The Big C

22 Mar 2017
POSTED BY Y Magazine

Cancer is on the rise in Oman, and fighting the disease is a hurdle most of us don’t consider until it happens to us or a loved one. Alvin Thomas meets one formidable survivor, and finds out how doctors and health experts are working to help patients deal with the deadly disease.

Christopher Reeve, the late actor who portrayed Superman and who was later paralysed in a horse-riding accident, once said: “A hero is an ordinary individual who finds the strength to persevere and endure in spite of overwhelming obstacles.”

When it comes to facing overwhelming obstacles, however, Felix Meza, a 35-year-old Venezuelan living and working in Oman, has a story of endurance and perseverance to share with us.

“It all started with an allergy,” says Felix. “I was having an itching sensation in my body, and I was having night sweats and fever. It then graduated to a very bad cough. I didn’t take it very seriously then.

“Things soon got more severe and I started coughing blood. I did several tests for seven months but no one could find any problems or give me an answer. I started seeing that the glands in my neck were swelling up. And in the X-ray, they found something abnormal in my chest. So they did a biopsy on my neck tissue.

“And that’s when they found out that I had Hodgkin Lymphoma, the cancer,” he says.

Felix, who was then only 24, was working for an oil company in Oman, and was also a part-time student at the Caledonian College of Engineering. He says: “I was shocked by the news. I wasn’t expecting to hear those words from the doctor.”

Hodgkin Lymphoma is a type of lymphoma (a cancer) that affects a part of the immune system called the lymph system. The disease can spread to nearby lymph nodes and spread to the lungs, liver and even the bone marrow.

Felix started treatment at the Royal Hospital in Muscat. He had to undergo 26 chemotherapy cycles and 16 radiations over an 11-month period, which saw him lose weight, his hair and become tired regularly.

“It was a difficult period,” he says. “After the chemo, I could not eat anything for a week. I survived by drinking fluids. Then I had one week when I could eat normally and try to compensate for the weight loss, before I had to go back for the next cycle.

With a heavy broken tone, he adds: “This period was particularly painful for my family and especially my father and mother.

“We were living in the same house, her room was by my room but we would still only communicate through emails and text messages.

“After 11 months of treatment, I was declared free of cancer,” he says.

For Felix, however, this was only the start of a long, painful ordeal. “Three months after my treatment, the disease came back,” he says.

This time, things were very different, too. His doctors told him that he needed a bone marrow transplant, and that it would be better if he headed back to his hometown for further treatment.

“As instructed, my mother and I headed back home. The treatment took longer than expected. It took almost a year.

“Chemotherapy sessions followed. But this time around, I contracted an infection in my teeth, throat, tongue, stomach and kidneys. I lost 10kg in 10 days,” he recollects.

Felix’s own stem cells were removed and frozen for transplant. Over the course of the week, he had to undergo frequent chemotherapy sessions to help the bone marrow make healthy cells again.

The transplant was successful but Felix was placed in isolation for 40 days – he had been experiencing convulsions following the transplant.

“Six months after the transplant, I was afraid to go out,” Felix tells. “I didn’t want to talk to people, I didn’t want to eat anything outside, I was in my room. I closed myself down from the outside world even though I was OK.”

But destiny had other plans for Felix. Two months later, during an evaluation, doctors discovered that his Hodgkin Lymphoma had come back.

“I needed another bone marrow transplant but from a donor.

“The only one compatible was my younger sister, who was only 12. I had booked myself a room in an institute in Italy for this transplant. But, as instructed, I had to travel to India for a test,” he says, almost inaudibly.

“My mother took the news very badly. She couldn’t accept whatever happened and what was continuing to happen to me,” says Felix.

“And on the day before I went to India, I looked at my mother and told her, ‘It’s time for you to let me go’. She replied: ‘If it is the will of God; if he wants you near him, then who am I to say anything’,” he recollects.

What happened next, however, was a shock to everyone. Felix travelled to India and took the tests.

To everyone’s surprise, his tests revealed that he had no trace of the disease in his body. 

“The doctors could not explain it,” says Felix.

“Since then, I have been healthy. I believe it was divine intervention.”

Today, he continues to work with the oil company and has been healthy for more than eight years now. Felix’s story inspires us, and is one of the stories with a happy ending that sheds light on the solemn topic that is cancer. According to Dr Bassim al Bahrani, the director of Oncology and the head of Medical Oncology at the Royal Hospital, there are more than 600 cancer patients for one million people in Oman (in 2016).

He asserts that in such a scenario (adjusting for population growth), the number could rise to as much as 3,500 cases of cancer every year.

Meanwhile, the latest statistics from the National Oncology Centre have shown that the number of visits to outpatient clinics reached 19,103 in 2015 – a sharp increase of 10 per cent from 2014 – and the number of cancer cases detected in Oman stood at 1,314 (1,212 Omanis and 102 expatriates), according to data released by the National Registry of Tumours.

The statistics also pointed out that the median age of diagnosis was 53. According to an oncologist (who wishes to remain anonymous) who is treating patients in Oman, age is only considered when “factoring in the type of cancer”.

The doctor says that Hodgkin Lymphoma (the cancer Felix was diagnosed with) is mostly found in people aged between 21 and 30. Meanwhile, he also says that children under the age of 14 could be prone to leukemia and tumours (cancerous and non-cancerous) in the brain, bone and spinal cord, neuroblastoma and cancer of the kidney.

In 2015, 87 cases of cancer were reported among children aged 14 and below, accounting for 7.3 per cent of the total number of patients that had been diagnosed with cancer.

However, more recent statistics revealed by Dr Ibrahim al Ghaithi, head of Paediatric Oncology at the National Oncology Centre, the Royal Hospital, says the number could be anywhere between 180 and 200 as of 2017.

The Sultanate has been ranked fourth among the Gulf Cooperation Council (GCC) nations in terms of registered cases of cancer. As a matter of fact, cancer has been deemed the third-leading cause of death in the country, after car accidents and heart diseases.

In Oman, breast cancer is the most common type of cancer among females, followed by thyroid and colon cancer. Meanwhile, men are most prone to prostate and colon cancer.

However, Dr al Bahrani revealed recently that lung cancer – a disease in which 97 per cent of those diagnosed are smokers – is expected to become the most common cancer in Oman over the next five years, but he also says that breast and colorectal cancer (also known as colon or rectal cancer) are currently the most common forms of the disease in Oman.

In an interview with – an Oman-based website – Dr al Bahrani says that cases of colon cancer have risen significantly since 2010. Studies have revealed that the areas where fast food is readily available – such as Salalah and Muscat – are generally seeing a higher rate of colon cancer.

Colon cancer begins in the colon or the rectum and is commonly found in people older than 50. However, it has been known to affect younger people too, especially those with a family history of the disease and smokers.

Colon cancers are characterised by the growth of a polyp in the inner lining of the colon or rectum called a polyp (all polyps are not cancerous).

The month of March is observed as “Colorectal Cancer Awareness Month”.

Statistics published by the Health Grove website show that the annual mortality rate per 100,000 people from colon and rectum cancer in Oman has increased by a factor of 17.2 per cent since 1990, reflecting an average increase of 0.7 per cent every year.

Cancer also accounted for 53.1 deaths per 100,000 men in 2013, with a peak mortality rate that was higher in men than women (42.1 deaths per 100,000 women). Factors that contribute to colon cancer include improper diet, low physical activity, high Body Mass Index (BMI) and increased alcohol, drug and tobacco use. These factors were known to have caused at least 52.9 per cent of the total deaths caused by colon and rectum cancer in Oman in 2013.

In a surprising turn, stomach cancer – which contributed to the mortality rate due to cancer in Oman – has shown a decrease of 19 per cent since 1990.

Meanwhile, breast cancer still accounts for 32 per cent of all cancers in females in Oman, and the average age of those fighting breast cancer (in advanced stages) is under the age of 50.

A family history of breast cancer, early menarche, late menopause, radiation exposure to the chest before 30 years of age, null parity and non-breast feeding are some of the factors that contribute to breast cancer.

Screening involves clinical examination by a surgeon, mammography and self-examination of the breasts. Again, early detection has been deemed the best cure for breast cancer.

In an interview with Y, Dr Wahid al Kharusi, the president of the Oman Cancer Association (OCA), says: “Early detection is key, and that is what we are striving to achieve. Our Mobile Mammography Unit has been adopted well in Oman, and I urge everyone to avail themselves of our services at the earliest.

“We try to create a lot of awareness with events across Oman. Last October, we held three conferences, as well as an art exhibition with regards to the ‘Pink Month’ – the month dedicated to breast cancer awareness worldwide,” says Dr Wahid.

“There is a saying that prevention is better than cure. But today, we live in a world where so many factors are affecting our health. And in such cases, the only thing we can do is detect the cancer early.

“The message that the OCA has been putting in since its inception is that you have to go through regular repeated examinations and evaluation of your body so that you can receive an early prognosis.

“Cancer can be cured,” he asserts. “We should not be afraid of it. We just have to stand up to it,” he adds.

The Oman Cancer Association currently operates the Mobile Mammography Unit and the Ultrasound unit for early detection of breast cancer. The services and diagnosis are completely free.

Apart from that, the association also runs the Dar Al Hanan initiative, which is an outreach programme dedicated to serving the needs of children with cancer who live outside Muscat.

The Dar Al Hanan initiative currently can host 16 families in the city.

As for treatment in Oman, the Royal Hospital has a dedicated oncology centre for radiotherapy, chemotherapy, nuclear medicine and surgery, with specialised doctors and nurses for children and adults. It is equipped with state-of-the-art medical equipment.

Another doctor from a private hospital, who wishes to remain anonymous, also points out that pancreatic, stomach and kidney cancers are on the rise.

“These cancers are also some of the most painful ones to endure. Pancreatic cancer for one can be attributed to increased alcohol and cigarette intake – something that has risen in Oman since 1990.”

Aaron Mathew, a life coach for international marine cadets, who also assists in counselling cancer patients, says: “Cancer is an illness that can alter the life of an individual and his or her family.

“I have seen many patients who have been fighting cancer. It isn’t an easy ride, but you would be surprised by the sheer strength that some of these patients have.

“Some of the patients don’t exhibit their strength merely to survive. Some of them just want to beat cancer and prove that their body and mind are stronger than the illness that haunts them.

“Of course, that is not the case with everyone, though.”

A recent study carried out by the psycho-oncology team at the Sultan Qaboos University Hospital and in collaboration with the Royal Hospital in Muscat, found that about 28 per cent of people with cancer had anxiety and 21 per cent had depression.

“Most patients undergo a period of denial in the beginning. This could lead to the patient detaching or isolating himself or herself from peers. This would be the time you and I must step up and let the patient know that they are not alone in their journey.

“Respect their privacy but don’t let them retract completely, as that can do more harm than good. If a person completely shuts down or is showing signs of depression for more than two weeks, immediately seek help from the patient’s doctor, as it could cause ramifications in the medical procedures.

“Coping with cancer is hard but it can be done.

“But if I were to give one advice, it would be that everyone should get themselves diagnosed on a yearly basis. After all, prevention is better than cure.”

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