In the past few years, Sri Lanka has had about 30,000 new cancer cases diagnosed annually. In 2019 alone, there were nearly 31,850. This means that the incidence of cancer in Sri Lanka’s population is 146 per 100,000, which is a doubling from 25 years ago. Childhood cancer too is increasing with about 1,000 new cases diagnosed annually and of these, seven out of 10 are from low income families.

Visiting Sri Lanka recently for the launch of Suwa Arana, Sri Lanka’s first paediatric palliative care centre, was the Chief of the Oncology Division of the PIH Health Good Samaritan Hospital in Los Angeles (LA), United States (US), the Los Angeles Cancer Network Partner, the Chief Executive Officer and President of the Sri Lanka Medical Association’s North America Western Region, and the Suwa Arana Co-Founder Dr. Lasika Seneviratne. He was on Kaleidoscope to explain the perceptions of cancer, myths surrounding the disease, and new findings.

What false beliefs and myths are there about cancer?

It’s mainly related to the treatments for cancer and these stem from the fear of the unknown. Many people perceive that cancer is treated only with chemotherapy and that chemotherapy is poisonous and very toxic. As a result, they tend to avoid mainstream treatment. I for one practice allopathic medicine, which is mostly driven by science and data, but there are other types of medicine, naturopathic, homeopathic, ayurvedic, etc., which also offer treatments for cancer. There are beliefs that cassava can cure cancer, for example. There’s also the belief (even in the West) that high doses of Vitamin C and Vitamin B-17 can cure cancer and there are those that go on extreme diets. I can’t comment on these but these treatments exist. However, what needs to be understood is that cancer treatments are advancing. We don’t treat everything with chemotherapy these days. There are many newer therapies at play, for example, like immunotherapy, which utilises the immune system to fight cancer. Then there are targeted therapies and medicines in pill form that are highly efficacious. Hence, this misbelief must be eradicated and people should be educated about it. 

You’ve repeatedly said that most cancers are curable. Which are curable and which are terminal?

There are huge strides being made in some cancers, including breast, lung, and colon. Vital to that is early detection. If we are to cure them, we have to detect them and treat them early. Some childhood cancers like acute leukaemia are highly curable. We are learning more about the mechanisms of the cancers, about how the cancers are surviving and what drives them. As new medicines are developed, we get the upper hand. For example, Chronic Myeloid Leukaemia, considered incurable in the past, with the only cure being an allergenic bone marrow transplant from another person, was highly morbid and had a high mortality. Now, it is treated with a pill and more patients are being cured. Lung cancer patients, who we never thought would have five years of survival even in the most advanced setting, are now living more than five years with a good quality of life. Therefore, while some cancers can be cured when detected early, there are other cancers where patients are able to live a long life even with the cancer in them. People with Stage IV cancer now live for 10-15 years with a good quality of life. 

What are some of the new findings in research and development?

There’s a paradigm shift in the way that we treat cancer. Chemotherapy which was used is the shotgun approach. But, as we learn more about what drives these cancers, we detect those targets and customise treatments. These new treatments are like drone attacks, where the treatment looks for its enemy (which is the cancer), binds to it and kills it right then and there.

Then there’s immunotherapy, which uses our own immune system, a very powerful fighter, against cancer. We use immune surveillance, similar to checkpoints, where the system tries to get rid of the potential cancer causing cells. To put it simply, cancer cells place a blindfold on the immune system to escape detection. We now know which mechanisms that these cells use to do that, so we potentiate the immune system by ‘unbinding’ it and thus, the immune system becomes very active in getting rid of the cancer. Targeted therapies are also important. The key here is that treatments are tailor made to suit the individual patient’s cancer. While two people may have breast cancer, they may get entirely different treatments, based on those targets.

Having witnessed and operated within the oncology space both in Sri Lanka and in Los Angeles, what are the major differences that you see in terms of perceptions and attitudes about cancer?

People weren’t accepting of the diagnoses of two illnesses, cancer and mental illness, both considered taboo. However, with more awareness, those perceptions are changing. When it comes to cancer, early detection means everything between being a curable cancer and an incurable cancer. People have to come to accept screening tools such as mammography and colonoscopy. Where there is a tool to detect a cancer way before it becomes problematic, you can nip it in the bud. In other countries, screenings are mandatory on recommended guidelines. In Sri Lanka, this doesn’t happen which partly is due to the unavailability of resources. However, awareness in getting mammograms and breast and rectal exams regularly, stool and blood checks, and pap smears is growing. These will make a huge difference in the outcomes. 

You’re a Co-Founder of Suwa Arana. What does this centre mean for children with cancer and their families?

The main problem with childhood cancer treatments in Sri Lanka is that there’s only one paediatric cancer treatment facility for the whole country, and so, needless to say, this place is overcrowded. People travel hundreds of kilometres to Maharagama to get their treatments and it’s not an easy journey. Cancer treatments are not a one and done deal as sometimes, it goes on for weeks and months. The biggest issue is that these patients travel from far and need to find accommodation. Logistically and economically, this is difficult and complex, which results in some giving up treatment. And these are potentially curable cancers. Therefore, Suwa Arana is a place for patients and their families to stay completely free of charge and have access to supportive services, including psychotherapy and coping mechanisms, while receiving cancer treatment. It’s positioned as a home away from home and a place for healing. Until now, there has been no structured programme in the country for children with terminal cancer to die pain free and exit this world with dignity and for parents and families to grieve and deal with the loss. The palliative care programme at Suwa Arana run by palliative care specialists will provide a service that addresses a previously unmet need of patients and their families. 

What should we as citizens be aware of when dealing with a cancer patient?

It comes down to accepting cancer as something that people endure. It’s not that the patient did something wrong, although some cancers are related to bad habits like smoking, so we need to be accepting of that. Especially in the case of women with breast cancer, if they lose a breast or their hair, acceptance helps their self esteem. As a society, we must embrace them. The West has numerous programmes, including ‘Look Good Feel Better’, where cosmetic artists and celebrities talk about looking good and feeling better during cancer treatments. This is a journey that’s hard both physically and mentally for patients. So, acceptance is key.

Why, of all the competencies that you could get into, did you choose oncology? Isn’t it quite depressing, day in, day out?

It is depressing, but also very rewarding, an emotional rollercoaster. In one room, you tell a patient that the cancer has unfortunately returned and that there’s nothing more to offer, and in the next room, you give the news that the cancer is cured. You see one person breaking down and another person elated. It is emotionally draining. The reason that I got into oncology was fate and circumstance. When I went to the US to do a Masters in Molecular Biology and Genetic Engineering, I was taking genes from one species, cutting it and putting a piece of it into another. It was a lot of bench research. When I went into medical residency training in the mid to late 1990s, the acquired immunodeficiency syndrome (AIDS) had become a national problem. I got involved in research and because AIDS patients were getting all types of cancers, I felt a pull into oncology. Cancer treatments are advancing tremendously and we are beating this disease slowly but surely. In my lifetime, we will see a lot of cancers being cured, which is most rewarding.

You’re working in a highly developed healthcare sector. Sri Lanka may not be on par, but, given what we have, how can we optimise on the facilities, care, and treatment available for cancer patients? 

The most important thing is the availability of medicines and resources. For any treatment of any disease, good infrastructure is vital, with medicine and the timely delivery of treatments. Sri Lanka’s doctors are fantastic. They are very well trained, but, without medicine, they can’t treat patients. There’s a severe shortage of medicines in some of these essential areas, which needs to be resolved. Secondly, having more palliative care centres in central areas around the country would be wonderful, because patients won’t need to travel hundreds of miles to get treatment. Sri Lanka also needs to explore clinical trials if the country is to get into cutting edge therapies. That’s what other countries in Asia and the Eastern Bloc are doing. Cancer is always evolving and there’s always newer treatments, so this is one way that we get tomorrow’s treatments, today, free of charge. 

(The writer is the host, director, and co-producer of weekly digital programme ‘Kaleidoscope with Savithri Rodrigo’ which can be viewed on YouTube, Facebook, Instagram, and LinkedIn. She has over three decades of experience in print, electronic, and social media)