An unspoken pandemic | Rising cancer incidence in J&K especially in elderly

Given the higher prevalence of cancer among the elderly population, it’s imperative to comprehend the burden of this disease in Kashmir. The valley of Kashmir has witnessed a significant rise in cancer cases in recent years, raising concerns about the state’s ability to provide adequate cancer care and treatment to its residents.

The leading types of cancer in Kashmir include lung cancer, breast cancer, cervical cancer, and gastrointestinal cancers. Over the past four years, approximately 51,000 cancer cases have been registered in Jammu and Kashmir. Tragically, around 36,000 patients have succumbed to cancer in the last five years after diagnosis, and this number continues to rise (Gk Jan 2023). Several factors contribute to this increase, including lifestyle changes, environmental factors, and improved detection and reporting mechanisms. While the exact causes require further research, addressing this growing concern is of utmost importance. A study by the Sher-e-Kashmir Institute of Medical Sciences (SKIMS) attributed the rising cancer incidence to “dietary practices and lifestyle choices,” as well as the consumption of foods high in salt content.

To effectively combat cancer, it is crucial to establish a comprehensive cancer registry that records and tracks cancer cases, treatments, and outcomes. Unfortunately, Kashmir currently lacks a well-established cancer registry, and many patients seek treatment outside the region, making it difficult to gather accurate data for planning targeted interventions.

Challenges in Cancer Care in Kashmir:

The landscape of cancer care has evolved significantly over the past few decades, with advanced treatment options and even cures for certain cases. Different types of cancer require tailored approaches to treatment. Access to the best available care is a patient’s right, but concerns about the quality of care, access to modern equipment, advanced treatment protocols, clinical trials, and specialized cancer specialists not locally available can prompt patients to seek care in more developed healthcare systems.

The only dedicated Regional Cancer Centre at SKIMS is often overwhelmed with patients from across the valley, resulting in challenges related to waiting times. Overburdened healthcare systems may lead to prolonged waiting times for cancer treatment, prompting patients to seek faster care options elsewhere. Some patients may choose to go outside Kashmir for holistic cancer care, which includes not only medical treatment but also psychological and emotional support, dietary counseling, and complementary therapies.

Resource allocation is another major issue in Kashmir. The region lacks specialized cancer treatment centers equipped with modern technology and the expertise required for complex cancer cases. As a result, patients often have to travel long distances to receive adequate care, which can be physically and financially taxing and hampers early cancer diagnosis and timely treatment. The shortage of trained oncologists and healthcare personnel in Kashmir is a significant barrier to delivering quality cancer care. The few available specialists are overburdened, leading to delays in diagnosis and treatment, and the lure of higher salaries in the corporate sector has led to leaving of many trained oncologists.

The costs associated with cancer diagnosis and treatment can be overwhelming for many families in Kashmir. High medical expenses, travel costs, and lost wages due to illness create significant financial burdens. It’s a common sight to witness emotional appeals for financial assistance, and unfortunately, not all oncology treatments are covered under the PMJAY insurance scheme.

Late presentation remains an issue. The cultural and societal stigma surrounding cancer often leads to delayed diagnosis and treatment. There is also a lack of public awareness regarding cancer risk factors, prevention, and the absence of a dedicated cancer screening program for early detection in Kashmir. People may hesitate to seek medical help due to fear, shame, or misconceptions about the disease. Therefore, educational campaigns are needed to empower individuals to take proactive steps for their health.

Perceived Quality of Care:

Some patients may perceive that the quality of care is better in hospitals outside of Kashmir, leading them to seek treatment elsewhere.

Strategies to Overcome Challenges in Cancer Care:

To address these challenges in cancer care in Kashmir, a multi-pronged approach is required:

Expand Access to Healthcare Facilities: The government is investing in building oncology healthcare infrastructure, especially in rural and remote areas. In the interim, mobile healthcare units and telemedicine services can be utilized to reach underserved populations. Establishing accessible and affordable specialized cancer treatment centers in Kashmir equipped with state-of-the-art technology and a team of expert oncologists is essential. Building public-private partnerships in cancer care is a strategic step. Initiatives should be undertaken to train, recruit, and retain more oncologists and healthcare personnel in Kashmir.

Financial Support Programs: State-sponsored financial support programs like PMJAY can provide much-needed relief to affected families. Expanding the scope of these programs to assist cancer patients and their families with the high costs of treatment, travel, and lost wages is crucial.

Investment in Healthcare Infrastructure: Expanding and upgrading cancer care facilities in Kashmir, including acquiring advanced medical equipment and recruiting and training more healthcare professionals, can improve local access to cancer treatment.

Reducing Treatment Costs: Efforts to reduce the overall cost of cancer treatment, including the availability of affordable medications and financial assistance programs, can help alleviate the financial burden on patients.

Telemedicine and Outreach: Telemedicine programs and outreach efforts can provide expert consultations and support to patients in remote areas, reducing the need for extensive travel.

Awareness and Education: Promoting cancer prevention and early detection by raising awareness about available cancer care resources within Kashmir and educating the public about the importance of early detection, screening, and prevention can help in tackling the disease at an earlier, more treatable stage.

Research and Partnerships: Collaborations with national and international cancer care organizations can bring advanced cancer care and research opportunities to the region.

NGO and International Partnerships: Collaborating with non-governmental organizations (NGOs) and international health organizations to build a not-for-profit cancer hospital can bring expertise, funding, and resources to improve cancer care in Kashmir.

Addressing the rising cancer burden in Kashmir is a multifaceted challenge marked by several key obstacles and possible solutions. The increasing cancer burden in the State of Kashmir is a cause for concern and requires urgent attention. The challenges in cancer care, such as limited access to healthcare facilities, the shortage of specialized centers and personnel, and the stigma associated with cancer, need to be addressed systematically. Implementing a comprehensive approach that includes the establishment of a cancer registry, expansion of healthcare facilities, public awareness campaigns, and financial support programs can help alleviate the burden of cancer in Kashmir and improve the quality of care provided to its residents. It is imperative that both the government and civil society come together to combat this growing health crisis and ensure that cancer patients in Kashmir receive the care and support they need.

Dr Fiaz Fazili is a consultant surgeon and member of the international community on cancer prevention and awareness programme and is team leader of the group campaigning for Not for Profit State of Art Cancer hospital in JK.