In 2005, a man diagnosed with multiple myeloma (cancer of blood plasma cells) asked me if he would be alive to watch his daughter graduate from high school in a few months. In 2009, bound to a wheelchair, he watched his daughter graduate from college. The wheelchair had nothing to do with his cancer. The man had fallen down while coaching his youngest son's baseball team, wrote cancer physician-turned writer Siddhartha Mukherjee in his Pulitzer-winning biography of cancer, The Emperor of All Maladies.
Life after cancer has changed radically over the past five years. Being diagnosed with the disease is still as frightening as it was a decade ago, but newer therapies have made life after diagnosis longer and less painful for the patients. “Advances in medicines over the past decade have turned cancer from a sure-fatal illness to a chronic illness. People with breast cancer, lymphomas and chronic blood cancers have benefited the most from new therapies. For example, 5-year survival after breast cancer diagnosis has gone up from 45-50% a decade ago to 70% today,” says Dr Sameer Kaul, a surgical oncologist at Apollo Hospitals, who founded the Breast Cancer Patients Benefit Foundation two years ago to pay for poor patients who can’t afford treatment.
Conventional cancer drugs were very toxic as they targeted all actively dividing cells, including healthy sperm cells, bone-marrow cells and cells in the gastro-intestinal tract that are shed every day. This caused side effects such as nausea, vomiting, impotence, weight loss and lowered immunity.
Newer targeted therapies use different methods to deliver and get drugs to act specifically on cancer cells without killing healthy ones. “These drugs are expensive, priced about four times more than conventional therapies, but disease-free survival (life without the cancer progressing) for many more years after diagnosis makes it worth it,” says Dr Kaul.
At any given time in India, there are 28 lakh people with cancer, which is the fourth largest killer after heart disease, respiratory diseases and childhood diarrhoea. A rising and ageing population, an unhealthy lifestyle, pollution and tobacco use is fuelling a cancer epidemic in the country, with the number of people with cancer growing at a rate of 1.2% each year, shows Population Based Cancer Registry data from the Indian Council of Medical Research.
Conventionally, surgery and radiation therapy are used to treat primary stage cancers and chemotherapy is used to treat cancers that have spread. “Targeted treatments pair a bioconjugate -- a biological carriers such as antibodies or peptides (protein segments) that targets specific cells -- with short-lived medical radioactive isotopes that are delivered directly to diseased cells to kill them. The energy given off by radioisotopes destroys cancer cells while sparing healthy ones,” says Dr G. K. Rath, head, Dr B.R. Ambedkar Cancer Hospital at the All India Institute of Medical Sciences.
The treatment works even for advanced cancers, with studies for prostate and breast cancers that have spread to bone and other organs are showing promising results at the European Institute of Oncology.
“Over 10 lakh (one million) people develop cancer in India each year, with the disease projected to rise five-fold — 2.8 times because of tobacco use and 2.2 due to ageing — by 2025. Tobacco use alone raises risk of cancers lip, tongue, mouth, pharynx, oesophagus, larynx, lung, urinary bladder, stomach, liver, kidney, uterine cervix and myeloid leukemia,” says Dr Rath.