My visit to Aga Khan Hospital’s cancer ward

Published: October 20, 2013

Molecular therapy can be very effective in treating cancer and has fewer side effects. However, it is an expensive treatment and not affordable for everyone. PHOTO: FILE

“The cells found are malignant and you are likely to have cancer.”

On a visit to Aga Khan University Hospital (AKUH), a 43-year-old woman suffering from lymphoma cancer, told me that her first thoughts upon hearing these words were about chemotherapy.

This was not surprising. Most cancer patients fear chemotherapy more than the disease itself. In fact, cancer patients absolutely dread the days scheduled for their chemo sessions.

Chemotherapy and the will to survive

The simplest and crudest definition of chemotherapy is poisoning an individual’s body with drugs that wipe out the malignant cancer cells while simultaneously re-producing healthy cells in the procedure. The after-effects are usually awful including emotional stress, physical pain, demoralising and despairing physical changes.

The diagnosis itself can be a traumatic experience for patients. The biggest blessing in such a condition is a good doctor who can motivate the patient and help keep dismal feelings at bay. After all, it is the patient who has to endure the pain and if he/she gives up hope and the will to survive, it becomes very difficult to initiate and continue cancer treatment.

Hence, after diagnosis the patient either wants to fight back or loses hope. In cases of despair, negative reactions can range from mild to extreme, like an ovarian cancer patient admitted,

“I was in a state of shock and reacted with revulsion against my oncologist.”

Hence, it is really important for the oncologist to engage in friendly conversation with the patient. During 15-20 minute sessions, doctors should try to gain the patient’s confidence. If the doctor seems hurried, it may be impossible to gain the patient’s trust which can greatly hamper chances of recovery.

Fighting cancer with emotional support

Cancer is truly a devastating disease in which abnormal cells divide and multiply. To make matters worse, diseased cells are able to invade other tissues through the blood and lymph cells. So patients often end up fighting not just one disease but a combination of many.

Cancerous cells can grow, divide, break and spread abnormally all over the body. The process of cancer spreading in the body is called metastasis. There are more than a hundred types of cancers and most cancers are named after the organ or cell from which they originate; for instance, cancer that begins in the colon is called colon cancer but breast cancer that has spread to the liver is called metastatic breast cancer and not liver cancer.

The behaviour, growth rate and treatment of cancer cells depends on the type of cancer it is. The stage at which cancer is diagnosed determines the intensity level of the treatment needed and can be a predictor of how successful treatment might be. Although the treatment of any disease is not easy, cancer’s treatment itself adds to the complex nature of the disease since the patient has to bear not just the pain of the disease but also the trauma of radiation and/or chemotherapy.

The question is how does one deal with such pain and hopelessness? How can caregivers encourage patients to keep their hopes up and fight to stay alive and regain health?

There are some patients who do have a positive approach like one who declared,

“I am looking forward to being a cancer survivor!”

Undoubtedly, the desire to fight is a definite factor in winning this battle. However, the fear of relapse can cause despair and certain events can trigger fears after the treatment such as follow-up visits to the doctor or the anniversary of the cancer diagnosis. 

Moreover, the diagnosis of cancer concerns the entire family. The chances of survival and cure are definitely better when patients have the support of family and friends. However, this battle can be emotionally draining for those around the patient.

Inside the chemo ward

The first thing that hits you upon entering a chemotherapy ward is the weariness on every face. There are women who have had their breast(s) removed, others who have lost their hair, and some who are going through blood transfusions to increase their white cell count. Visiting the children’s chemo ward is an even more traumatising experience because they are so young. These little angels are just at the onset of life when they are told that they’ll have to fight for it.

My heart broke to see a four-year-old receiving chemotherapy in the children’s ward. She was diagnosed with leukaemia at the age of two. Her mother told me,

“It is a painful task to bring her here for a session. She is always scared before coming here, because she knows her squeals can’t stop the treatment. The mental torment starts as soon as she smells the alcohol swabs. It seems like a never ending process, but honestly, I don’t want to stop no matter how long and how hard it is.”

As difficult as it is for children, adults don’t go through chemotherapy easily either. An adult described the aftermath of chemo in the following words:

“The nausea sets in after a day making me feel gross and feeble, that is the time when I count how many more to go.”

The hospital staff also plays an extremely important role because every patient is not accompanied by family and attendants have to fill that gap. They have to be gentle and supportive and often patients get attached to them which helps them recover faster, like a staff nurse said,

“Loss of hope weakens the immune system, affecting the patient physically as well as spiritually. We always tell the patients not to be pessimistic.”

Physical changes caused by chemotherapy can include loss of hair, darkening or paleness of skin, dryness and flakiness of skin, discolouration of nails and weight loss if the patient has trouble eating. On the other hand, many patients gain weight during or after chemo. Although these changes are very upsetting, they can usually be reversed after the treatment is over by establishing a good lifestyle.

Improvements in cancer treatment

New drugs and therapies in recent years have given new hope to cancer patients.  Monoclonal antibodies are a relatively new innovation: they’re laboratory produced molecules that are carefully engineered to attach to specific defects in cancer cells and work by making the cancer cell more visible to the immune system.

Rituximab (rituxan) helps the immune system to attack the cancer cells and Avastin is a monoclonal antibody that can treat a number of cancers except breast cancer. It intercepts the tumour signals and stops them from connecting their targets. Many other antibodies drugs like Zevalin, Erbitux and Hereceptin are available to treat various types of cancer.

Researchers have made major advances in finding drugs which target cancer cells. In targeted therapy, drugs actually attack the surface of cells and control the switches of growth or control blood supply to the cancer cells. This is an amazing treatment to help cancer patients live longer and control the disease. In order to know if a cancer patient is eligible for targeted therapy, the doctor advises a special test of tumour, called a molecular test, by taking a sample or performing a biopsy of the tumour.

Molecular therapy can be very effective and has fewer side effects. Since only the pathways of cancer cells are targeted, only those cells are affected without damaging other parts of the body. Moreover, the side effects of molecular therapy are very mild as compared to chemotherapy. Traditional chemo can cause nausea and hair loss, but its most serious side effect is low blood count. On the other hand, side effects of molecular therapy hardly ever go beyond diarrhoea, fatigue and skin rashes.

Targeted therapy can be done in isolation or along with traditional chemotherapy. Herceptin, Avastin, Rituxan, and Tarceva are the first wave towards safer and more effective therapies and they help block the blood vessels feeding the tumour. However, the major hurdle in targeted therapy is the cost involved and naturally, the pressing concern in our country is that the treatment isn’t affordable for everyone.

Dr Nehal Masood, head of the Department of Haematology/Oncology at AKUH told me,

“Targeted therapy drugs are very effective with few traditional side effects; so not all chemo is toxic and today there are many patient-friendly drugs in the market. A lot of patients undergoing chemo at AKUH are receiving these new drugs.”

After the diagnosis

Needless to say, cancer is like an unwelcome house guest. Amidst all the turmoil, sometimes the one thing that we can control is who to tell and when. Although people keep the news of a cancer diagnosis to themselves for valid reasons, family and friends can feel offended upon finding out at a later stage. A leukaemia patient at AKUH told me,

“I didn’t want to tell my immediate family until I could better understand what was happening.”

Also, many people assume that talking about the disease has nothing to do with its cure. All things considered, talking positively about it can be the one thing that keeps optimism alive. Support of relatives, friends, doctors and nurses can literally mean ‘life’ for cancer patients. A 23-year-old cancer patient at AKUH admitted,

“The condition was disclosed to me by the doctor in such way that I took it as a challenge rather than a disease. Therefore, I have no fear and I am determined to fight for my life.”

Sadaf Khalid

Sadaf Khalid

A Remedial teacher for children with learning deficits. She tweets @sadafkhalid2 (twitter.com/sadafkhalid2)

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Bangalorean

    Good article! I learned something today.Recommend

  • http://www.captainjohann.blogspot.com/ captainjohann samuhanand

    The author seems to be a votary for “Molecular therapy” but she has done great harm to chemotherapy patients. I am on chemotherapy for Pancreatic cancer stage III metasized. I have undergone 25 sessions of chemo therapy called Abraxane/Gemisitob combo. But being a internet junkie i know what it entails and I can say with confidence that Chemotherapy is not that dreadful at all as it was made out in this article and also by some of my friends and relatives. the actual chemo takes normally about an hour or so and it can be a daycare procedure as many are doing here. It causes hair loss which can be traumatising may be for ladies and young while for me a 73 year old it dies not matter at all.For the first two days after chemo “Constipation” is the biggest problem but one has to take precaustions by eating fruits and other vegetables like guava etc which prevent constipation.Walking after chemo and before is a must and also love to lead your life as you have been doing.Do not bring sympathisers with long faces into your room and learn to love those beautiful nurses and how much friends one can make.One of the greatest thing about cancer is now one can eat anything you want!! By the way I want to quote here a small wish a friend sent me . Cancer cannot take from You “Your Faith,Shatter your hope, or lessen yoour love, It cannot destroy true friendship, invade th soul or take away eternal life.It just cannot conquer your “SPIRIT”"”" He all those cancer patients from one chemo champ to another love you all.Recommend

  • Nadir Hasan

    The problem with Oncological/Chemotherapy in Pakistan is the cost. In almost all developed countries – where these treatments were/are developed, the State provides Cancer care as part of some sort of ‘National’ health service. In the USA insurance (usually) covers Oncology. Otherwise, even in the ‘avanced’ West, no one could affort to pay for these prohibitively expensive medicines!Recommend

  • Cruz

    I’m sorry to hear this.I had an Fnac come out negative a few months ago,but the scare I had waiting for the results made me take another view of my life-one that I never had.Even if you’re undergoing chemo,you help your body heal by taking wholesome foods & not stressing it out with a high fat,diet/processed foods. Cutting out fat,sugar,salt & filling up on wholegrains,nuts,vegtables,fruit,skim milk,fatty fish,green tea will help your body deal better with the tissue damage from chemo.I feel very bad to read this.I will remember you in my prayers.Recommend

  • sara

    Very nice attempt. Two things I would like to point out- the following statement is not correct-

    “The simplest and crudest definition of chemotherapy is poisoning an individual’s body with drugs that wipe out the malignant cancer cells while simultaneously re-producing healthy cells in the procedure.”

    Chemotherapy does not produce healthy cells. It kills malignant as well as rapidly dividing healthy cells. This is the reason patient suffers from hair loss, nausea/vomiting etc,

    Secondly, there is incorrect information here -
    “Some who are going through blood transfusions to increase their white cell count.”
    Blood transfusion or transfusion of any blood component increases red blood cells or platelets but not the white blood cells. There are specific drugs that increase the white blood cells.Recommend

  • OK

    An informative & well-researched articleRecommend

  • PC is BS

    Chemo is made out to be more scary than it is. First round barely left a mark on me and the second round of higher dosage got me in a delayed fashion. Any effects which got me were the hair loss and dry eyes which were delayed for weeks, other than that during the actual chemo, absolutely nothing happened to me. That put me in remission but they’re anticipating it creeping back up again so it probably won’t be my last time.
    (this is in reference to acute leukemia)
    I forget my Disqus name comes up different. I’m probably better known as “Something Clever” on here.
    Recommend

  • raj

    A good article about what the cancer is all about but I am sorry to say, a complete opposite to what the title promised. Personally, the title lured me to to read the article as I thought of having some good information about what this new cancer ward is there to offer as compared to other cancer wards in Karachi or Pakistan. A better article would have all the facilities for cancer patients that AKUH offers which helps patients survive the disease. As a cancer researcher, I would say most of the stuffs in the article will not be of any use to the layman as these are total scientific terms and has nothing to do with common people in Pakistan. Never the less, a good piece as far as what patients think about cancer is concerned. CheersRecommend

  • raj

    In the US, not every one has insurance and if they suffer from any disease, its way too expensive than in Pakistan. Infact Pak people living outside pak comes to pakistan for treatments esp at AKUH. Also, the most expensive thing in cancer is not chemotherapy but the medicine that has to be taken for next 5-10 years and that kills families all togetherRecommend

  • raj

    Sir, sorry to hear about that all. But here is the difference you just mentioned. Age does effect you. If you get a disease at 60 or above, you tend to not care just because you have already lived your life, have seen ups and downs, had a good time with lovely family but for a 20-30 year old or even 40-50 year old whose life has just started to shine (in case of 20-30 year old) or whose life has just given fruits that he/she riped during the early part of life, this can be a traumatizing situation. Esp when it comes to Pakistan where having cancer is considered a big crime and people tend to offer more pity than confidence, it is totally different. In fact, cancer patients start to hide things in front of others whereas cancer survivors are considered Heroes in the west. so the society do effect you internally.Recommend

  • disqus_qgr69HY8uM

    This article brought back memories of someone who passed away not so long ago from cancer. I didn’t know her personally, but I know of the deep torment her loved ones felt and that alone pained me – as the 3rd person to put it into context.

    God forbid, this disease seems to be one that will put both the patient and their loved ones into a huge, never ending endurance test.

    Fortunate are those that have family and friends who can care for and support them in such trying times. Ultimately, life is a test and cancer is just another excuse.Recommend

  • http://www.captainjohann.blogspot.com/ captainjohann samuhanand

    Though my FNAC came negative after two biospies, still the Oncologist wanted to have a web biospy.He will not accept the two biospies.I declined. By the way the best test for cancer is PET scan(not CT scan and do not waste money on that) and I hope this fascility is available.Recommend

  • sad

    i am glad to see people going through the treatment with such courage and determination. i hope you all are always willing to fight for your life. obviously the disease varies…… age, affected body organ…..everything matters. its not same for every patient. i am sure we all have seen people who become terrible during the treatment or even before the treatment. chemotherapy or molecular therapy or any treatment related to cancer is tough to handle financially , morally and physically and there are many people in our country who don’t even go through it or abondon it half way because it becomes too much for them. lastly, many cancer patients do need counseling which is unfortunately not available in our country.Recommend

  • Dr Imran Afzal

    A very nicely written article covering every detail and aspect,with excellent choice of words and description . I think being a doctor I would only comment that the word cancer malignant itself is very difficult to tell any patient of any age disclosing it to him or her we as doctors some times don’t realize what patient goes through when he finds out,let alone the treatment . Chemotherapy is a very painful procedure,I would say nightmare for some ,depending upon the site or organ one is suffering .But in my twenty eight years of practice never seen any patient comfortable with chemo . I hope what Dr Nehal Masood’s so called patient friendly discovery drugs are able to benefit patients and they go through less misery . One last advise to oncologists to please be more patient, humble and friendly to their patients as this quality lacks in few of my brother Oncologists.
    Recommend

  • Haroon Rashid

    Encouraged by the article on this important area I compliment Sadaf Khalid to write more on Oncology treatment in Pakistan, institutions as AKUH, NGO’s, Government and Public Hospitals, Shaukat Khanum Memorial Hospital etc.
    Not only the hospital and hospitalisation, but also on dispensing, and reccomending medicines, or dispensing the medicines in the hospital.
    The use of steroids is very, very common in the cancer patients, not only other areas. Absence for the code of conduct for the rights of patients to inform that the doctor will have to use steroids because it is indispensible. What are the harmful effects of steroids, and why he is suggesting it.
    My suggestion is an awareness campaign be conducted by the local and country wide industry or health bodies, as PMDC, PMA, health organisations, health related recognised media, international media as LANCET etc., etc.
    Recent hospitalisation of my mother at the AKUH Emergency, and the so called Special Wards stay is worth visiting by the bloggers.
    Not only AKUH but all the public hospitals in Karachi Government, free, and paid should be visited by bloggers to review their operations, behaviour, nursing, medical advise, effectiveness, patient satisfaction, ambiance, environment, logistics, costs, charges, etc., etc. are important. I suggest bloggers to please this area in Karachi, which would be of interest to the readers, and lay the process of accountability to the respective property owners means the hospital for the strive IRR (Internal Rate of Return) running emergency, centers. It is a very lucrative, and I can help a prospective build an IPO (Initial Public Offering) to qualify to raise equity stocks/shares from the stock exchanges of Pakistan qulifying for a Public Listed Company in Pakistan with tons of capital bearing no interest.Recommend