Introduction

When we think cancer, we think of death and dying. Collectively we need to review the subject from a different perspective. One needs to understand the impact of cancer on individuals, communities, society and nation. The need to reduce the burden of cancer is truly wanting at all levels.

Cancer has major commonalities with Non-Communicable Diseases (NCD). International literature indicates that Cancer is largely preventable if we group together and act appropriately. Cancer is preventable, is good news!
                      
Current Status
                     
The Ministry of Health has initiated a strategy towards cancer prevention. The establishment of a Cancer Prevention Unit within the Non-Communicable Portfolio is been actively undertaken. The National NCD Officer is in the process of operationalising a team of ground zero experts to develop a national cancer registry. World Health Organisation (WHO) has also agreed to send in a Short Term Consultant to provide additional technical expertise. The research question is simple, identify where we currently stand with respect to the incidence and prevalence of cancer. Then only, can the operational team determine where we ought to be, in the next decade at a national level.

The Strategy

Prevention International data demonstrates beyond doubt, that all the risks which contribute to our evolving lifestyle are responsible for the increasing incidence of Cancer.

We know that reproductive tract cancers are a direct result of exposure to the Human Papilloma Virus. These viruses are sexually transmitted generally. Incidentally, these viruses are known to cause throat and gut cancers too.

Yet with availability of a vaccine against Human Papilloma Viruses, society remains ambient to its advantages.

Breast Cancer is increasingly recognised in our urban females. Lifestyle changes with high fat/caloric diet, increased body mass, reduced incidence of breast feeding all contribute to this disease entity.

Advocacy and public education needs to be established if we are to impact on any cancer prevention program. Prevention will take us a certain distance but a multi-pronged approach needs to be planned with all stakeholders in society for a fuller impact.

Early Diagnosis

Society wants early screening collectively yet we note great reluctance on the part of individuals presenting for screening tests. The advocacy of wide spread screening cannot be over-emphasised. Wellness checks cannot be relegated to those who can afford to pay only.

The example of Papanicolaou smears is a good example of a wide screening tool which can assist in early detection of suspicious pathology which has the potential of cancerous changes. There remain limitations with the National Health Service to the number of tests which can be reviewed annually.

The use of mammograms which are being recommended will need ideological planning as x-ray radiation resulting from such procedures can be problematic, if we do not have protocols.

Other such screening tests carry false negative and false positive variables which need to be factored in. All the same an early diagnosis needs to be made.
                     
Early treatment

Various methods of treatment can be undertaken if an early diagnosis is made. These treatments are affordable and can be undertaken locally. Surgery, local radiotherapy and chemotherapy can be contemplated and carried out with early diagnosis today for many tumours. Complex chemotherapy and radiotherapy will remain on the radar margins for some years yet. The establishment of an adequate separate, basic facility is being contemplated and in design phase with the assistance of international agencies.
              
Rehabilitation

Some cancers grow rapidly compared to others. The individual's immunological ability to withstand the ravages of cancer differs. The individual outcomes vary as a consequence. Quality of life issues matter then.
Civil society groups such as The Fiji Cancer Society can play a major advocacy role if there is sufficient support by members of community become involved in its operations.
One sadly notes the apathy of communities. Individuals and society need to be proactive and not just reactive when relatives and friends are struck with cancer or other illness. Empathy is rather late in arriving. One is then left with the blame game. The ball then is thrown into the ministry of Health's court.
                    
Dying and Death

Rehabilitation and terminal care are the end points and can be made easier with better team effort. The State's ministry of Health, cancer society and other stakeholders need to get together and plan facilities where we can provide holistic care, knowing full well that someday death will arrive. Rather too many patients and relatives are rather poorly counselled on dying and death. The process of dying should be supported with adequate holism. Medication, physical, emotional, religious and legal support are some important components. Relatives and friends should be better prepared in most cases.
  
Role of the Healthcare team

The healthcare team continues to serve in all facets of the disease continuum. The team must learn greater empathy and to truly provide genuine care.

There is need for greater skills in addressing prevention issues when society does not heed advice. The screening is avoided by individual denial and the most vulnerable seek advice the least. Symptoms are treated with herbal medicine and sorcery. Finally when desperate help is warranted the healthcare system fails to kick in with the various resource limitations.

The health team needs to be truthful in all facets of the treatment cycle especially when dying and death is close and visibly on hand.

Conclusion

The Fiji health reform process sees the establishment of its Cancer Prevention Unit in 2010.This is the first step in the journey towards addressing the range of morbidity and mortality associated with cancer. The assistance of World Health Organisation is acknowledged. The work of the Fiji Cancer Society needs much more support from the wider community.
                            
The Private -Public sectors must collaborate to make any impact. Corporate organisations need to pitch in their muscle power and see the dream of a hospices developed in all four divisions. Communities and faith based organisations must also work towards addressing prevention and promoting earlier diagnosis.

The message of healthy living includes regular exercise, weight control, life style modification of modifiable factors-cigarette smoking, alcohol, yaqona and stress management will all contribute positively. Celebacy, monogamy will all contribute to wholesome and active living.

The meaningful gains of disinfectants, antibiotics and vaccination successes of the last 50 years are fast being eroded through non-communicable diseases i.e. Diabetes mellitus and those of the cardiovascular system. These same conditions have commonalities with cancer and we now bare witness to this additional insult. The preventive measures are the same, so act now. Get involved.

Dr Neil Sharma

7th Feb 2010