awareness of cancer prevention and treatment options among marginalized populations is essential for reducing the burden of cancer in Pakistan. It will require collaboration and dedication from all stakeholders involved in the delivery of cancer care.
Potential Model for the Developing World
The Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) is not just a source of hope for deserving Pakistanis but for all individuals suffering from cancer across the world. It serves as an example for establishing similar cancer centers in developing countries, regardless of race, religion, or economic status. The strong level of trust and support from donors, both within and outside Pakistan, has enabled the institution to provide cutting-edge radiation oncology facilities to its patients, despite limited government resources.
While the SKMCH & RC has established hospitals in Lahore, and Peshawar, and is nearing completion of a project in Karachi, there is still a need to expand services to other remote areas of the developing country. Similarly, other nations can generate funding among their own people to establish similar institutions in areas of need and eventually consolidate their resources.
Not-for-profit organizations, such as the SKMT, can supplement existing state organizations rather than acting as primary institutions in the private-public sector. However, a comprehensive cancer center must be continuously upgraded to keep pace with evolving international healthcare standards, and this requires continuous financial support from donors.
Radiation oncologists can take advantage of global telecommunication technology to enhance collaboration with other top radiation oncologist and therapy centers, provide free online journal access, and offer cost-effective education for staff. Such sharing of information and experiences can benefit the entire cancer community. Furthermore, there is a dire need for greater collaborative global cancer care efforts in both research and education to effectively combat cancer.
Conclusion
In conclusion, oncology in Pakistan is facing numerous challenges in terms of cancer care, prevention, diagnosis, and treatment. Despite the efforts made by the government and various healthcare organizations, there is still a significant lack of awareness and infrastructure development, which leads to a high cancer burden in the country. The shortage of trained healthcare professionals, limited access to new therapeutic agents, and inadequate training in pediatric oncology, are some of the major challenges faced by the healthcare system.
However, the government and healthcare organizations have taken some positive steps toward improving cancer care in Pakistan, including the establishment of cancer centers and the implementation of cancer registries. It is crucial to continue working towards improving cancer care and prevention measures in the country by addressing the existing challenges and developing new guidelines. With the appropriate policies and infrastructure development, it is possible to provide quality cancer care to all patients in Pakistan.
FAQs
Which is the best oncology treatment in Pakistan?
The best oncology treatment in a cancer center in Pakistan varies from case to case and depends on the type of cancer, its stage, and the patient’s overall health. However, some of the top cancer centers in Pakistan are Shaukat Khanum Memorial Cancer Hospital and Research Centre, Aga Khan University Hospital, and Indus Hospital. These hospitals offer state-of-the-art facilities, advanced technology, and highly trained medical professionals to provide quality cancer care to patients.
How many oncologists are there in Pakistan?
According to the Pakistan Medical and Dental Council, there are around 400 registered medical oncologists, radiation oncologists, and surgical oncologists in Pakistan. However, there is a shortage of trained oncologists in the country, especially in rural areas, which makes it difficult for cancer patients to access quality health care there.
What is the difference between cancer and oncology?
Cancer is a disease characterized by the uncontrolled growth and spread of abnormal cells in the body, whereas oncology is the study and treatment of cancer. Oncology includes the diagnosis, treatment, and management of cancer, as well as the prevention and research of the disease.
Why is cancer so common in Pakistan?
There are several reasons why cancer is so common in Pakistan. First, there is a lack of awareness about cancer prevention and screening, which leads to late diagnosis and treatment. Second, there is a shortage of trained medical professionals and facilities in the country, especially in rural areas, which makes it difficult for patients to access quality cancer care. Third, lifestyle factors such as poor diet, lack of exercise, and tobacco use contribute to the high incidence of cancer in Pakistan. Finally, exposure to environmental factors such as pollution and radiation also increases the risk of cancer in the country.