Optimising Resources For Better Outcome
With over half a century’s experience in scientific research, Dr Ulhas Ganu shares his thoughts on the future of cancer researchBy Dr Ulhas Ganu
A couple of decades ago, in an advertisement, I came across a photograph of kids enjoying a boat ride on a river. There were ten of them, across race and religion, all of them smiling and enjoying the experience. But the text beneath the photograph posed a chilling question: This boat is likely to sink in the next ten minutes, and due to a constraint on facilities, you can only rescue six of them.
That’s a very daunting dilemma no one would want to find themselves in. Unfortunately, oncologists face such a choice almost every day in clinical practice with pediatric cancers, especially in Acute Lymphoblastic Leukemia. I recall stumbling into research by chance in 1966 as a research student, when the Cancer Research Institute, a part of Tata Memorial Center, offered a good scholarship that gave me the freedom to earn and learn without having to depend financially on my family. A walk through the alleys of Tata Hospital’s OPD was always heart-wrenching as frail, advanced stage adult cancer patients and kids with typical yellow pallor were seen waiting for their turn to be examined. The anticancer drugs those days were considerably less effective yet continued to be prescribed for a lack of better alternatives. While researches showed the utility of L-Asparaginase from guinea pig serum in murine leukemia in 1953, it took another 25 years for the E. coli derived L-Asparaginase to gain approval from the US FDA. So much time elapsed between early observations & approval because of the lack of availability of adequate quantities of L-Asparaginase for a clinical trial.
L-Asparaginase made a huge impact on the long term survival of ALL (Acute Lymphoblastic Leukemia) patients compared to the earlier protocols. That made non-L-Asparaginase containing protocols redundant. Yet, the cost of therapy made it difficult for many parents to forego such a regimen option. Almost until the late 1990s, the L-Asparaginase formulations contained 10,000 IU per vial. The need for smaller amounts either meant the loss of the costly medicine or tying up with another parent for sharing the cost. A fever or some reaction in the other kid meant no sharing partner for the next dose. Sympathies were not enough! Though fairly late, after several rounds of discussion with oncologists & IV technicians, the desired change was brought about, and a couple of companies introduced 5000 IU & 10,000 IU formulations. Many oncologists have shared with me their moving encounters with the ailing child’s parents. To these doctors, breaking the news about the child’s cancer to the parents, telling them that there is no curative therapy for their child, or that leaving therapy midway because of financial strains could be unfruitful, has never been easy. I used to travel extensively across India in the 90s and found that quite a few NRI students of the BJ Medical College had sponsored the therapy of underprivileged ALL children undergoing treatment at Gujarat’s Cancer Research Institute.
The incident further opened my eyes to humanity’s goodness, and as opposed to the newspaper advertisement, there were optimized efforts to save all the children, rather than 60%. Indeed, there is a need for funds to supplement the therapy of children. Reducing load on resources such as doctors’ and nurses’ time, admissions, and diagnostic facilities also need to be worked out by focusing on awareness campaigns that can help in early detection and diagnosis. This work requires joining of hands by the pharmaceutical industry with the medical fraternity, or even better, with medical institutions