By Susan Miesfeldt, MD
The inaugural Cancer Control in Primary Care Course took place in Bhopal, India, in March 2015, which was fitting since it was the site of the largest environmental disaster in world history. As a result of the Union Carbide Corporation's chemical discharge in 1984, the estimates of the lives lost range from 3,000 to 10,000, with many thousands more suffering from late health consequences, including cancer. From an outsider's perspective, the only evidence of this disaster today is the skeleton of the decontaminated, long-vacated Union Carbide plant on the outskirts of the city. Although acknowledged as a major event in Indian history, Bhopal residents have clearly moved past this disaster.
Residents of the vibrant "City of Lakes" warmly welcomed ASCO International staff, American and Indian faculty, government representatives, and course attendees for the 2.5 day session. The course covered a wide range of topics, including an overview of the Indian cancer burden, primary and secondary prevention, cancer basics, treatment overviews, and survivorship care. Breaks in the educational program allowed for open dialog, information exchange, and problem-solving among attendees, local cancer specialists, and American faculty.
Those attending the course were practicing primary care clinicians from 41 largely rural, government-run district hospitals throughout the state of Madhya Pradesh, where Bhopal is located. One of the largest states in India, Madhya Pradesh is composed of 53 districts, with a total population of 73 million, and is located in Central India. Course attendees were part of a unique cancer control program founded by Dr. Dinesh Pendharkar, an oncologist practicing within a tertiary cancer care setting in Mumbai. Through a combination of government support and close collaboration with cancer specialists, this program links cancer professionals with grassroots community health care providers who serve much of the state. The program greatly extends access to care throughout the state to the most vulnerable and underserved populations. Through this ongoing partnership, local district hospital physicians are serving six critical roles, including:
- Leading community-based cancer awareness and prevention education
- Conducting cancer screening and early detection services
- Referring patients to appropriate tertiary centers for diagnostic and tertiary care services, including surgery, radiation, and adjuvant treatment care planning
- Administrating basic chemotherapy services, under the ongoing direction of specialists
- Conducting post-treatment surveillance
- Providing palliative care and end-of-life services
Although this unique program is new, it has already served a substantial number of socioeconomically disadvantaged patients with cancer throughout Madhya Pradesh. The program appears to be sustainable through ongoing government support and the volunteer efforts of Dr. Pendharkar and other cancer care specialists. It was an honor to be a part of ASCO's inaugural Cancer Control in Primary Care Course. I benefitted from the course as much (if not more) than those in attendance and gained an invaluable understanding of the tools currently available to India's cancer clinicians, as well as the significant challenges they continue to face. Congratulations to the ASCO International staff, Dr. Pendharkar, and course director Dr. Prince John on the success of this important event.
Susan Miesfeldt, MD, is a practicing medical oncologist, clinical investigator, and principal investigator for Maine Medical Center’s past National Cancer Institute Community Cancer Center Program. She currently serves as the Medical Director for the Cancer Risk and Prevention Program at Maine Medical Center. In addition, she serves on the International Affairs Committee for ASCO.