This is my suggestion of tackling the problem. Comments, criticisms, suggestions are welcome.

1. Cancer Project in Lao PDR Dr. Partha Mukhopadhyay MD, DNB Consultant Medical Oncologist & Manager, S E Asia Operations, Health Care Global Enterprises

2. Cancer Treatment Facilities in Lao PDR Lao PDR does not have any cancer registry (both population based as well as hospital based) The cancer treatment facilities in the country are primitive. Surgery is done in some cases facilities for chemotherapy and radiotherapy are non existent. Patients travel to neighboring countries e.g. Thailand and Vietnam for their treatment.

3. Cancer Treatment Facilities in Lao PDR Since there are no cancer registries in Lao PDR, the national data for cancer does not exist. The incidence and the prevalence rates of different types of cancer are similar to those of Vietnam and the nation borrows heavily from that data.

4. Cancer Incidence in Lao PDR The population of Lao PDR is 6.8 million (2009) Overall cancer incidence combining males and females is approximately 110 per 100,000 population This extrapolates to approximately 7500 new cancer cases in the country per year In addition there are prevalent cases (almost double the incident cases at any point in time) which add up to the previous number

5. Cancer Incidence in Lao PDR contd… Since the country does not have any substantial cancer care facilities (including treatment by surgery, chemotherapy and radiotherapy and palliative care) , the majority of the patients go to neighboring countries to get themselves treated thus costing the national exchequer, and wasting their time , energy & money With this amount of cancer burden in Lao PDR, the country should have at least 4 to 5 cancer care facilities in the major cities

6. Cancer Incidence in Lao PDR contd… Extrapolated data from Vietnam For males (in order of incidence) Lung Cancer Stomach Cancer Liver Cancer Colorectal Cancer Nasopharyngeal Cancer

7. Cancer Incidence in Lao PDR contd… Extrapolated data from Vietnam For females (in order of incidence) Breast Cancer Cancer of the Uterine Cervix Stomach Cancer Colorectal Cancer Liver Cancer

8. Most Common Cancers in Males

9. Most Common Cancers in Females

10. Modalities of Treatment

11. What needs to be done Create awareness about cancer and the total management of cancer cases in the country extensive CMEs & training of doctors in the country talks at different forums, public meetings, different forms of advertisement Organize cancer care facilities in a scientific manner. public awareness, media awareness, physician awareness, prevention strategies, early detection strategies, management and treatment of established cases in an optimal manner and beginning of palliative and end of life care in a scientific manner.

12. What needs to be done To start basic facilities of a cancer clinic with day care facilities for chemotherapy and supportive management. To establish hospital based cancer registry initially & population based cancer registry at a later date Radiology facilities like a CT, MRI and Mammogram, Colposcopy needs to be established at the earliest with trained support staff (local). Establishment of good laboratory & pathology services including high end investigations Establishment of a high end radiotherapy facility Telemedicine services to be established extensively

13. To continue to be the leader in Oncology care in South Asia making high quality cancer care accessible by adopting global innovations .

16. Greetings from HCG - Health Care Global For over fifteen years Health Care Global Enterprises has been defining the future of cancer care in South Asia by designing, building and managing cancer centres with a steadfast vision: to transform cancer care environment by bringing core clinical services to one central place. The intent of this single place is to help patients achieve longer, better lives - and to improve cancer care one centre at a time. HCG Capabilities and Infrastructure: 1. Medical Oncology 2. Surgical Oncology 3. Radiation Oncology Cyber knife IGRT with CT on Rails – First in Asia State of the art Linear Accelerator with: 3DCRT – 3 Dimensional Conformal Radio Therapy IMRT - Intensity Modulated Radio Therapy Brach therapy: HDR Unit

17. Cont… 4. Hemato Oncology 5. Maxillo Facial Department 6. Pediatric Oncology 7. Gynec Oncology 8. Bone marrow transplant 9. Nuclear Medicine Department 10. Radiology Department 11. 24/7 Blood Bank with cell component and Pheresis facility 12. Triesta Sciences: State-of-the-Art Cancer Bio Marker Research and Diagnostics laboratory with India’s first Laser Capture Microscope. 13. Biological Safety Cabinet /Cytotoxic drug mixing cabinet: For chemo drug mixing 14. Dialysis Unit

18. CyberKnife® - HCG gifts India, the world’s most revolutionary cancer treatment system. Cyberknife Facts: Approved by the US FDA in 2001 to treat tumors and lesions anywhere in the body when radiation treatment is required Over 200 CyberKnife systems currently operating in the world Over 1,00,000 patients have been treated successfully Currently more than 50% of all CyberKnife procedures in the US are extracranial. CyberKnife Robotic Radiosurgery System is the first and only robotic radiosurgery system designed to treat tumors anywhere in the body, including the brain, spine, lung, liver, pancreas and prostate. CyberKnife is a path-breaking cancer treatment system that delivers high doses of radiation with pinpoint, sub-millimetreaccuracy. Because CyberKnife can deliver radiation beams from virtually any direction, the radiation beams are focused precisely on the tumor minimizing damage to the surrounding healthy tissue and critical organs. CyberKnife does not use blades or scalpels – offering a pain-free, non-invasive option to patients

19. CyberKnife The HCG CyberKnife has successfully completed more than 300 operations so far, and the number is increasing. Tumors that can be treated with CyberKnife. CyberKnife treats both benign and malignant tumors in various sensitive and inoperable regions of the body (Dr. Adler with Dr Ajai at HCG CyberKnifeCenter) Patients from all over the world including the US, Europe , Africa undergo treatment by the most advanced technology in cancer treatment at HCG Bangalore . CyberKnife: The Clinician Advantage A new treatment option for patients who refuse surgery, or when surgery is not possible or complex Continuously tracks, detects and corrects for tumor and patient movement throughout the treatment Provides unsurpassed Linear Accelerator maneuverability and complete access and coverage for tumor located anywhere Complements existing radiation therapy, IMRT or IGRT programs

20. The CyberKnife patient advantage Highest level of comfort Pain-free No anesthesia No invasive head or body frame No breath-holding during treatment Superior Quality of Life Significantly reduces treatment time Treats only affected areas Minimizes side-effects Immediate return to normal activity Treats inoperable tumors Treats tumor anywhere in the body Pinpoint accuracy Dynamic motion tracking Stereotactic blood-less surgery

21. ARTISTE SolutionAdaptive radiation therapy system HCG makes cancer treatment more accurate, comfortable with minimum side-effects. Asia’s First IGRT with CT-on-Rails. Features: High-precision CT-on-Rails for in-room 4D Gating in imaging and treatment 2D and 3D imaging for flexibility 3D Megavoltage cone beam imaging High resolution, accurate field shaping Clinical benefits: High level of accuracy Minimized dose of healthy tissue, maximized dose to target Board selection of imaging options Image-based target verification

22. Center for Breast Health HCG Pink Hope – Breast Cancer Support Group is a forum formed by women who have survived cancer and now lead normal, healthy lives. The support group was formed with the intention to provide a platform where women diagnosed with breast cancer could gather, with their family, to discuss their concerns and answer any questions they may have. The Group is supported by the HCG Foundation – the social wing of Health Care Global – focused on providing world class cancer care to all. The objectives of the HCG Center for Breast Health are to: Disseminate information that Breast Cancer is increasing in incidence in India. One out of 22 women could be affected by Breast Cancer. Educate women that early detection gives them an opportunity to heal quickly and lead a normal, long life. Create awareness in women about lifestyle changes that could actually decrease the incidence of Breast Cancer. Identify high risk women and put them on a protocol for early detection. This may include families with Breast Cancer patients. Spread awareness that there is no need to remove the breast in all women with Breast Cancer. In fact, only a small percentage requires removal of the breast. Importance of proper diagnosis, proper staging, and proper treatment to achieve long term control or cure. In advanced countries this has been achieved and HCG is taking a leadership role in achieving the same in India.

23. One women in India is diagnosed with breast cancer every 6.5 minutes-Shabana Azmi is the brand ambassador for breast cancer awareness at HCG Prevention with mammography. There are two types of mammography available: The standard mammography system which uses the traditional type of film used in radiology. This is usually found in radiology departments and surgery departments. The full field digital mammography system uses a digital detector. This is the latest generation of mammography equipment, and offers new facilities for processing images Shabana Azmi (zoom, contrast adjustment, computer assisted diagnosis, etc.) and is the way forward to future innovations. Leading experts, including the National Cancer Institute, the American Cancer Society, and the American College of Radiology, recommend a Mammogram every year for women age 40 and older. When breast cancer is found early and is still localized, the relative survival rate at five years is 96%.

24. PET CT [Positron Emission Tomography] and Medical Cyclotron HCG has installed a state of the art PET CT scanning facility and also a medical cyclotron facility. Medical cyclotron facility is the only cGMP facility in the country, thus providing very high quality isotope production facility which will meet US FDA and EU norms. Cyclotron and state of the art laboratory will produce variety of PET-Traces also called as radioactive molecules which will be used for diagnosis of various illnesses. PET CT scan is useful for... Cancer: Cancer diagnosis, to asses tumor aggressiveness, To monitor success of therapy, to detect early any recurrent tumors, to provide a whole-body survey for cancer that may have spread, to identify benignant malignant growths, used for radio guided surgery, used for PET guided radiotherapy Heart Disease: To determine what heart tissue is still alive following a suspected heart attack, to predict success of angioplasty (balloon, stent) or bypass surgery, to determine if coronary arteries are blocked, PET guided evaluation for heart muscle viability (only center having this facility) Brain Disorders: To diagnose Alzheimer's and other dementia, to determine the location of epileptic seizures prior to surgery, to diagnose movement disorders like Parkinsons' disease, to diagnose brain tumors and response to treatment

25. Clinical Trials Clinical trials form an integral part of the drug discovery process worldwide. A clinical trial is defined as "any research study that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes." Interventions include not only drugs, but also cells and other biological products, surgical procedures, radiologic procedures, devices, behavioral treatments, process-of-care changes, preventive care, etc. In short, clinical trials are the systematic studies in human patients aimed at determining the safety and effectiveness of new or unproven therapies. Types of Oncology Clinical Trials: Treatment Trials: What new interventions (e.g.., drugs, biologics, surgical procedures, radiation) can help people who have cancer? Prevention Trials: What kinds of interventions-such as lifestyle modifications, dietary supplements, or drugs - can prevent cancer from occurring? Screening and early detection trials: What tests can find cancer as early as possible in healthy people? Diagnostic trials: How can new tests or procedures identify a suspected cancer earlier or more accurately? Quality-of-life and supportive care trials: What kinds of interventions can improve the comfort and quality of life of people who have cancer?

26. Triesta A friendly project associate is your one point contact to solve all your queries related to laboratory, PET, bio-Repository, sites, investigators, recruitment etc. Our clients save valuable time during each stage of their project. 1. Triesta is experienced in all the phases of clinical trials, initial feasibility studies, and site management ranging from site selection to site training and closeout visits. 2. Medical Writing at Triesta comprises of protocol development, writing and managing clinical study reports, and serious adverse event reporting. 3. Triesta has a state of art Bio-repository operational under stringent guidelines and well laid down processes and SOPs. 4. A state of art Laboratory with latest in oncology diagnosis is another hallmark of Triesta. In a short period of four years, Triesta has established itself as a leader in the field of cancer biomarker research in India. Accreditations: The laboratory is working towards NABL and CAP accreditation. The laboratory has also recently been recognized by the National Board of Examinations, New Delhi to admit students for the DNB (pathology) course.

27. Thank You