CANCER CAMPAIGN

Dominion, Volume 28, Issue 103, 25 January 1935, Page 8

CANCER CAMPAIGN

Analysis of Progress In Dominion AUTHORITY’S VIEWS Weakness in Methods of Attack Au analysis of the progress of the Campaign against cancer in New Zealand, difficulties in the way, methods by which more effective results can be secured, the importance of educating the public to assist —these are points embodied by the eminent authority on cancer treatment. Dr. 11. JI. Moran, consultant for radium, Royal Prince Alfred Hospital, Sydney, in a report prepared by him for the New Zealand branch of the British Empire Cancer Campaign Society. At the' invitation of the society Dr. Moran recently visited New Zealand and made an exhaustive investigation of the hospitals and methods of radium treatment as practised in this country. He backs up the society’s insistence on the centralisation of cancer treatment by special methods, and observes that if the difficulties resulting from decentralisation are removed there is no reason why New Zealand could not meet with outstanding success in the battle. In the course of his report Dr. jloran says:— J’ “The education of the lay public in respect to cancer has been very largely Ja failure in New Zealand, just as, with the exception of one State (Queensland), it has been ineffective in Australia. Apart from patients with skin cancer and possibly those with carcinoma of the tongue, we do not think the sufferers from malignant disease present themselves any earlier than formerly. The occasional spasmodic attempts to provide information in the early revealing signs of this disease have for the most part been fruitless. It is fair to remark that even in America, where a violent assault has been made on the feelings and Imaginations of the laity, their great efforts have brought forth but negligible results. It must surely be manifest by now that even if this matter of popular education in medicine were better done, and it surely can be better done, both in the Dominion and in the Commonwealth, nevertheless as a method it places too great a reliance on the individual’s intelligence and initiative. In point of fact such an approach to the solution of this problem is quite wrong. The only effective measure is to be found in the setting up of public clinics for the routine and regular examination, not of the -already diseased, but of those members of a population believed to be healthy. Professional Obstacles. “It is to be frankly, if regretfully, admitted that one of the greatest obstacles to progress in the early discovery and treatment of the cancer .patient is a certain type of medical

man, unfortunately uot rare. . Such a practitioner has too early lost bis mental alertness and in its place reigns a sort’of fatalism born of ignorance concerning the new methods of treatment and of his lack of faith in their ability to cure or relieve. This, again, is true for Australia as for New Zealand. Even now, a majority of medical men fail to understand the significance of radiation-therapy and cannot appreciate its well-defined value and its very great limitations. Moreover, their very training has taught them unconsciously to identify the existence of disease with their own interests. They have no fine sense of achievement in the prevention of maladies or in the avoidance of complications.

“This is largely due to the imperfections of our medical training and to the defects of a social order which ordains that the medical practitioner shall draw a profit from pathological conditions. If medicine ever becomes solely an affair of the State, the alteration of such a condition of affairs may be a real gain among the many doubtful blessings. In any case, there must eventually be some form of legislative enactment which will require a registered practitioner, to undergo refresher courses during his life. Meanwhile, tjie best we can do at present is to create in the public mind a distrust and a dislike for the medical man who disdains to keep himself in the current of medical progress and prefers to remain in the same backwater anchored to ancient practices and exploded beliefs Value of Concentration.

“In New Zealand there are, outside the four chief cities, numerous important towns with excellent hospitals. It is natural that the committees, lay and medical, of such hospitals should desire to set up cancer treatment centres and to provide themselves with their own radium and their own modern deep therapy machine in order that the most recent methods of treatment should be available to tneir own community. It is difficult to convince them that only by the concentration of many patients at a few centres can ever sufficient experience be obtained by a limited number of specialists In this new treatment with radiation to enable them to become expert and to achieve a reasonable measure of success. The actual application of radium should lie allotted to two or three only of the honoraries, and these should be required to give evidence of having undergone some special post-graduate training in this work. In one important New Zealand hospital, np till recently, 71 patients suffering from cancer of the uterus had been treated by 14 different members of the staff. The practice. I understand, has recently been altered, but this error in control is still being committed in other institutions. Obviously none of the large number of honorary medical men using radium could ever become highly competent in its use.

“But even if a medical man is equipped with the proper knowledge lie will still be unable to obtain any high degree of success if the radium supply available at the hospital is in a form which cannot be adapted for use in the ordinary techniques. At Auckland Hospital, where cancer of the cervix uteri has been treated by radium therapy for a number of years, the radium is in a form which, makes it quite impossible

to carry out a proper technique. At Dunedin Hospital, also, a not inconsiderable part of the radium supply is in a. form unsuited for use by modern methods. It is uneconomic to have in store radium that is not used because of its being in unsuitable form.” Dr, Moran recommends that there should immediately be a checking-up of the form and filtration of all the radium in the public hospitals of New Zealand, to determine its adequacy for use in the treatment of cancer. Co-operation of Physicists. “In respect to the X-ray therapy (the report continues), the impression was gained that in many cases there was no proper scientific control of the dose. X-ray therapy which is not scien. tifically controlled becomes a more or less empirical method of treatment. Mr. Strong, JI.Sc., who has been appointed to calibrate the various instruments, will be of the greatest assistance, but it will be an impossible task for him to spread his services over all the centres. In each of these centres a local physicist should be in close touch with the consultation committee, It was surprising to me to find that Coutard’s technique, which has been the most noteworthy contribution to Roentgehtherapy during the past ten years, is in no part of New Zealand»adopted. “The time has passed when in public institutions a particular specialist should be permitted to give free rein to his own enthusiasm for a particular form of treatment. Every cancer patient admitted should come under the direction of a committee of consultants which should include at lease a specialist in surgery, one in radiotherapy, and one in pathology. Such a committee is to be found in most of the leading hospitals in New Zealand, but not infrequently it is competent for a particular honorary to . decide and carry out a particular form of treatment although it is in opposition to the opinion of a majority of the committee. This is not in the best interests of either the hospital or the patient. Value of Research. “It is sometimes contended that-it is a waste of time-and money to set up research laboratories in the Dominion. In support of such an argument it 1s stated that moneys collected for research can be more effectually used by endowing established research laboratories in England. Admittedly, centralisation of research is of the greatest value. But in New Zealand as in Australia, research work is, a necessary part of the cancer campaign; research and treatment are complementary, they must never be completely dissociated. Every properly-conducted plan of treatment can be made the basis of work in research; the deductions from research work can be used to modify our methjds of treatment. The present work being carried out by Dr. Begg is highly considered by those abroad who are competent to judge. Very often lay members of a cancer committee grow impa'ient for some immediate practical result from the research being done at a particular laboratory. It must be remembered that each scientific worker is weaving a tiny corner of a great tapestry, the significance and design of which will become apparent only when thousands

of different workers will have completed their task. Radium Emanation. “I found the opinion was entertained in some parts of the country that the use of radon should be more generally encouraged because it could be extracted at one centre in each island and distributed when required to medical men in the outlying areas. In point of fact, this is one of its greatest drawbacks; it lends itself too easily to use by practitioners utterly unacquainted with the principles of radiotherapy. To encourage such a practice ■will, in the judgment of those most competent to express an opinion, inevitably bring this form of treatment into disrepute. The actual indications for the use of radon are extremely limited. Its greatest advantage is that it can be used in sites difficult of access without the worry or danger of losing the implanted seeds. The physicist will affirm that it is possible to obtain the same results with radon as with radium element, since the same amount of actual energy can be delivered to the tissues. This is not true. .Such a statement neglects the biological effect of radiation and the significance <;f the time factor in its production and in treatment. Highly sensitive growths such as lymphosarcoma or basal-celled carcinoma may be treated with either radium or radon indifferently. But the falling off of intensity with radon is so rapid that it is impossible to employ it for long-time techniques; yet in certain cases successful results can be obtained only by distributing the dose over a long time. “Jloreover, in using radon, calculation of the dose is extremely complex and uncertain. There is one other advantage, however, in the use of radon, and that is that it can be used in the treatment of out-patients who can lie allowed to return home with the radon in position without any concern for the loss of this emanation. But it must not be forgotten that the erection of a plant for radon extraction immobilises a considerable amount of radium, and unless the radon is in constant demand, the method is therefore extravagant.' Here again there is a call for an accountancy and for a reckoning of the number of patients for whom radon has been used and of the results obtained in relation to outlay and expense of upkeep. It is in a similar way quite wrong to set up deep X-ray therapy plants which rapidly deteriorate and become old fashioned if they are only occasionally used or are used unscientifically and with only a vague idea of the dose in international units, delivered at the cancer site. Apart from the waste of public money, such radiotherapy without proper scientific control is merely occultism. Post-Graduate Teaching. “There is a need for a regular postgraduate course in radiotherapy for surgeons and general practitioners, which should include lectures on physics, radiobiology, and pathology, as well as demonstrations of the modern techniques in radiotherapy,” said Dr. Jloran. “Only by such means can a high level in radiation work be maintained, for it is essential to have ,the body of general practitioners educated in the new developments in cancer treatment. There is one important point which should not be overlooked. The radiotherapy clinic should never be allowed to become a purely cancer clinic. A large field for X-ray therapy

lies unexplored in the treatment o£ inflammatory diseases and of certain neuralgic states. The use of radiation for those conditions should be extended in every way. If a department becomes known purely as one for the treatment of hopeless cancer sufferers it will always bo difficult to induce a patient in the early stage of malignant disease to go there for treatment. Moreover, the association with numbers of patients all suffering from cancer, many in an intractable condition, must render difficult the carrying out of any prescribed course of treatment.”