Blog
What can help make Breast cancer treatment a little more affordable in India?
“Cancer drugs may be most expensive in the USA, but Indians and Chinese have to stretch their pockets the maximum, in order to afford them”1,2

That was a piece of news that caught my attention earlier this month. At a recently concluded meeting1,2 (called ASCO 2016), experts compared prices of 23 cancer drugs in 6 different countries. And while cancer drugs were costliest in the USA, compared to India, China, Australia, South Africa and the UK, the drugs were least affordable in India and China (because “affordability” has to take into account the economic situation of the country and its people as well).



It’s news like this that makes you consider the immense cost of cancer. On the one hand is the tremendous physical and psychological cost for the person who is diagnosed, as well as the family and loved ones. And then there’s the tremendous financial burden linked to surgery, treatment, medicines and home-care—which is particularly daunting when you realize that over 80% of India has no health insurance, which means they need to pay from their own pockets.3

Treatment costs depend on several factors
That said, treatment costs can vary quite a bit though. Consider breast cancer, for example. The World Health Organization estimates that 145,000 women in India are diagnosed with breast cancer every year.4 Breast cancer treatments may often require up to 8 cycles of chemotherapy (with every cycle consisting of a treatment phase for 1-5 days, followed by a break for 3-4 weeks).5 But almost half of Indian patients cannot afford chemotherapy costs and stop visiting the hospital after just 2–3 chemotherapy cycles.4

According to an article in liveMint6 (2013), breast cancer surgery can cost INR 1.2 lakh in a private hospital. A more recent article7 (2015) pegged the cost of breast cancer treatment in the private setting, inclusive of investigations, surgery and radiotherapy, at INR 5-6 lakhs. Targeted therapy, which is one of the newer lines of treatment that can be very beneficial, often comes with a very steep price tag that ranges from INR 12-20 lakhs.7,8

And yet, there are quality institutes around the country that can offer breast cancer surgery at a mere INR 5000 and chemotherapy can cost INR 2500 per dose.6 But there’s a flip side to that. Because of the sheer number of people who have no choice but to opt for treatment in the public sector or in specialized institutes that charged subsidized rates, patients have to often endure day-long waits, in crowded waiting rooms, often with not much privacy. Understandably, even the consultation times are drastically shortened.

But there’s a glimmer of hope
But the eternal optimist in me wants to look for the silver lining. And there are quite a few.



For instance, last year, the government inaugurated AMRIT pharmacies (which stand for “Affordable Medicines and Reliable Implants for Treatment”) that will sell 202 cancer drugs (along with certain other medications) that will be 50–60% cheaper than those in the open market. Though these pharmacies are limited to a few locations for now, the plan is to have them in other parts of the country soon.4 In June this year, India’s National Pharmaceutical Pricing Authority (NPPA) reduced the prices of several important medicines, including the breast cancer drug Paclitaxel (metastatic breast cancer injectable) to INR 11,590 per vial.9

My hope is that the government continues these efforts and regulates more cancer treatment prices, just like the Australia and England governments do1, in a way that benefits patients, while continuing to allow the major institutes and pharma companies to continue to fund the research they need to. Rose-coloured glasses? Maybe.

But why not.

References:
  1. WebMD. U.S. Pays Highest Prices for Cancer Meds: Study. June 6, 2016. http://www.webmd.com/cancer/news/20160606/us-pays-highest-prices-for-cancer-meds-study
  2. Goldstein DA et al. Global differences in cancer drug prices: A comparative analysis. J Clin Oncol 34, 2016 (suppl; abstr LBA6500). http://meetinglibrary.asco.org/content/164423-176
  3. Bansal S. Health cover: Too little, too scarce. The Hindu. April 12, 2016. http://www.thehindu.com/sci-tech/health/policy-and-issues/health-insurance-in-india-too-little-too-scarce-reveal-national-sample-survey-data/article8462747.ece
  4. Press Information Bureau, Government of India. Health Minister opens AMRIT outlet at AIIMS for selling affordable drugs for cancer & heart diseases. November 15, 2015. http://pib.nic.in/newsite/PrintRelease.aspx?relid=130495
  5. Cancer Research UK. About breast cancer chemotherapy. August 1, 2014. http://www.cancerresearchuk.org/about-cancer/type/breast-cancer/treatment/chemotherapy/about-breast-cancer-chemotherapy
  6. Gale J. Breast cancer surge in India means non-private exams for patients. liveMint. Oct 30, 2013. http://www.livemint.com/Politics/T0InitoEpqehyOVn0ZW4ZP/Breast-cancer-surge-in-India-means-nonprivate-exams-for-pat.html
  7. Mukerji C. Can you bear the cost of cancer treatment? Find out how to buy the best cover. ET Bureau. Jun 22, 2015. http://articles.economictimes.indiatimes.com/2015-06-22/news/63708670_1_cancer-treatment-globocan-2012-10-lakh-new-cases
  8. Rajan A. Why is Cancer Care expensive in India? ETHealthworld.com. April 16, 2015. http://health.economictimes.indiatimes.com/news/industry/why-is-cancer-care-expensive-in-india/46942857
  9. Raghavan P. Essential medicine for leukemia, stomach cancer to become cheaper in India. ET Bureau. Jun 07, 2016. http://economictimes.indiatimes.com/industry/healthcare/biotech/pharmaceuticals/essential-medicine-for-leukemia-stomach-cancer-to-become-cheaper-in-india/articleshow/52633695.cms
NUTRITION DURING BREAST CANCER TREATMENT
If you are undergoing treatment for breast cancer, then eating healthy food is an important aspect to help you get back on your feet. Also, some foods can improve your immune system and keep your body the healthiest possible.

One way you can make sure you’re eating right is to divide your plate in 3 parts: fill up 50% or more with vegetables, 25% or more with protein and up to 25% with starchy vegetables or whole grains.2 Try and include plant-based proteins in your diet everyday.1,2

Other basic principles of healthy eating still hold true if you are undergoing treatment, such as, reducing your fat intake, drinking sufficient amount of fluids and keeping a watch on your weight.



Chemotherapy side effects and food:
It is difficult to know how your body will respond to chemotherapy. You might be able to eat everything during the treatment or your eating habits may change drastically because of the side effects. Moreover, your pattern of eating may change many times during the chemotherapy cycle. The following tips can help you deal with the common side effects of the treatment.3

Changes in appetite: Consider having five to six small meals instead of three big meals. Have milkshakes, juice or soup if you do not wish to have solid foods. Do not have a lot of fluids before or during meals as it could reduce your appetite.3

Feeling sick: You can drink plenty of fluids when you feel sick, but avoid having large quantities at once. Also, eat less and frequently.3

Sore mouth: Chemotherapy can cause a sore or dry mouth, which can make eating difficult. In such a situation, opt for soft foods like soups or smoothies and avoid salty, very spicy or hot foods.3

Change in taste: Foods can taste bland during treatment, so “spice it up” a little with some of your favourite seasonings and herbs.3

Constipation: Eating or drinking less than usual, or having to take certain medicines can trigger constipation. So, eating foods rich in fibre such as fresh fruits, lentils and oats will help ease the problem. Also, drink plenty of liquids.3

Diarrhoea: Some chemotherapy medication can cause diarrhoea. In that case, reduce the amount of fibre you consume. Peel your fruits and vegetables so that you can still get the nutrition but with less fibre. Also, eat small amounts of fruits and vegetables, and drink lots of fluids.3



In conclusion, a healthy diet can help you in maintain a healthy weight and give you that extra energy you need to improve your overall quality of life. Eating healthy is also vital for restoring muscle strength and overpowering the side effects of chemotherapy. So, embracing a healthy way of eating and cooking will be helpful both during and after the treatment.4

References:
  1. Eating Unhealthy Food. Available from:
    http://www.breastcancer.org/risk/factors/unhealthy_food. As accessed on: 27/6/2016.
  2. Nutrition & Breast Cancer. Available from:
    http://cancer.ucsf.edu/_docs/crc/nutrition_breast.pdf. As accessed on: 27/6/2016.
  3. Diet during treatment for breast cancer. Available from:
    https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/living-beyond-breast-cancer/your-body/diet-during-treatment-breast-cancer. As accessed on: 27/6/2016.
  4. Healthy Eating After Treatment. Available from:
    http://www.breastcancer.org/tips/nutrition/after_treat. As accessed on: 27/6/2016.
Managing the side effects of Breast cancer treatment – Hair, Skin, and Nails
While chemotherapy is an effective way to battle breast cancer, it leaves patients with an unwelcome reminder of the ordeal in the form of hair loss, dry skin and brittle nails.

It can be especially distressing to watch your hair fall out. It is generally very important for someone as to how they look and the thought of losing hair can be devastating to people.

There are actually many things you can do to prevent these side effects.

Caring for your skin during Chemotherapy
Dry and irritated skin is one of the side effects of Chemotherapy. Dry skin is not just a cosmetic problem, but it can become inflamed and hence get susceptible to infections. Long, hot showers or baths should be avoided. The thicker consistency of moisturizers is better at preventing skin dehydration than lotions. You can apply the moisturizer within 15 minutes of showering.


Your skin may become susceptible to sunburn due to some chemotherapy drugs. In this case it’s important to use a sunscreen with SPF 30 which protects against both UVA and UVB rays Ingredients in the sunscreen like zinc oxide or titanium dioxide provide protection against UVA.

Itching is also a common side effect during chemotherapy. Your doctor may prescribe you medications which can be applied to your skin to help you get some relief from itching. Chemotherapy can also make the skin undergo color changes particularly with breast cancer treatment. If the hands or face get affected, it can make the patient feel self-conscious. Salicylic acid present in bleaching creams and exfoliants will help in this case.

Caring for your hair during Chemotherapy
During chemotherapy patients lose their hair not only on the scalp but also on rest of their bodies like eyebrows and eyelashes. Cancer cells or tumor cells are rapidly dividing cells. Many drugs used in chemotherapy attack these rapidly dividing cells but they also sometimes kill normal cells which are rapidly dividing as a side effect. Hair follicles are susceptible because they too divide rapidly.


It’s important to ask your doctor the likelihood of hair loss before you start your treatment. It can be really emotionally challenging for anyone who is losing their hair. A wig, scarf or a cap may help how you see yourself after the chemotherapy. It’s recommended to decide whether you want to wear a wig before starting chemotherapy because hair loss progresses quickly after chemotherapy begins. This will help you shop for your desired wig which matches your hair color. Cutting your hair short helps reduce the emotional impact of watching your hair fall out.

It’s important to not perm or color your hair because these chemical treatments can enhance hair loss. It’s ok to resume dyeing your hair once you are done with your chemo treatments and your hair has grown back. Hair loss is usually temporary with chemotherapy. Although when it grows back new hair may be very fine and soft, of a different color or texture.

Caring for your nails during Chemotherapy
Certain chemotherapy drugs make nails develop lines and ridges, and go brittle and dry. The effects are temporary usually lasting a few months. Nail problems are commonly associated with chemo drugs known as taxanes used to treat breast cancer. It may cause the nail to separate from its bed. There is no need to worry about marks on your nails as they will grow out in a couple of months.


It’s important to take extra care of your nails not just for vanity but to avoid infection. Consult your doctor immediately if your nail becomes inflamed or if there is any discharge from the nail bed. It usually states an underlying infection which needs immediate attention with appropriate antibiotics. As a home remedy, patients can soak their nails in a solution of white vinegar and water for 15 minutes. It helps kill the bacteria and keeps your fingers and toes healthy.

References:
  1. http://www.webmd.com/ovarian-cancer/features/appearance-during-chemo?page=4
  2. http://www.cancerresearchuk.org/about-cancer/cancers-in-general/treatment/cancer-drugs/side-effects/your-skin-nails-and-cancer-drugs
Breaking the news: telling your loved ones about a cancer diagnosis
If you’ve ever had to hear the “C” word from a doctor, then you know how mind-numbing and devastating it can be to hear that. But once you’ve heard the news yourself, often the immediate challenge is “how am I going to break this news to those close to me”.

I’ve known someone who was in the same place as this. So I wanted to put something together to help her, and other people like her, who need to break the news to their loved ones. Here are some things I read, that may be useful if you or someone you know ever found yourself/themselves in the same situation:

Break the news when you’re ready
Coming to terms with the diagnosis is not easy. Not in the least. Your emotions may range from anger about why this happened to you, to despair about what the future may hold, to fear about your family and those you care about, to nervousness about finances. Remember, this is normal. This is OK. Admit what you’re feeling and don’t be hard on yourself.


And once you’ve given yourself time to process the news, tell your family. Do it when you think you are ready. Only you, really, can decide when that is.

Prepare yourself before you tell people
Then you could make a list of the people you want to tell and what you would need to say; for e.g. your type of cancer, the treatment that you may need to undergo, what the doctor may have told you about your prognosis and how they can help you.

Remember, if you have to take leave from work, you may always want to talk to your boss and HR. At the same time, how much you want to tell them is up to you.

If you have to tell children
What you tell children usually depends on how old the child is. Younger kids may not need to know too much, while older children will have more questions. You could let a child know: the name of the cancer, the part of the body that is affected, what kind of treatment you need, how the cancer will affect their lives. But also stress the fact that the cancer is not the child’s fault (because kids tend to think that way), and that they won’t get the cancer by hugging or playing with you. Remind the child that you love them a lot and that the whole family will stick together and cope with the treatment together.


People usually don’t know how to react
Once you’ve broken the news to those around you, remember, even those who are close to you may not know how to react. It may take some time for them to process what you’ve told them. The fact that they may see you suffer pain can be frightening. Others may not show their sadness because they are trying to be strong and don’t want you to feel any worse. Some people may get angry—but they’re angry at the cancer, not at you. Some people, in an effort to make you feel better, may seem almost too cheerful.

Remember, if these are people who care about you, then they are genuinely trying to do their best for you. It’s ok for you to get irritated or angry. But keep the lines of communication open and let them know how you feel. Coming back to why I wrote this: the person I knew with cancer did go through her rounds of treatment. It wasn’t easy, not for her, and not for her family. And there were good days and not-so-good days.

But she’s a fighter, and she’s doing really well now.

References:
  1. American Cancer Society. How should children be told that a parent has cancer?
    http://www.cancer.org/treatment/childrenandcancer/helpingchildrenwhenafamilymemberhascancer/dealingwithdiagnosis/dealing-with-diagnosis-how-to-tell-children
  2. American Cancer Society. Telling Others About Your Cancer.
    http://www.cancer.org/treatment/understandingyourdiagnosis/talkingaboutcancer/talking-with-friends-and-relatives-about-your-cancer 6
Exercising your way to better health during Breast cancer treatment.....
The health benefits of regular exercise is quite well known, however it also helps improve the overall quality of life for patients in treatment and offers the greatest potential to help reduce the side effects of particular therapies.

Nowadays, an exercise program is prescribed to cancer patients as a supplement to recovery post treatment.

Exercise offers a lot of benefit to women with breast cancer. One study published in the Journal of the American Medical Association found that women who did some kind of moderate exercise which is equivalent of walking 3 to 5 hours per week maintaining an average pace after a diagnosis of breast cancer had improved survival rates compared women who led a sedentary lifestyle. Apart from improving muscle quality and strength, it can counteract cancer related fatigue and nausea. It lessens the risk of developing lymphedema. Helps prevents weight gain associated with hormone therapy and relieve stress due to anxiety and depression.


Moderate exercise is a must

There are many types of exercises that you can try. But it is essential to find something that you enjoy because only then you are more likely to maintain it. You may have to choose between different types of exercise before you find one that you enjoy. To keep it interesting, avoid following a monotonous routine, and try alternating between different types of exercises. Like for example, you could consider alternating between walking, yoga and swimming on different days. If you were regular with your exercise before your diagnosis, you can now get back to your routine during your treatment. If you have any questions or concerns about exercising during or after treatment, seek advice from a medical professional.

Types of exercises you could choose from include
  • 1)Weight-bearing exercises – As a general rule, you do these exercises while on your feet. Some examples include walking, jogging, tennis, squash and dancing. Swimming and cycling don’t fall under the category of weight-bearing exercises.
  • 2)Resistance training exercises – these exercises involve exercising with weights, including free weights or weight machines found in gyms.


    Running is a cheaper alternative

If you have are menopausal or post-menopausal, or have bone metastases then you may have to take caution since you have a higher risk of suffering a bone fracture. In such case you can try less strenuous exercises such as walking, swimming or yoga.


Practice Yoga to have a healthy body, mind and soul.


You may be at an increased risk of infection, for example, if you are presently undergoing chemotherapy and have a reduced white blood cell count. In such a scenario it is a good idea to check with your medical oncologist first before going for a swim.

Incidental exercises are a very good alternative. These basically refer to regular daily activities such as doing household chores, walking up the stairs instead of using the lift, walking the dog, walking to the shops instead of driving etc. It is recommended to keep track of your daily exercise routine in a diary because it will not only help you stay motivated but enable you to see all your accomplishments at a glance.

It’s also important to not get disheartened if you are not able to achieve your goals for any reason. Instead try focusing on those exercises that you were able to complete successfully, and gradually work your way towards achieving your goals.

The magnificence of exercise as a method is that it can be done by most women at low cost and with low risk of side effects. Always remember, it’s never too late to relish the health benefits of exercise!

References:
  1. http://www.breastcancer.org/
  2. https://www.fredhutch.org/en/events/healthy-living/Trim-Risk.html
    Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. Journal of the American Medical Association 2005; 293(20):2479–2486
Managing Fatigue in Breast Cancer
“Fatigue” is another word to describe feeling tired and seeming to have no energy to perform all your daily activities inside and outside the house. Fatigue is a common side-effect for women who are undergoing treatment for breast cancer—as many as 9 out of 10 women may experience this at some point during their treatment.

Fatigue can cause you to feel tired the entire day, even though you may not have done a lot of work. While fatigue affects your ability to complete your daily chores, it can also cause you to lose interest in family, friends and things you generally like to do. Some of the other common symptoms include sleeping more than usual, feeling tired even after sleeping, an unwillingness to do regular activities, giving less importance to personal appearance, trouble thinking or concentrating and difficulty in finding words or speaking.1

Additional tips to fight that fatigue 2
  • Read a novel
  • Listen to your favourite CDs
  • Watch a funny movie
  • Spend time or work in a garden
  • Limit your caffeine to the morning time 
  • Consider yoga as a relaxation therapy

What causes fatigue?

Chemotherapy, radiation, hormonal treatment, some pain medications as well as poor nutrition can all contribute to causing fatigue. 3 However, the good news is that many women get back to their normal energy levels within 6 months to a year after treatment is completed. 4

How can you manage fatigue?
But if you are undergoing breast cancer treatment right now, you don’t have to wait 6-12 months to feel better. Here are some simple tips to follow regularly to help you feel a little less tired:

Be physically fit: Getting about 4 hours of exercise every week has been recommended. But reaching this target might seem challenging when you are busy with radiation therapy or drained due to chemotherapy. Do not worry about that target but start slowly, even if it is just 15 minutes a day, and gradually increase the duration.1

Eat a healthy diet: You can fight fatigue with a well-balanced diet that provides you all the nutrients you require. Opt for a healthy diet full of fruits, vegetable and whole grains. Consuming adequate amounts of proteins, calories, vitamins and minerals is important. Also, make sure your fluid intake is adequate. 1





Eat smart: Try to eat more when you are feeling good. What that means is, for instance, if you seem to feel fatigued by the end of the day then eat more at breakfast and lunch. Eat different types of nutritious snacks such as raisins, yogurt and carrots every day to meet your protein and calorie requirements.1





Take a short nap: A daytime nap for about 30 minutes daily can help. But remember not to indulge in a long nap as it might keep you sleepless at night.1

Stick to your routine: Go to bed at the same time and wake up at the same time every day. Always try to get sufficient sleep.1

Maintain a "fatigue log": What this means is that you should keep a diary to record when your fatigue is the worst and when it is least disturbing. Also, plan activities during the time when you feel energetic. Also try and balance each activity with a rest period, to avoid fatigue.1

Save energy: Don’t hesitate to ask for help from other people for various chores like shopping or doing housework. Another way to save energy is to sit down whenever possible while doing various activities.5

Remember, the key is to conserve your energy and use it wisely to do what’s most essential in your daily routine.

For more information visit us at: https://www.facebook.com/HER2BC/

References:
  1. Fatigue. Available from: http://www.breastcancer.org/treatment/side_effects/fatigue. Last modified: 23/4/2015. As accessed on: 27/6/2016.
  2. National Comprehensive Cancer Network (NCCN). Fighting Cancer Fatigue. Available from: https://www.nccn.org/patients/resources/life_with_cancer/fatigue.aspx. As accessed on: 28/6/2016.
  3. Possible causes of fatigue. Available from: http://www.breastcancer.org/tips/fatigue/causes. Last modified: 12/5/2016. As accessed on: 27/6/2016.
  4. What is cancer fatigue? Available from: http://www.cancerresearchuk.org/about-cancer/coping-with-cancer/coping-physically/fatigue/what-is-cancer-fatigue. As accessed on: 27/6/2016.
  5. Treating cancer fatigue. Available from: http://www.cancerresearchuk.org/about-cancer/coping-with-cancer/coping-physically/fatigue/treating-cancer-fatigue. As accessed on: 27/6/2016.
Disclaimer
The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Sorento Healthcare Communications Pvt. Ltd. & its Divisions make no representation and assume no responsibility for the accuracy of information contained on or available through this web site, and such information is subject to change without notice. You are encouraged to confirm any information obtained from or through this web site with other sources, and review all information regarding any medical condition or treatment with your physician. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE.

Sorento Healthcare Communications Pvt. Ltd. & its Divisions do not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific tests, products, procedures, treatments, services, opinions, health care providers or other information that may be contained on or available through this web site. Sorento Healthcare Communications Pvt. Ltd. & its Divisions ARE NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS WEB SITE.

The photographs used on this website, except the ones in the actual patient stories, are for representational use only. The photographs do not represent any actual person affected by the conditions, or in any way connected to the content of the website.

The profiles of patients/ caregivers of HER2 positive breast cancer, including their photographs, are real. The patients’/ caregivers’ stories and case studies are their own and procured of their own volition. The content may have been edited for grammatical accuracy. All the signed consent forms from the featured patients/ caregivers are on file with the website.