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