Medical Oncology Centre is the busiest centre at Dharamshila Narayana Superspeciality Hospital in India and handles a work load of 200 - 300 patients (adults and children) per day in OPD, Daycare and IPD. As the name suggests Medical oncology is a division of oncology which takes care of medical needs of cancer patinets with medicines instead of surgery or radiation.
The scope of work in Medical Oncology includes taking care of Preventive, Diagnsostic and Therapeutic needs of patinets; Supportive care; Teaching and Training Programmes of Doctor and Nurses (DNB Medical Oncology and Post Basic Diploma in Nursing Oncology) and undertaking various National and Global Multicentric Research Projects.
Most Cancer Patients enrolled in Medical Oncology centre require Chemotherapy, Biological Therapy, Immunotherapy, Parantaral Nutrition, Blood and Blood Components.
Patients who develop neutropenia are isolated and provided with double barrier nursing and growth factors, wherever indicated.
Medical oncology is not just administrating chemotherapy but the scope of work is much more beyond it. It begins right at the time when the patient first walks into our centre and much before chemotherapy is planned like deciding what vaccination needs to be given to the patient. Cancer Patients are generally very weak and immune compromised and are at risk of various life threatening infections. So many among all, needs to be vaccinated so that they do not succumb to these infections later on during course of their disease.
Then comes deciding the right chemotherapy for the patient. We at Dharamshila Narayana Superspeciality Hospital make sure that each and every case is discussed in the tumor board and the best treatment plan is decided by the board, so that each and every patient gets standard international protocol.
Now “How” chemotherapy has to be administered is also a very important decision that needs to be taken at the right time. Not every patient may have good veins so that intravenous chemotherapy can be given. The latest chemotherapy administration devices like PICC Lines, Central Lines, Chemo Port, Infusion pumps etc are available at out hospital so that chemotherapy can be easily and safely administrated. And the risk factors like drug extravasations and painful venous thrombosis can be minimized to a large extent.
Not only that – not all patients require systematic chemotherapy. There will be many where regional therapy is indicated which is much more efficacious and less toxic. For example in urinary bladder tumours, intravesical therapy is given i.e. drugs are instilled directly into the urinary bladder. This is much more effective locally and has much less systematic absorption and toxicity. Similarly we have other regional therapies like Intrapleural therapy where drugs are instilled directly into the pleural cavity.
In various abdominal tumours like carcinoma ovary Intraperitoneal chemotherapy may be given where chemotherapeutic drugs are directly instilled into the peritoneal cavity. This produces much better tumour control.
Similarly in various brain tumours where CSF seeding is there, intrathecal chemotherapy is indicated where drugs are directly instilled into the cerebrospinal fluid which surround the brain. Intrathecal Chemotherapy is also given in cancers like leukemia where there is high risk of cancer cells spreading to the brain later.
Going beyond, a good medical oncology practice is not just administrating chemotherapy and getting over with it but also providing excellent supportive care so that the patient can tolerate the therapy with minimal side effects and minimum breaks and hence, maximizing the results. The latest in the field of supportive care like growth factor, pegylated growth factors, erythropoietins etc. are incorporated with the treatment plan of the patient, where ever indicated. So that he/she tolerates the treatment well.
For most people cancer medicine is only chemotherapy. This is no longer the case.
The realm of medical oncology also includes biological and immunological therapies, hormonal therapies, targeted therapies etc.
With recent advances, the targeted therapies have come up in a big way. We at Dharamshila Narayana Superspeciality Hospital have the facilities and take help of our pathology experts to identify specific targets on the cancer cells. e.g. even genetic mutations, like EGFR Mutations , K-ras Gene Mutations cells surface antigens etc. can be identified.
What is the benefit of identifying these targets? One can actually give individualized treatment. What therapy is best for the patients and how it can be incorporated in to the treatment plan is decided with the help of these targets. The way “not one Shoe Size fits all.” The same goes for chemotherapy not one chemotherapy is for all.
For example, in lung cancer cases identifying EGFR mutations can help us in offering targeted therapies for these patients in the form of oral tablets which are much more convenient and easier to take as compared to chemotherapies.
Needless to say, medical oncology is the backbone of cancer treatment. More than 85% of the cancer patients require chemo therapy and/or targeted therapies during the course of their disease. Sometime chemotherapy is administrated up front to decrease the size of primary tumour to facilitate other modalities to work like Surgery or Radiotherapy. It may also be given concurrent with radiotherapy, where it improves the results.
We at Dharamshila Narayana Superspeciality Hospital is a “one stop” destination for oncology, where a joint decision of the experts is taken in the tumour board regarding each and every case and best treatment options are decided incorporating the latest in the field of oncology.