I am indeed delighted to participate in the dedication of the Linear Accelerator and the Integrated CT Simulator with treatment planning system for 3-D conformal radiotherapy and intensity modulator radiotherapy at Hemlata Hospital, Bhubaneswar. I greet the organizers, distinguished doctors, oncologists, pharmacologists, paramedics, other staff and distinguished guests.

I have been studying the work done in the Cancer care by various institutions in the country during the past five decades. Pioneering work on curing patients has been done in the area of tobacco induced oral cancer. Our researchers have been able to identify the radiosensitive action of Bleomycin, which has been used to treat oral cancer patients in conjunction with chemotherapy. This has resulted in high percentage of successes in treating oral cancer cases. With the increase in cancer cases particularly among women, where the cervical cancer alone contributes to hundred thousand new cases detected every year, there is a need to find advanced and innovative ways of treating the patient. In many parts of Orissa particularly the tribal population needs to be screened for cervical caner detection. This work has to be done by a good medical team. After screening Cancer affected patients can be brought to Hemlata Hospital for treatment. Hemlata Hospital can be one of the important hospitals to fill the gap in Cancer treatment in the eastern part of the country and will be able to provide state-of-the-art treatment in a cost effectdive way to the patients using the facilities such as digital linear accelerator and integrated CT simulator. Now I would like to discuss on the topic "Integrated treatment management for Cancer".

Insights into Life

I would like to share a few experiences of people and their pain and possible solution. Last year I was at the Centre for Cellular & Molecular Biology at Hyderabad. I met hundreds of young scientists working on the genetic origin and manifestation of diseases, particularly Cancer. The young scholars very enthusiastically shared with me their knowledge of molecular biology and cellular research. They told me about the information encrypted on the DNA of a cell and how both problems and solutions to the human lives reside on the software that nature has embedded in each life it creates.

Cancer, unlike many other diseases that come from the external factors, like infections, life styles and other environmental and physiological stressors, emanate from within the cell. The life software embedded in the DNA material gets mutated and start growing in a way that is not in-line with the cells around. Life turns against itself. The tragedy becomes unfathomable when it happens too early. Now I would like to give my experience with a few of my friends who are bravely fighting against Cancer.

Brave Hearts

I have three friends so valiantly handling their blood cancers. The first one is an industrialist-scientist , second one is an author and the third one is a painter, all three are handling their blood cancers with courage. Undaunted by the presence of a disease of poor morbidity in their bodies they are relentlessly pursuing life with courage and treatment. The industrialist-scientist says, like a gladiator, he will defeat his cancerous cells and he is doing. His family is helping him to fight against cancer. The author is learning more about Self by writing books of great spiritual and literary value. One of his work is titled ?Celebration of the Cells?. I have invited the painter to stay in the Rashtrapati Bhavan. He created beautiful paintings capturing the beauty and life in Mughal Garden. He showed me one painting of excellence which he did while undergoing chemotherapy at the Tata Memorial Hospital. According to him, to overcome the pain, he created one of his best pieces of work. The indomitable spirit was shining over the trauma of pain. I learnt from interaction with these three men that the life of a cancer patient is a process of adjustment to a disease that at times is in remission and at other times active. Any illness or even discomfort can direct us to the often-ignored self. It can even become a journey of faith. The medical practitioners can take a lead from this experience while advising patients.

Breast Cancer: a new project

The suffering of cancer does not remain confined to the patient alone. The psychological and financial suffering often engulfs the entire family and the social surroundings. The emotional trauma is just intense. The Bangalore Cancer Research Foundation conducted a unique multi-institutional study with DRDO with the participation of Defence Institute of Psychological Research (DIPR), Defence Institute of Physiology and Allied Sciences (DIPAS) and Centre for Cellular and Molecular Biology (CCMB). The study was aimed at establishing the relationship of the stress of breast cancer patients with the neuro-endocrine response leading to immune modulation, which will determine the prognosis to treatment or progression of the disease. The perceived stress of the patients will be influenced by the social support being provided by the spouses and caregivers and hence in the study a systems approach was made to evaluate the stress of the patients in the social ambience. Patients of breast cancer, their spouses and equal number of the care givers served as volunteers for the study.

Standard psychological methods were used to quantify the stress of the patients, their coping strategies, blood cortisol, cell mediated immunity and humoral immunity were measured in all the three groups. The study revealed specific correlation of the stress of the patients with the immune responses. Patients who received adequate social support had lower level of perceived stress and their prognosis to surgical, radiation and chemotherapy were better than those who had higher level of perceived stress due to inadequate emotional support from the spouses and care givers. The primary message, which emanated from the study, indicates that for successful prognosis, it will be essential to combine psychotherapy along with the conventional medical management of cancer. It also emphasises the necessity to address the problem at the mind-body complex to facilitate the better treatment of this complex disease. The sample size is small. Elaborate further research in this area is very vital.

Stem Cell Research

Newer knowledge is emerging out of research on stem cells from abroad and India. In fact, regenerative medicine is fast getting established as a complete branch of medical science. The embryo starts out as a mass of undifferentiated cells, which then divide, multiply and go down differential paths to take the shape of various tissues and organs of the body. The mechanisms which constitute this orderly process of differentiation is fast getting understood at the laboratory level. And the state-of-the-art in this area holds the promise of regenerating tissue that malfunctions due to injury, age, disease or genetic abnormality. Whether large volumes of cells of repeatable quality can be produced from stem cells is yet to be seen. I hope that the day is not far when a six year old boy I once met who was suffering from Thalasimia, will get a tailor-made bone marrow out of stem cells to survive for the next sixty years and beyond.

Affordable & Accessible Therapeutics

Treatment of cancer involves any one but most often a combination of radiation, chemotherapy and surgery. Genetic diagnosis can help to take good decisions while charting the course of therapy. On the drug side, instead of looking for agents that kill dividing cells, researchers are now looking for agents that encourage cell to get destroyed. Inside a growing ball of cancer cells, the blood supply can run short, so the cells begin to suffocate. Malignant cancers get over this problem by sending out a signal to the body to grow new arteries into the tumour. These arteries characteristically grow like a crab-claw that first gave cancer its Greek name. Many drugs, called angiogenic agents, are now available to destroy these supply lines. These drugs are imported and are very expensive. Industry-hospital-research institution consortia need to be established to develop affordable indigenous products, especially using nano-technology. I understand some of our scientists have found by examination of homeopathic drugs which is used for treating arthritis, through electron microscope that it contains gold in nano-form. There is a need to carry this study further and bring medicines in nano form for delivering to the cancer patients. This may become not only a cost-effective solution since the quantity needed will be very small, but also penetrate and reach the spot precisely and cure the patient faster.

Networking of institutions

There are number of hospitals providing cancer treatment in the country. It will be useful to network these cancer treatment centers for enabling consultancy among specialists and directing the patients to the right type of specialists who may be available in one of the networked institutions. This type of consultations among experts will generate confidence among medical community to undertake treatment of complex cancer cases and enable them to cure the disease with cumulative experience. Also, it will be useful to have monthly or bi-monthly conferences among the specialists of different centers through telemedicine facility to discuss the special cases treated during that period. This will create treatment synergy between centers. During one of my visits I found that cancer centers have immunologists, physiologists and psychologists working together. I would recommend Hemalata Hospital can get networked with other cancer treatment centres located in different parts of the country have periodic tele-conference and collaborative research based on the available clinical data.

Maintenance Support

The digital linear accelerator is sophisticated complex electronic equipment. It is very sensitive to steadiness of supply voltage and frequency. Hence, I would consider it is desirable to have dedicated suitable capacity UPS for the system with appropriate voltage and frequency control. Also, the spare parts of the digital linear accelerator are costly. It may be advisable to work with certain bio-medical equipment manufacturer so that the spare parts required for the digital linear accelerator can be manufactured in the country. This will enable the maintenance of the equipment at a reasonable cost and short period of time.

Conclusion

I would also like to share with you a quote in the paper which I came across on the topic ?One World, one people, one surgery" by Dr.T.E.Udwadia which states: "The poorest of the poor have as much right as anyone to less pain after surgery, reduced medication, less morbidity, shorter hospitalization, and early return to home, family, and work. Minimal access surgery and the expensive technology it requires are advocated, not as homage or tribute to new technology, but in appreciation of the manifold benefits this new technology gives to our patients and our people." This thought has to be the focus of all the doctors, specialists and other members of Hemlata Hospital.

With these words I dedicate the Digital Linear Accelerator and the Integrated CT Simulator. My best wishes to all the members of the Hemlata Hospital for success in their mission of providing faster removal of pain of the cancer patients.

May God bless you.

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