DIMAPUR — Besides being a form of illness, cancer in Nagaland comes attached with its own share of stigmas.
As Dr. Keduovinuo Keditsu points out, some of the common stigmas include the view of cancer as a death sentence; social isolation and lack of support; misinformation; abandonment by family, friends, and society; and blame on the individual’s lifestyle, behaviour, “or past sins.”
Dr. Keditsu, who is a Consultant Cancer Surgeon and Head of Oncology Services at Putuonuo Hospital in Kohima, informed Eastern Mirror that in India, breast cancer is the most common cancer and the leading cause of cancer deaths among females, followed by cervical cancer and oral cancer.
With more than a decade of experience in the state, Keditsu pointed out that the main factors influencing an individual’s cancer risk are genetics, tobacco—both smoked and smokeless forms—as well as exposure to secondhand smoke, dietary habits, a sedentary lifestyle, certain viral and bacterial infections like human papillomavirus and Helicobacter pylori, exposure to UV radiation, X-rays, and gamma rays, and environmental factors such as exposure to pollutants, pesticides, etc.
According to her, 30-40% of cancers can be prevented by reducing tobacco use—both smoking and smokeless—and consumption of alcohol; eating a healthy balanced diet; avoiding UV radiation exposure; minimising exposure to outdoor or indoor air pollution, especially reducing smoke inhalation; not sleeping in the same room as the kitchen fire (which is common in the villages); HPV and Hepatitis B vaccination as appropriate; regular physical activity; screening; and knowing the family’s medical history.
Equitable access
Acknowledging that ensuring equitable access to cancer treatment is a complex issue, Keditsu suggested potential solutions beyond existing health schemes, which can help address the gaps in access to cancer treatments: Public-Private Partnerships between hospitals and NGOs, collaborations with pharmaceutical and tech companies to provide financial assistance.
She suggested that the use of telemedicine for remote consultations can increase access to cancer specialists for treatment planning as well as treatment follow-up, overcoming the challenges in difficult geographical locations and cutting costs of travel. Use of online platforms can enable patients to connect with cancer-related resources and financial assistance.
Crowdfunding platforms, she said, can be created to help cancer patients raise funds for their treatment. Supportive financial models such as sliding scale fees, where hospitals or cancer centres offer discounted rates based on the patient’s socioeconomic status, she added.
Diagnosis and patient care
Keditsu stressed the importance of sharing a diagnosis in a calm manner, “empathising with them, understanding fully that they may be too shocked to understand anything you say, without frightening them, and yet not deviating from the truth.”
“The initial counselling is a gradual process, where I give time to the patient and family to go back home, discuss, and return for any further questions. I believe the most important aspect of providing emotional support during treatment is empathy. Being sensitive to the suffering and prioritising them is key.
“In our hospital, we are supported by two NGOs—Dr. K&T Keditsu and Rev. Moa Longchari Cancer Foundation (RMLCF)—and several well-wishers, through which we are able to address any acute financial needs of our patients and alleviate stress,” she informed.
Cancer aid and challenges
Dr. K&T Keditsu Foundation, founded in 2016, is not specifically a cancer foundation. “However, medical aid is one of our main objectives, under which we conduct cancer prevention activities such as cancer awareness talks and free cancer screening camps, mainly for breast cancer, cervical cancer, and oral/mouth cancer,” she said.
The foundation also conducts a free cancer clinic, in collaboration with the RMLCF, every Thursday at Putuonuo Hospital.
“I would advocate for creating more collaborative programmes for cancer screening, encourage more NGOs and charitable societies to focus on cancer prevention, and develop strategies to detect cancer at an early stage and save lives. I would hope to see significant advancements in creating a more equitable and sustainable healthcare system where all patients, regardless of geographical location or socio-economic status, have the privilege to get a basic health check-up, screening for a few common cancers, and if diagnosed, avail at least a decent basic cancer treatment,” she advocated.
Breaking the bad news
Family Medicine Consultant at Eden Medical Centre Dr. Nepuni Athikho says that palliative care is all about addressing practical concerns of patients and families and offering counselling and support to the affected family.
He said that most of the patients are under the wrong assumption or come to him with the notion that palliative care is exclusively “end-of-life care.”
“People should be aware that palliative care is termed as specialised medical care for people with serious illnesses. The care would be focused on relief from the symptoms of stress, and the goal would be on improving the quality of life for the patient and their family,” the doctor said.
Dr. Athikho pointed out that most of the referrals they receive are through the oncology department and not through self-awareness. Along with the patients referred by the oncology department, he said most of the patients seeking palliative care are those who go outside the state for treatment and come back “as they are more aware of the palliative care while seeking treatment outside.”
“While palliative care is crucial for improving quality of life for seriously ill patients, it remains mostly unknown, and many people suffering from terminal illnesses may not be receiving the necessary care to manage and improve their well-being, and this is due to a lack of awareness about palliative care,” he said.