The Shaukat Khanum Memorial Cancer Hospital & Research Centre

A new hospital and cancer research center in Lahore, Pakistan, was built with private funds and collaboration between medical personnel in Pakistan, Britain and the USA.

In the 1980s there was no health facility devoted specifically to the diagnosis and treatment of cancer in Pakistan or the surrounding region. A tragedy was the catalyst for the development of such a center, The Shaukat Khanum Memorial Cancer Hospital & Research Centre in Lahore.

Mr. Imran Khan, the internationally famous cricket player, like most people, had no personal experience in the care of terminally ill patients; he was appalled by the poor diagnostic facilities and absence of palliative care when his mother lay dying of cancer. He realized that if such a paucity of services were available to his mother, who was certainly able to afford the best possible facilities, the situation must be much worse for the average poor person in Pakistan. From this arose his determination to build a modern institution to provide cancer services to all patients regardless of ability to pay. Today the Shaukat Khanum Memorial Cancer Hospital & Research Centre, named after Imran’s mother, stands as a model of state-of-the-art tertiary cancer care in the region.

Land was donated for the hospital on the outskirts of the large city of Lahore (estimated population: seven million) in the southern Punjab province. The hospital was planned and developed by Dr. Nausherwan Burki, Professor of Medicine at the University of Kentucky Medical Center, in Lexington, Kentucky, USA, an expatriate Pakistani with strong ties to his home country. Dr. Burki recruited a health care architectural firm from Louisville, Kentucky, Arrasmith, Judd & Rapp, Inc. and over a period of eight months in 1990 developed a master plan for a hospital at the site in Lahore. The master plan envisages three phases for the development of the hospital over a ten-year period.

Because accurate data on the incidence and prevalence of cancer was not available for Pakistan, much of the initial hospital planning had to be based on estimates. Thus, it was estimated that during Phase I the hospital should be able to cope with approximately 20,000 outpatient visits a year, and provide inpatient services to approximately 60 patients at any given time. During planning, it became apparent that expatriate help would be necessary for hospital administration as well as for nursing administration; on the other hand, very high-quality medical personnel of Pakistani origin practicing in Pakistan, Britain, and the USA provided a readily available reservoir of medical expertise.

As Imran Khan undertook an extensive fundraising campaign in Pakistan, Europe and the USA, building began in 1991. The building meets the stringent requirements of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the USA hospital accrediting agency. In Phase II the hospital will be expanded to accommodate 150 inpatients and in Phase III will expand to 250 inpatient beds, with concomitant expansion of outpatient and ancillary facilities.

Current Operations
The hospital opened in December 1994, and in the first year registered 8, 600 patients, of whom 5,200 were cancer patients. The hospital provides modern diagnostic facilities in the pathology (including immunohistochemistry, fluorocytometry, etc), radiology (MRI and CAT scanning, stereotactic breast biopsy, etc) and nuclear medicine departments, and the latest treatment facilities in adult and pediatric oncology, including radiation medicine. About 48 outpatient chemotherapy treatments are provided daily.

A crucial feature of any cancer hospital is the blood bank services. The hospital was the first institution in the region to provide blood component products. Donated blood is screened for hepatitis B & C, syphilis and HIV; it is of interest that of approximately 25,000 samples screened to date, none has been found to be HIV positive, reflecting the very low incidence of HIV in Pakistan.

A cancer registry has been developed, which currently has nearly 20,000 patient entries. The hospital registers about 3,500 new patients annually, of whom 89% are adults, with an equal balance between men and women. It is planned to collaborate with other institutions and organizations to develop a population-based cancer registry.

The catchment area for the hospital includes not only all of Pakistan, but also Afghanistan, Central Asia and the Gulf States who are beginning to avail themselves of the hospital services. In its first seven years, the hospital has had a major impact on cancer awareness in the region and on hospital management services.

Education
A major objective of the hospital is to provide education in all aspects of hospital function—administrative, nursing, technical and medical. Accordingly, continuing medical programs are in place, with nearly 40 medical housestaff in training. Courses are offered in advanced cardiopulmonary life support (ACLS) not only for the hospital staff but also for outside physicians.

At the inception of the hospital, the area of greatest concern was the quality of the available nursing services. Therefore, training programs were developed whereby nurses undergo a rigorous classroom and bedside teaching program , in spite of the fact that they are already licensed. As a result, the hospital now has a cadre of highly trained chemotherapy nurses as well as nurses with expertise in intensive care, operating room services, etc. The hospital was instrumental in establishing a diploma training program in oncology nursing, approved by the Pakistan Nursing Council, and currently has six nurses enrolled in this one-year program.

Hospital technical expertise was also highly deficient in Pakistan; the hospital undertook to train college graduates as technicians in the pathology laboratory, in radiology and nuclear and radiation medicine, as well as in respiratory therapy and modern hospital pharmacy services. The hospital is proposing to provide its own diplomas in these areas to the technicians it trains and it is now ready to accept trainees from outside the hospital. The pathology lab subscribes to the American College of Pathology quality control program, providing results that can be accepted with confidence by the physicians and community.

Public education by means of lectures, newspaper articles, and open hospital days are planned to increase cancer awareness in the region.

Research
The hospital has undertaken a number of clinical studies that have been presented at international meetings; in addition, a collaborative project examining the genetics of breast cancer has been initiated with the German National Cancer Research Center and is likely to bear fruit in the next few years. The hospital welcomes joint research projects, both basic and clinical, with any interested research workers or institutions.

Charitable Status
The most important aspect of the institution is the fact that it is run entirely on charitable donations and yet is able to provide cancer diagnosis and treatment at a level rivaling that available anywhere in the world. For this, the hospital runs fund-raising programs both within and outside Pakistan. To date, approximately $60 million has been donated by millions of people, permitting the hospital to provide totally free treatment to the majority of its cancer patients. In its first year, 89% of patients received absolutely free treatment and services; this figure has now dropped to approximately 68%, with the rest of the patients contributing in various amounts to the costs of their diagnosis and treatment.

The hospital has been intimately involved with the INCTR from its inception, and has been represented at every annual meeting of the INCTR. Plans are underway to strengthen this association and to use the expertise and assistance of the INCTR to further develop cancer services in the region; the hospital plans to open its training facilities to the region in collaboration with the INCTR.

Under the guidance of the Board of Governors and the Hospital Director and CEO, Mr. Rod Bull, and Medical Director, Dr. Faisal Sultan, the hospital looks forward to continuing to develop its cancer diagnostic and treatment facilities and research, while providing education in all aspects of hospital function and cancer care to people within Pakistan and in the region.