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'Stigma' delays cancer action

Doctors say many patients have worrying attitudes about the illness and subsequent life-saving treatments.

Patients diagnosed with cancer are seeking repeated medical opinions, delaying treatment and risking their lives because of a "stigma" associated with the disease. Doctors say a diagnosis of cancer, or saratan in Arabic, is traditionally sensitive in many Arab nations, including the UAE, and many patients have worrying attitudes about the illness and subsequent life-saving treatments.

"Saratan in this culture holds a different meaning and connotation than the word 'cancer' in the West," said Dr David Spence, the chair of the department of medicine at Sheikh Khalifa Medical City. "For people who haven't been exposed to western medicine and thinking, there is still a thought that being diagnosed with saratan is similar to being given a death sentence. But this is wrong and it's a bad mindset in the culture."

Cancer rates are on the rise in the UAE and doctors say late diagnoses and treatment, in many cases, mean patients are dying from often treatable forms of the disease. Only about one-third of women diagnosed with breast cancer are in the early stages of the disease, according to estimates by cancer specialists. A late diagnosis means more invasive treatment and higher chances of death. World Health Organisation figures reveal cancer is one of the biggest killers in the UAE, behind cardiovascular disease and accidents. One in 10 people who died in 2005 was killed by the disease.

Dr Spence said doctors would discuss the diagnosis with a patient and their family during several sessions. "But the family normally resist understanding the diagnosis and want to take the patient for a second, third and fourth opinion. This can delay treatment," he said. Dr Ali Hindawi, a paediatrician at Al Hindawi Medical Centre, said the issue often originated from the medical profession. "There is a problem in the Arab world compared to European countries," he said. "Sometimes, doctors aren't as direct with their patients as they need to be. This attitude applied not just to the diagnosis of cancer, but other serious conditions," the paediatrician said.

"Another problem we face is the interference of families and relatives. We tell them first and the patient, but sometimes the relatives interfere and don't want us to tell the patient right away. It's not right; we need professionals to be in charge." Dr Tahani Mustafah, an Abu Dhabi psychologist, said doctors must learn to approach patients appropriately, from the diagnosis to the treatment process.

"There is definitely a bit of a problem in discussing the dangers of cancer due to the stigma in our societies," said Dr Mustafah, who works at Khalifa Medical City. "Doctors don't like to tell the patient [about cancer]; it shocks them, and it becomes an unnecessarily dramatic ordeal afterwards." She said it was vital that cancer patients were equipped with the information to deal with cancer as a "new part of their life instead of hiding it away as a social stigma and not discussing it".

Dr Spence said:"The superstitious understanding of saratan is different from the modern understanding of the disease." Patients need to know that many forms of the disease are treatable and curable. "The implication of the word is not the same as it might have been 50 years ago, when there was no treatment in this part of the world." However, health professionals warned that, as in any culture, the diagnosis of a serious illness must be treated carefully.

"You need to be 100 per cent sure before telling a patient any news," said Dr Mohammed Bahnasawy, a consultant dermatologist at Al Noor Hospital in Abu Dhabi. "There is no rush and no need to affect the patient's mental or emotional state without being sure ... the word saratan is scary to everyone, whether it is in Arabic or not." The Ministry of Health recently released a proposal for a new cancer research centre in Abu Dhabi, where specialists hope to bring together expertise and information from around the Gulf to improve outcomes for people diagnosed with the disease.

Dr Adel Anis Hajj, the head of oncology at Cedars Jebel Ali International Hospital, said recently that researchers had to find out what the most common cancers were, what the risk factors related to those cancers were and how awareness campaigns could be adapted to make more people aware of them. Presently, doctors believe the most common cancers are breast, prostate, colorectal and skin cancers.


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