Unpredictable Nature of Cancer

dear friends

actually i’m a surgical oncologist and

we are used to

be in the hospital most of the times so

we deal with

a disease called cancer which is a

chaos in the body and it is

very complex disease and we try to

understand this

and we try to control that so i’ll be

just talking

uh how we actually deal with the cancer

so before that

we have been seeing the speakers telling

about belief

we believe something then we accept that

and once we accept that we start acting

for that belief now that is what we all

do now

most important is the belief that is

there in our mind which drives us to do

everything that is possible i just want

to tell a small story like

i was traveling i was not an expert then

in

oncology i was traveling in a train and

i came across

a is officer who had his wife

in a terminal stage of cancer he was

treating her and he was doing the best

from his side

so he was very much down and he spoke to

me

about all his efforts to save his wife’s

life

and what memories haunt him whenever he

sees her

struggling and finally he said a

beautiful thing

which made me think a lot before i

became expert

the first thing he said is like

i found that life has no meaning we

start giving meaning to that

the second thing he said that it’s

what can i do as a human i can do what

is best possible from my side

i can give her the best treatment i can

take her to the best place

i can engage the best doctors and what

the doctors can do they can do

what is best available in mankind they

would bring all the best

uh technology that is available and then

give a treatment

and in spite of all this what might

happen later

that is inevitable and worst thing is

i have to live with that i have to

accept that

it might happen and once it happens i

have to keep it as a hurt locker

inside me inside my brain and i have to

live with it

all my life and that is how it is so

i’m ready for it now i could not

understand like

how could he assimilate but i realized

that

once you go through that phase once you

go through this painful

journey in a hospital with a cancer

patient you realize

how the family suffers with this disease

it’s not a disease of a person it’s a

disease of a family

and the most problematic thing is the

belief system that

runs across this disease there’s a

belief system in la public

about this disease which i realized

because i was a very similar kind

i realized once i became expert that

this belief system is not true

there is something else which you have

to think we have to change our belief

system

when we deal with a chaotic disease like

cancer

so what i can say about cancer is in

simple terms

it’s a oversimplification of a complex

disease i can say it’s like chaos

we know all in science we had gone from

newtonian mechanics to quantum mechanics

from quantum mechanics we were talking

about chaos

that is an unpredictable thing so

predicting

unpredictable thing is a huge challenge

for mankind

we have to see how we can actually bring

out that like how we can predict

what’s going to happen and not only

about predicting it’s about controlling

after predicting

you need to control it and that’s what

we are supposed to do and this is what i

understood

the cancer like people talk it’s like

this it came from this it

came by a risk factor like smoking or

alcohol some people never had it but

still had it

now why is this this is actually a

genetic mistake in the unit of

life called cell we are nothing but a

huge

tower of cells trillions of cells which

are moving like two new galaxies

and if you go inside the cell it’s like

one more huge galaxy

so our mankind has tried to understand

the scales

it’s like standing under the huge banyan

tree in calcutta and just

imagining how exactly this tree looks

like now that that’s not

simple that’s not easy but that’s what

we as a mankind are trying to do that

and science has no country science has

no boundaries science is for everyone

it’s for mankind

so what we are doing is we are doing

non-linear measurements it’s not like 2

plus 2 is equal to 4.

it’s about trying to understand a

complex situation where

we are trying to derive a equation which

i have never understood

that is e is equal to m c square so it’s

more or less

we are trying to understand this complex

relation so cancer is like

telling e is equal to m c square it’s

not like 2 plus 2 is equal to 4.

so how we actually got trained as expert

is

by learning something called

biostatistics

so i still feel when you are doing a

non-linear measurements

this is the language of non-linear

measurements that is biostatistics

so this is something which always i like

the quote by aristotle one of the

foremost thinkers

a plato student who said art is long

life is short experiences are deceiving

and judgment’s difficult i believe he

said about chaos only

it looks more matching to cures and this

chaos is nothing but

the disease which is the most complex

and the most challenging disease for

mankind

that is cancer now

what did i understood let my uh take out

all the jargon that is used like

confidence interval p-value i’ll take

out all this

and i’ll try to put it in a simple way

like biostatistics

we are trying to understand the

observations about this chaos

by telling what i am thinking is it

close to truth

is it truth is it a lie or a spectrum in

between

and this is what we have understood and

this is what we have been trained for

so whenever we talk about a a

finding or if we talk about a treatment

we

look through this our mind scans through

this and then it gives you opinion it’s

just not that

it just comes to us it’s been a trained

mind

and that is how it puts out

so i’ll just tell you this is our expert

system how it works but which if you see

from the patient’s point of view

is something different let me say the

existing system

and then i’ll tell you how we can change

this system i’ll just give some

examples in which how we can make a

decision to survive this chaos

of cancer so the first is we think that

it’s the patients think that it’s an

emergency so i’ve seen

just about three days back i had a whole

family uh

wife children everyone and a lot of

attenders mainly

the patients relatives who had come and

they thought that he is going to die the

next moment

so they bought and they said he is

having a cancer the cancer in the mouth

now that was a early stage if we had

left like that

he would have lived for another two

years without treatment

but for the patient family is something

different what they think is that

it will spread in no time so it is

diagnosed today tomorrow cancer spurts

everywhere

the third thing is they’ll say that

there’s no cure everyone at the home

in the environment everywhere they come

around and tell you

it’s there’s no cure wow there’s nothing

you can do about

it and the person who has got

this diagnosis and the family who has to

bear this

emotional problem starts thinking we

have to act fast we have to do something

this is all that runs in their mind let

me do something for him

now when you have this thing in the mind

do something what are you going to do

how are you going to deal with it so

this is where you get distracted

a lot of things that go wrong after this

do something comes in mind

so i just want to tell you like where we

can go wrong and how we can

come out of this belief system the

belief system

which says that cancer cannot be cured

and there is no cure for it i’ll just

say these points which will tell you

how it can make a change in

that point of time where you don’t know

what to do next

so

first i’ll talk about the concept in our

mind called generalization we all

are used to this as humans we like not

to put too much stress on our thinking

we don’t want to

think too much at one point of time so

what we try to do is we try to

generalize because it makes the life

much easier so we say that all cancer

patients die

now this is easy to tell because you

don’t have to put the effort of

searching through the statistics just

searching through

what you have to do so if you actually

see there are five percent of the

survivors in u.s because we don’t have a

study

i’m quoting from national institute of

health us

so there five percent of the

population american population are

actually

survivors or actually had been diagnosed

with cancer

and they have beaten this disease

they’ve survived over it and they’re

living

so the second thing is every year there

is an

increment of decreasing the cancer by

two percent this is something where

mankind has been able to achieve among

the keywords it’s not easy to

control chaos you know once weather

reports are read it is difficult to

predict when it will rain when it will

not rain

they might come very close but can you

control it you cannot control it

this is one place where mankind has put

its best effort

to control this this control this chaos

and we are trying to bring down the

death rate by two percent every year

now that’s an achievement and if you see

from 1991 to 2016 data

25 decrease in the death rate now this

is

something we have to acknowledge of all

the

midnight lights which have been burnt by

people who have dedicated their life

to bring a change and to save the

mankind

from these cures and 30 percent of the

cancers

are curable this is something which we

have to understand not all

cancers are not curable 30 of the

cancers are curable

and most important early detection that

is before it comes by screening like

suppose

do a mammogram do a pap smear you come

to know about

it this is something called early

detection or early diagnosis where you

actually go immediately you have a

problem you reach the doctor the doctor

goes and sends you for a test

and then the test is done and you find

out now this is called early diagnosis

if you have an early diagnosis

cure is possible now this is what we

have

to look at this is the perspective which

we have to look at

so the danger is not in the diagnosis of

cancer

the danger is actually in the delay in

making the diagonal what will he think

what will she think may not be

these denials these ideas in the mind is

what

actually prevents you from getting

treated

getting the chance of cure is lost then

so uh generalization is the first thing

that we have to stop

we have to replace the thought by saying

that all

cancer patients do not die many may

survive

and if they are detected early they can

be saved

this is what first change that has to

come the second

is once you know do something what are

you supposed to do

now here you get distracted by so many

ideas that are coming come across to you

because

obviously you are sensitive you try to

share you try to get inputs because you

are not able to decide you are clouded

by emotions

you are clouded by confusion you are

clouded by pain and this is a situation

where nothing works in your mind

how much ever bold courageous brilliant

you are this is the point

of time which shakes you and at that

point of time what happens

you come with an existing belief system

where

actually non-experts who are non-experts

somebody

your neighbor it could be a relative it

could be a person who had cancer who got

treated for that

and then got successful and they tell

about this

treatment is successful or not or this

doctor is good or not this hospital is

good or not

so these ideas come compile and then

come to the pressure

patient and the caregiver now they have

to decide

like what treatment i have to take now

because there are so many parties like

uh like what i say delapatis like

homeopathy

ayurveda

and so many parties now you have to

choose which is the right path for you

because if you choose the wrong party

you will be in trouble

so what’s the right path here nobody

knows

so the most important thing what happens

at this

juncture is that people start talking

about side effects

you go for that treatment it will have a

lot of side effects you will lose hair

you will become very big and that pillow

diet we have such a beautiful uh way of

putting it across to the patient that

they should really get scared and think

no way i will go for it so this is what

it does

and there are enough patients also who

actually glorify their side effects

though it may not be to that extent what

they’re telling

now why is it because it’s subjective

and what is objective

nobody is looking at it because

subjective is what impresses you what

drags you

what creates emotion in you so

objectivity does not create emotion

and it has to be analyzed so it takes

time for us to get into that

so what i suggest is like what we do is

we should not see the risk benefit

analysis that’s the world which we use

so risk of side effects versus the

survival benefit

the same patients have survived for 30

40 years

or got a full life for a side effect

which might have lasted for

a few days or for a few months suppose

there’s a hair loss

we give her for god we give her for many

reasons but we are hurt

when it comes to this treatment but what

we try to motivate is see

you have to change your perspective when

you look at that point of time

because when you are expecting a longer

survival then that is the right

treatment for you because

i would like my father to be alive

rather than

his hair or having some problem so

for me he is more important so that is

how it works

so you always have to see where is the

largest survival benefit which party

gives you

larger survival benefit and not which

has which gives less side effect

and no benefit

next comes choosing an expert now uh

like the previous speaker had shown

there was a great expert

who speaks about cosmic rays and many

things around it

and what all can be done so i’m talking

about the same thing

here we have experts there are different

kinds of oncologists there are different

kind of

cancer experts now let me say it’s like

a cup of water

you have content you have form more form

less content less content more form

most of the technical people we know

very well are

extremely good but they may not be able

to communicate they may not be able to

express but they’re brilliant they know

their job

they can do it excellent and that is

what i’m trying to tell there is more

content

and less form these are the people who

actually are

useful but we what we get carried away

is again like i told subjective

emotional so we get people who are in

limelight all the time who are media

savvy who speak only about a rare

accidental success

which was actually accidents that

surprisingly it happened

and they keep talking bragging about it

throughout their lifetime in every

speech

in every talk they talk about it they

don’t talk about a vast area of

experience

they don’t talk about all the cases they

have dealt with they don’t talk about

how many failures they had they don’t

talk about how many have not survived

because of their treatment

they don’t talk about how much have died

because of their misjudgment

they talk only about success because we

we all love to hear about success we

have never been trained to

take failures and this is what happens

so

what we try to get in get involved is we

try to

feel about okay uh uh what’s the success

so he keeps talking but

true expert will talk about statistics

about truth

and what are his results how many has

failed how many complications

how many have been successful so this is

the spectrum which he gives he is the

right expert

so choosing a right expert at that point

is pretty important

and most important there are many

patients who come to our consultation

room

with big egos because they are in some

position or whatever has made them

they come and ask you do this you do

that now we tell we don’t treat egos

we treat your disease we are here to

treat your disease and what is that

that is do what is right rather than

what you like

so we don’t care like what they think

about

or what they feel about you but what is

important for the patient’s life

what is very important to treat the

problem

we have to do that so this kind of

expert there’s another kind of expert

who will please you he will tell you you

don’t worry they are so

versatile they are able to put rhetorics

they try to tell you i can do this

if there doesn’t want okay we will do

the other thing we will do that

this is specifying and this is not truth

so

what i say is the hardcore objective

thinking

is like a documentary you have to

document you have to understand you have

to put your brain

you have to analyze while on the other

side you have a fantasy feature film

where you really enjoy it you really

like the way they talk the way

it expresses but at this point of time

like i told you earlier

this is not two plus two we are dealing

with e is equal to mc square

so you need to find the right expert

now choosing a resource now this is

something again i have to tell

during consultation we come across so

many patients who come and tell us

you should not drink coconut water you

should not drink barley water you should

not eat sugar

you should not eat this why why we are

we supposed to do that

or are we supposed to get up at six

o’clock it stops cancer

now this is something which comes and

some

made in blocks where they are not

experts when you are seeing a resource

always try to see the authenticity of

the resource

you see whether it’s coming from a

government

agency like example nih or is it coming

from an

institution like it could be mskcc

or any other tata memorial hospital or

it could be an organizational could be

an nccn

or indian grid and then

this is what i am saying it is always

resources have to be

focused based on evidence and not based

on

emotion because one patient blog might

tell i had this problem this happened

that doctor did this

see you are actually getting diverted

you are because

our mind is very much focused on

emotions

rather than on logic logic is something

which comes next

first is emotion so that is where we get

into trouble

and that’s why it’s important to choose

a resource when you have trouble

next is choosing the place of treatment

now this is something we see

we get carried away by ambience we care

we get carried away by the

flaunting things around and we say

that’s the best place to get treated

i’ll tell you all the best places in the

world are there

where people are focusing on

the outcomes how the results are coming

out from the hospital

rather than on the external things so as

doctors as

oncologists we are more focused on what

we get to operate what are the

technologies we have with us

and how are we going to do with it and

that is what we try to tell

so a long history of good

results is what matters first the second

is

the team of experts it’s not just one

person’s ego or a

doctor who thinks i am the last person

on earth who knows everything

it’s a team of experts who are very

logical skeptical

and critical and do a self-appraisal

they try to put it across

saying that it can i can have a bias you

just check and tell me this is the

scientific temper

which happens in a tumor board and that

is what we call team of experts

so it’s not about me it’s about the team

so it’s not one person who brings out

the result it’s the entire team of the

hospital which brings about the result

but unfortunately one person’s name come

you very well know dhoni don’t even know

dhoni is he a batsman is he a bowler

but all the time because he leads the

team it’s very much similar there are

many people

who contribute to the success of a

patient’s life

and that is never ever seen

so see a good infrastructure and a

support system how is the nursing care

how is the hospital equipment how is the

thing what is their history

this is what you have to look at so

offline we have good

comprehensive cancer centers where

everything is compiled together

and it’s a very objective place where

research happens

and discussions are at the level of

objectivity

rather than subjectivity

so sometimes there is always a dilemma

like when i have a diagnosis i am not

ready to agree with that

i feel it may not be true it may not it

may be wrong

so what we try to do is we try to

take a second opinion so how do we take

a second opinion

not going to the next expert but an

expert who is senior who had a varied

experience

who has seen all kinds of side effects

all kinds of

problems related to the disease and who

can give

a explanation which

will convince you so this is what you

have to

look at choosing for a second opinion

now this is one thing

which i want to put and i want to stress

upon

is getting over the gut feeling now this

gut feeling is something

i don’t understand the gut feeling can

do only two things

it can either help you to burp or it can

help you to

fart other than that it doesn’t do

anything so don’t go with the gut

feeling gut feeling is something

which tries to put a matches more

effect or whatever but what i’m trying

to tell is

gut feeling is emotion derived and it is

meant for simple things like

okay i have a gut feeling i have to take

right turn or left that looks good

but when you are dealing with the

equation like is equal to m c square

if you think i have a good feeling to

solve this

there’s no answer for that so gut

feeling is the last thing

when to think about when you are making

a decision

so to

summarize i would say what is the belief

system

when you have to change when you have a

situation

have to do something so what is the

belief system

first is remember do not generalize

say think that cancer patients survive

70 percent may or may not but 30 percent

will definitely survive

and early diagnosis or early detection

is going to cure them

this is the first thought that should

come to your mind the second is

choose a treatment any party who gives

you

larger survival not the person not the

party who gives you less side effects

and less survival the third thing is

listen to a person who has a talks about

many number of cases over a period of

time talks about his success and failure

stories

puts you all the possibilities rather

than to a person who just

who speaks about only success and never

about his failures

next if you want to check for a resource

go for a resource

which is authentic which has got

government

institutional or organizational

backup rather than for some blogs or for

some

domains where you really know that they

are not authentic

so lastly i would say that

never rely on your gut feeling and take

a decision

that what is right you do rather than

what you like

thank you