May I please take the liberty of seeking your esteemed views on a question which has been engaging my mind as a clinician for quite some time? I have volunteered to work in very remote and low resource areas. What is the best course of action when confronted with a cancer patient in such places? Many of us may believe that we need to refer such patients to speciality centres or at least the district hospital.However, does the patient really benefit from such an exercise? For one, we may only be able to provide him with resources to reach such a place but his ordeal does not end there. For the patient and the caregivers from such areas to land up in a city with not much in their pockets does nothing to end their misery. We only feel light because we have got the burden off our shoulders without doing much good to the patient or the community.
Do we therefore, only offer palliative care to all such patients? Palliative care is surely important but even palliation is not well done unless accompanied by some degree of anti cancer therapy. Conventional chemotherapy is not really difficult to administer and may sometimes not be very expensive either but the biggest challenge is to monitor for and manage associated adverse effects in such places.
Over the past few years, there has been much effort in the scientific world to repurpose drugs (generally used for other indications) for cancer therapy. Interesting such examples include metformin, chloroquine, mebendazole, clioquinol etc.The beauty is that these agents are not very expensive, easily available for other indications, devoid of major adverse effects and most clinicians are comfortable with their use.Further, many of them seem to work on many different cancer types and thus could be useful even if a very precise diagnosis of the kind and origin of cancer is not feasible.
Of course, none of these agents are as of today licensed for use in this indication and at the current pace this could take a long time because:
a) No pharmaceutical industry would find it lucrative to invest in them
b)Even if a trial is done they would be compared with current standard of care and the trial may thus not be positive.However,if the comparator standard of care is what is actually available to patients in these areas, the results could be very different.
I therefore wonder would it not be in the interest of such communities to urgently conduct clinical trials on these repurposed drugs in such settings where the comparator arm is the reality of life today.