Cancer Research at Shaukat Khanum Memorial Hospital and Research Center

Dr. Mariam Hassan

Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMCH & RC) is a state of the art specialist cancer care center dedicated to providing the best possible care to all patients, irrespective of their ability to pay.

The hospital was the brain child of Pakistan’s star cricketer Imran Khan, and was built in the memory of his late mother Mrs Shaukat Khanum who suffered from cancer in the late 1980’s and eventually passed away. The shocking lack of cancer treatment in a developing country like Pakistan and the resultant agony of millions became the inspiring force for a global fund raising campaign by Imran Khan for a cancer care facility which would eventually become Shaukat Khanum Memorial Cancer Hospital. His dream became the dream of millions of people and after a ground breaking ceremony in 1990 and with an estimated project cost of US $ 24 million , the hospital was completed as promised in a span of four years.

Cancer Research. Research is a top priority at SKMCH&RC, with an active clinical research office involved in several international collaborative research projects and clinical trials. There is a contemporary data management team responsible for an advanced medical record system and the development of an institutional and province wide cancer registry. A basic science lab has been equipped with latest in molecular biology technology and genetic experimentation. SKMCH&RC is fulfilling its vision to be a leader in cancer research in Pakistan. Despite these three fully functional units dedicated to research activity there was a need for a centralized research section housing each of these divisions in a shared and organized space thereby encouraging interaction and collaborative work.

April 27, 2006 marked the much anticipated inauguration of the Abdul Hafeez Cancer Research Wing at the hospital. The facility is the result of over whelming generosity of Begum Tasneem Naeem who donated Rs30 million for this cause in the memory of her late father, Mr Abdul Hafeez. The new research wing has an area of approximately 15,000 square feet and is furnished with state of the art equipment. It has one main, two standard and several auxiliary laboratories constructed in accordance with international bio safety standards. It also houses a large conference room and a library, the clinical research office and the data management office.

Clinical Research Office. The Clinical Research Office is the standing office of research. It acts as a main liaison between researchers, collaborators, sponsors and patients. The office has a team of doctors who are well familiar with international standards of research conduct and facilitates linking patients to clinical research. The office also facilitates scientific peer review of clinical studies to determine their scientific validity and provides support to the Hospital Ethics Review Committee (called Institutional Review Board, IRB). The IRB safeguards the well being and rights of human subjects who participate in research and has physician as well as lay members. The Chair is always a non-SKM individual, thus reducing institutional bias. Our IRB is registered with Office of Human Research Protection (OHRP) at the U. S. Department of Health and Human Services, making us one of very few research organizations in Pakistan to have obtained this registration. It certifies our compliance with well-defined standards essential for the welfare of human subjects involved in research. We are conducting a number of clinical trials in diverse therapeutic areas, most of which are linked to cancer. Many of these are being conducted in collaboration with international pharmaceutical companies and are part of a joint, multinational effort. Apart from these we are also engaged in collaborative research with other international research organizations and groups like Cancer Research UK, Deutsches Krebsforschungszentrum (DKFZ) in Heidelberg, Germany , International Network of Cancer Treatment and Research (INCTR) and the Trans-Tasman Radiation Oncology Group (TROG). We have recently also acquired membership of the prestigious Breast International Group (BIG), which is a non-profit organisation for academic breast cancer research groups. With these research efforts we aim to make a positive impact on the general lack of awareness and education about research and ensure our participation in international therapeutic trials, which would allow advancements in treatments and care at a faster pace. Similarly with our institutional and international collaborators we strive to conduct clinical research that is more responsive to the health needs and priorities of our community.

Cancer Registry and Clinical Data Management. The Cancer Registry and Clinical Data Management (CRCDM) unit is responsible for maintaining the hospital based cancer registry and compiling a disease specific index (cancerous and non cancerous) using international classification systems. The CRCDM unit has qualified experienced statisticians and epidemiologists as part of its team and is actively involved in cancer epidemiological research with several publications to its credit. The CRCDM unit is involved in generating cancer statistics from the registry database using our advanced medical records system. The computerized Cancer Registry at SKMCH & RC is a data system designed for collection, management, and analysis of detailed data on patients registered at the Hospital. The Cancer Registry at the Hospital has been functioning since the inauguration of the Hospital in December 1994. Every year the Registry generates cancer statistics according to sex, age, demographic area, topography, morphology, stage, grade etc. To further study the epidemiology of cancers, the unit is attempting to develop a population based city wide cancer registry with the collaboration of other hospitals and laboratories in Lahore. The registry is also involved in conducting a pilot project on breast cancer screening in a locality close to the hospital.

Basic Science Research Laboratory. The Basic Science Research Laboratory at SKMCH&RC is equipped to conduct molecular, cellular and genetic studies. The lab is involved in trying to gain information about genetic and environmental risk factors for common cancers in Pakistan, through combined epidemiological and basic science studies. An important development in this respect has been the initiation of a research project testing BRCA1/2 mutations (a genetic change strongly associated with breast and/or ovarian cancers) in Pakistani women at high risk of developing breast and/or ovarian malignancies.

Specific viruses have also being linked to cancer; studies are being conducted to explore the role of known pathogens in the development of cancer in our population, with the hope that effective preventive measures will reduce the number of cases. The immunology and pathogenesis of different cancers is currently being explored through a number of research projects by the research scientists of SKMCH&RC to find better ways to diagnose cancer at early stages and to monitor effectiveness of treatment.

Social Impact. SKMCH&RC is also involved in helping postgraduate students from other institutions to utilize the expertise and resources of the of the research group at Shaukat Khanum Hospital in the course of completion of their research work for their post graduate degree program. Many students from several prestigious universities of the country have benefited from this programme.

The Hospital has a team of UK and US trained physicians who provide diagnostic, treatment and support facilities to its cancer patients. Patients are provided multi-disciplinary care by a team of medical, radiation and surgical oncologists supported by world class pathology and imaging services and a specialized pharmacy .The hospital has indigenously developed fully integrated software “Hospital Information System” which maintains the diagnostic and treatment record of each patient and is accessible to the concerned doctors and staff on a real time basis. The institution has a dynamic educational and a recognized training program for doctors including the only nursing oncology program in the region.

At SKMCH&RC every effort is made to ensure that the quality of services being provided to the patients is being constantly monitored and enhanced. To date, thirteen departments from the hospital including clinical as well non clinical are ISO 9001:2000 certified. The hospital also conducts regular monthly meetings called Morbidity and Mortality meetings where (peer) review of errors occurring during care of patients is carried out. Another monthly activity is Clinical Audits which are also aimed at highlighting important issues and making recommendations for future improvements. We have also implemented a system of patient feed back and Annual Patient Satisfaction Surveys to assess patient satisfaction level and bring about improvement in patient care.

SKMCH&RC has always strived to keep its facilities updated to international standards. In keeping with this mission, the first bone marrow transplantation procedure was carried out on April 26, 2006 making it the first such facility in Lahore. The transplantation which costs about £ 14,000 was conducted absolutely free of cost. Another milestone in this respect was the acquisition of Pakistan’s first ever PET –CT scan facility, an essential tool in the early diagnosis, accurate staging and precise treatment of cancer, on February 08, 2010. As part of our mission to provide free of cost care this scan will be provided without charge to the deserving patients and at a fraction (Rs 32,000) of its actual cost (abroad) to the rest of the patients.

Today Shaukat Khanum Cancer Hospital provides state of the art cancer treatment to approximately 4000 new cancer patients annually, and provides absolutely free of cost treatment to approximately 70% of these patients. Another 10% are provided financial support.

The author works at the Clinical Research Office of SKMC&RC. This article was originally posted at Planet Earth.