The MDT approach: Cancer can be conquered with integrated treatment
Photo Collected
Cancer means death—a notion that has been proven wrong in an age of unprecedented medical advances. Today, it is possible to defeat cancer with the combination of timely disease detection and modern treatment methods. However, it is difficult for a single doctor to achieve 100% success in the treatment of complex diseases like cancer. And from this idea, the ‘Multidisciplinary Team’ or MDT approach has become popular around the world, which has opened a new horizon in the treatment of cancer in Bangladesh.
On Wednesday (May 20), four young and experienced oncology experts of the country highlighted various aspects of this revolutionary treatment system in a special online discussion titled ‘World-class cancer treatment now in Bangladesh’ organized by SKF Oncology. They are Dr. Ishtiaq Ahmed Anik, Dr. Zulfikar Saif, Dr. Md. Sajid Rezwan and Dr. Md. Suman Ali. Hosted by Nasiha Tahsin, the program was broadcast live on Prothom Alo and SKF Oncology’s Facebook page.
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At the beginning of the discussion, National Cancer Research Institute and Medical Oncologist Dr. Ishtiaq Ahmed Anik. Referring to various international and domestic surveys, he said that every year in the country, about 53 to 106 people are newly diagnosed with cancer and about 12 percent of the total death rate is now due to cancer. This growth rate in the last 10 years is very alarming.
He attributed the long-term habit of smoking and use of tobacco products like jorda, lime, gul, white leaves as the main reason for this. In particular, behind the cancer of the mouth, esophagus and lungs, this tobacco is playing a direct role in the serious air pollution of Dhaka. In addition to this, aging-related cancers are increasing due to the increase in the average life expectancy of people, as well as the irregular lifestyle of modern life, staying awake at night, excessive stress and the tendency to eat fast food or processed food increases this risk. However, he pointed out that the country’s medical infrastructure and the number of specialist doctors are still not sufficient compared to the patients.
বিজ্ঞাপন
Radiation oncologist of National Cancer Research Institute and Hospital Dr. Zulfikar Saif. He said, ‘In cancer treatment there really is no chance of being a single hero, it is a complete “team game”. In the developed world, this method has long been considered the “standard of care” in treatment.
The MDT or multidisciplinary team includes medical oncologists, surgical oncologists, radiation oncologists, pathologists, radiologists, as well as hematologists, psychiatrists, and oncology nurses as needed. The main objective of this approach is to provide holistic care to the patient. It does not only treat the tumor or cancer, but also removes the side effects of the treatment, relieves the emotional trauma and brings the patient back to a normal working life. Earlier in Bangladesh, doctors used to treat patients separately, but by adopting this approach, everyone is brought under one umbrella to ensure the best treatment for the patient.
Dr. explains the role of MDT in making a correct and perfect treatment plan. Ishtiaq Ahmed Anik. He said, ‘This team works best to ensure accurate diagnosis of cancer and start treatment quickly without any delay. In medical terms this is called ‘Individualized Treatment Plan’. In other words, even if it is cancer of the same organ, depending on the stage and physical condition of the patient, the type of treatment may be different.
Dr. Zulfikar Saif talks about the benefits of the MDT approach and its limitations in the context of Bangladesh. He said that the biggest advantage of this method is to prevent wrong treatment and to give treatment according to the guidelines. For example, whether a patient would benefit more from early surgery or early chemotherapy for breast cancer is determined through collaborative discussion. As a result, the patient does not have to waste time and money visiting different surgeons or oncologists from door to door. However, the 64 districts of Bangladesh still do not have these specialist facilities or adequate manpower, which is a major limitation of this approach. At present patients have to come at least up to the divisional city to avail this service.
Dr. clarified why so many tests are required in cancer treatment. Ishtiaq Ahmed Anik. He said, it is no longer possible to start treatment just by looking at a simple biopsy. IHC test to understand the specific type of cancer, CT scan, MRI or PET-CT scan for staging and various genetic marker tests for modern targeted or immunotherapy. It is possible to go to the perfect treatment only with proper examination.
There is a common fear in our society—that a biopsy will spread the cancer. Surgical oncology specialist Dr. gave a scientific explanation of this misconception. Md. Sajid Rezwan. He clarifies, ‘The idea that a biopsy will spread the cancer is completely untrue in most common cancers. Biopsy is very safe and necessary in case of breast, colon or stomach cancer.
Dr. Md. Sajid Rezwan said, when surgeons operate, they cut out the original tumor along with the part of the needle or track that was used for biopsy. As a result there is no chance of spreading separately. However, certain cancers, such as those of the liver, pancreas, gallbladder, or kidney, are diagnosed with advanced imaging and usually do not require a biopsy. And MDT is needed to ensure that these delicate decisions do not go wrong.
Colorectal surgery specialist Dr. discussed in detail whether it is possible to avoid cancer through diet and lifestyle changes. Md. Suman Ali. He said, the two main causes of colorectal (colon and rectal) cancer are environment or diet and genetics. Our current generation tends to eat red meat (red meat), extra spicy foods, processed or smoked foods, which stimulates the production of cancer cells in the stomach.
Our previous generation were fish-and-rice Bengalis and ate lots of vegetables and fiber, so they had less disease. Dr. Sumon advises, if you avoid fast food and increase the amount of vegetables and fruits in your diet, the risk of this cancer is reduced to a great extent. Apart from this, if the disease is detected in the early stages or polyps are detected through regular colonoscopy screening after the age of 45 or 50 years, it is possible to cure it 100%.
Stage four means the end of life? In response to such questions of the director. Zulfikar Saif said that the results of stage four cancer in traditional treatment are not promising, but modern immunotherapy is changing this concept. For example, in the case of colorectal cancer, if the disease spreads only to the liver, it is possible to cure it. Even in other complex cancers, immunotherapy now results in complete cure or longevity in 10 to 20 percent of cases. Although this treatment is very expensive, researchers hope that within the next 10 years, the price of this drug will be within the reach of the general public.
Another common gripe many have is that ‘medicine in Bangladesh does not work properly’. Dr. dismissed this idea as completely wrong. Ishtiaq Ahmed Anik. He assured that every cancer drug in the country maintains very strict quality and comes in the market with a specific certificate from the Drug Administration. It is a different matter if the patient’s body is already resistant to a drug, but the indigenous drug is of international standard and is equally effective.
Is the treatment of Bangladesh lagging behind the global standards? Dr. in response to this important question. Md. Sajid Rezwan said with great determination, ‘The standard of cancer surgery in our country is not lower than America, India or Singapore in any part. Our surgeons are using world class techniques for the benefit of the global village. Bangladesh has one of the best surgeons in Asian continent for breast cancer surgeries. People often run abroad due to lack of publicity and old psychological reasons. However, due to the fact that they spent all the money in the operation abroad, they can no longer carry out expensive cancer treatment in the future.
Another big fear of colorectal surgery is to carry a stoma bag for the rest of your life. Dr. Md. Suman Ali removed this fear and said that not all operations require a bag. Basically bags are used in three cases, out of which two cases are temporary. In cases of middle or lower rectal cancer and complete blockage of the pulse due to cancer, a temporary bag is given postoperatively, which is then normalized by surgery. Only if the cancer has spread further down the anus or into the muscles that control the bowels, is a permanent bag given. Thanks to modern surgery, most patients are now living healthy lives without bags.
In the last part of the program, the doctors put special emphasis on ‘compassionate care’ or compassionate care. Dr. Zulfikar Saif said, Oncology is a field where treatment is not just like guidelines or machines. Since there is no health insurance in our country and patients have to pay out of pocket for treatment, doctors have to imagine themselves or their family members in the patient’s place and provide compassionate care.
Cancer patients face various complications after going home. Then a little reassurance from the doctor or an answer to the phone call gives them great mental strength.
Doctors opined that awareness at the right time, proper use of modern technology and expansion of MDT or integrated medical system can make Bangladesh cancer free.
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