Number of cancer patients rising, treatment remains inadequate

Sakhina Haydar, 55, a resident of Shimulia village of Noakhali, had been suffering from a severe cough and chest pain for two years. At first, she received treatment at a local hospital in Noakhali. Later she came to the capital and was admitted to a private hospital where she was diagnosed with lung cancer.

Her relatives tried to transfer her to the National Institute of Cancer Research and Hospital (NICRH) because of the high cost of the private hospital. After two months of trying, they were able to secure a seat at the NICRH for her. 

After radiotherapy, currently, Sakhina is undergoing chemotherapy.

The number of cancer patients like Sakhina has been increasing in the country. They all suffer because of inadequate treatment facilities in the country. The high cost of cancer treatment in the country is also a big problem for patients.

Anjuman Begum, 52, a resident of Jaldhaka, Nilphamari, has been suffering from cancer since 2009. She has been receiving treatment at different hospitals in Bangladesh and India. 

Thus far, her family has already spent Tk1 crore on her treatment.

Shantana Begum, 48, a resident of Sirajganj, was diagnosed with cervical cancer two years ago. Her husband, a farmer, has already lost everything to pay for her treatment.

"My wife has undergone chemotherapy 12 times. It costs Tk20,000-25,000 for per round of therapy. I have sold my land and animals to afford the treatment."

Dr Habibullah Talukder Ruskin, associate professor and head of the Cancer Epidemiology, National Institute of Cancer Research Hospital, said, "Cancer treatment in the country is centralised in the capital. Patients have to come here from different parts of the country. Many of them cannot find a place in government hospitals. The private hospitals are very costly."

According to a 2018 report of Globocan, a global project on cancer research, every year around 1.5 lakh people are diagnosed with cancer in the country. The number was 1.22 lakh in 2012. The report said 1,08,137 died of cancer in 2018.

No local institution compiles statistics about the total number of cancer patients in the country.

Dr Golam Mohiuddin Faruk, joint secretary of the Bangladesh Cancer Society, told The Business Standard, "There are 14 to 15 lakh cancer patients in the country. Around two lakh new patients are diagnosed with cancer every year. Among them 50,000-60,000 patients receive treatment while others remain outside of the healthcare system."

He said, "Around half of the patients who receive treatment die. This is primarily because of the delay in diagnosing and treating the illness."

"We have started registering cancer cases in the country. The Bangladesh Cancer Society and the health department are jointly working on this at the national level. There will be accurate statistics from next year," he added.
Dr Ruskin said, "The number of cancer patients has been increasing because of different reasons including: unplanned urbanisation, unhealthy diet, physical inactivity, pollution, smoking, drinking, etc."

According to the World Health Organisation (WHO), one cancer centre is needed for every 10 lakh people. Bangladesh needs 160 centres to adhere to the WHO standard. However, the country only has 18 cancer centres.

Most of the centres do not have enough machinery. In some centres, the majority of the machinery is non-working. There is also an insufficient workforce to operate the existing machinery.

At the government level, only the National Cancer Research Institute and Hospital provide full cancer treatment options. Every day around 1,200 patients are treated at the 300-bed hospital. Around 300 cancer patients receive chemotherapy and 350-400 patients take radiotherapy everyday.

Dr Muhammad Rafiqul Islam, assistant professor of the Department of Medical Oncology, National Institute of Cancer Research Hospital, said, "Every day, an average of 25-30 patients are admitted to the 10 departments of the hospital. Some days there are more patients than usual. The demand for free beds is high as most of the patients who come here are poor."

There are only 200 cancer specialists in the country and no government hospital has an  oncologist nurse. Cancer screenings and detection facilities are also inadequate.

Doctors say it is important to prevent cancer – that the Hepatitis B and HPV vaccine play an important role in preventing liver and cervical cancer. People should be warned about the symptoms of cancer to detect it at an early stage.

Dr Ruskin, said, "Screening and detection services should be provided at the upazila level. This would make some positive change." 

He said, "Ecnec [the Executive Committee of the National Economic Council] has approved projects to construct cancer hospitals in eight divisions of the country. This is a major development in cancer treatment here."

Medical oncology neglected
Doctors say there are three courses for cancer treatment – surgery, radiotherapy and chemotherapy. In most countries, cancer patients go to oncology doctors first. The oncologists decide whether patients need surgery, radiotherapy or chemotherapy. However, in Bangladesh, cancer treatment is dependent on radiotherapy. According to doctors, cancer needs integrated treatment.

Medical Oncology is neglected in Bangladesh, according to doctors. Medical oncologists should provide chemotherapy, but in Bangladesh, both radiotherapy and chemotherapy are provided by radiologists, they said. There are only four seats to study oncology in the country's medical education system.

Dr Islam said, "We need 400 oncologists in the country, but we have only 20. Our cancer treatment is not developed because we do not put enough importance on the medical oncology department. The patients are not getting necessary services because of that, as a result, they often go to India for cancer treatment."