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In 2019, Rita Ghalan, a resident of Bauddha, Kathmandu, noticed droplets of blood in the basin while brushing her teeth. She found that the blood came from her mother's mouth who was coughing rapidly. She was covering her mouth with a small piece of white cloth that had turned red with the blood coming out. Rita immediately took her mother to a doctor, who after a quick scan noticed that the patient had developed small lumps on her lungs which later was confirmed to be 3rd stage of lung cancer after a biopsy test. Her mother developed a cough after several months of unintended weight loss and increasing joint inflammation and pain. According to Rita, her mother, who is undergoing cancer treatment, was a smoker for a long time and her grandmother also died from lung cancer years ago. This resembles the struggles faced by thousands of lung cancer patients and their family members face in Nepal.

According to Dr Bibek Acharya, a senior consultant radiation oncologist, lung cancer is one of the major causes of mortality in the world including in Nepal. According to World Health Organization (WHO), 1.8 million people lost their lives to lungs cancer in 2020. This number was 2285 in Nepal while around 2505 new cases of lungs cancer were reported in the country. "People, mainly aged over 50 years are more vulnerable to lungs cancer in Nepal and the finding is based on hospital cases," says Acharya who is the Head of Department of Clinical Oncology at National Academy of Medical Sciences, Bir Hospital. "Long exposure to tobacco smoke, air heavily polluted with dust particles and fumes of toxins and harmful chemicals are the main causes. But for some patients, it might be due to family genetics." A 2014 WHO study found that lung cancer mortality in Nepal is 6,000 per 100,000 patients which is among the highest in the South Asia region.

Scientists have found that cancer causes changes in cells. The cells grow too quickly, without dying off. Normal cells in the body usually die at a certain stage in their life cycle, thereby preventing a buildup of too many cells. In cancer, however, the cells continue to grow and multiply. As a result, tumors develop. Lung cancer occurs when cells divide in the lungs uncontrollably, causing tumors to grow. These can reduce a person’s ability to breathe and spread to other parts of the body. "Lung cancer is the leading cause of cancer deaths worldwide. Smoking is the most important risk factor for lung cancer. Approximately 80 percent of lung cancers are caused by smoking," says Dr Binay Shah, a US-based oncologist and hematologist. According to him, tobacco smoke has carcinogens (chemicals that cause cancer) that damage the cells of the lungs. "But a minority of patients (less than 10 percent) have genetic predisposition for lung cancer," he mentions.

Lung cancers are mostly fatal. Medical science states that there are two types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC is the most common, accounting for 80 to 85 percent of lung cancer cases, while SCLC accounts for 10 to 15 percent. However, between 30 and 50 percent of cancers can currently be prevented by avoiding risk factors. "The cancer burden can also be reduced through early detection and appropriate treatment and care of the patients. Many types of cancers have a high chance of cure if diagnosed early and treated appropriately," mentions Acharya, adding, "When identified early, cancer is more likely to respond to treatment and can result in a greater probability of survival and less morbidity, as well as less expensive treatment." Significant improvements can be made in the lives of cancer patients by detecting cancer early and avoiding delays in care.

Doctors say that the treatment of lung cancer is quite complex which depends on the stage of the disease and includes surgery, radiotherapy, chemotherapy, targeted therapy and immunotherapy.

"Prevention is much better than treatment because lung cancer is highly lethal. It's better not to smoke and keep the air pollution in check," suggests Acharya.

Dr Shah adds that it is also essential to recognise that passive smoking also increases the risk of lung cancer in many people who live near cigarette smokers. Given the fact that the anti-smoking campaigns have not been successful despite many years of attempts, medical experts suggest that the government needs to have a holistic approach to tackle this disease. " From a policy perspective, there has to be a good tobacco control program at the federal, state and local levels. Running meaningful programmes aimed at raising public awareness about tobacco control are essential aspects of lung cancer control," he opines.

In terms of infrastructure, Nepal is slowly progressing in providing healthcare services to lung cancer patients. There are two publicly-funded cancer centers - BP Koirala Memorial Cancer Hospital and Bhaktapur Cancer Hospital. Similarly, the Nepal Cancer Hospital and Research Center, Lalitpur and Purbanchal Cancer Hospital have been operating as private healthcare institutions dedicated to cancer treatment in the country. Other public multispecialty hospitals such as Teaching Hospital, Civil Hospital, and Bir Hospital provide some cancer treatment like surgery and basic Chemotherapy to the patients of lung cancer, whereas Radiotherapy is limited to Bhaktapur Cancer Hospital, Nepal Cancer Hospital, and BP Koirala Memorial Cancer Hospital. According to Dr Shah, there is a need to improve cancer care by the establishment of regional cancer centers. "Doing this will help improve access to cancer care," he mentions.

Treatment of lung cancer is one of the most expensive propositions for many Nepalis. Many people still prefer to visit India for lung cancer-related treatment, as they find the treatment cheaper than in Nepal. The government has been providing Rs 100,000 to cancer patients from poor and backward communities. But people have been demanding the government to raise the fund, as the current fund hardly covers even the basic treatment cost. In 2017, during the ministry tenure of the then health minister Gangan Thapa, the Ministry of Health had proposed the Finance Ministry increase the amount of cancer assistance fund to deprived patients to Rs 500,000. However, the finance ministry is yet to take any decision in this regard.

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