editorial letter

First Editorial

"The best way to predict the future is to create it''…Peter Drucker

Why another website? Are we not already overloaded with information? Moreover, in this era of fleeting attention spans who will take the time and effort to access this site? While there is some truth in these observations, we wish to explain our raison d'etre.

The annual incidence and mortality from pancreatic cancer are almost equal - a large majority of individuals diagnosed with pancreatic cancer, die of it. Although many of these people are older in age, they are still valuable members of the society, loved by their family and friends. In recognition of its deadly potential, considerable effort is being expended world-wide on researching and treating this cancer. Unfortunately most of these efforts are concentrated in the developed western world. While this brings many advantages like huge research budgets etc. it also means that specific concerns of the developing countries are lacking in this domain.

What are the specific concerns of patients and medical community in a country like India? There is lack of organized health care coverage beyond the rudimentary basics, for the majority of population. Even when such care is available in large cities, it is often beyond the means of most patients. To complicate the situation, the cost of medical care, including new targeted drugs, has reached stratospheric levels. The pattern of pancreatic cancers is somewhat different in this country. Periampullary carcinomas that mandate a specific management paradigm constitute a larger fraction of patients. Patients with pancreatic and periampullary carcinomas are often younger compared to those in the west. This is most likely the result of the demographic structure of our population that is still predominantly young. In real life this often means that the patient of pancreatic cancer is also the earning member of the family. There is a lack of palliative and end-of-life support to the patients, which is very important in a fatal disease like this. There is a dearth of oncologists in general and pancreatic cancer specialists in particular. Until recently, medical and radiation oncologists approached pancreatic cancer with an attitude of therapeutic nihilism. Even with the advent of recent radiation and medical advances, this situation has not largely changed. On a more optimistic note, pancreatic resectional surgery is on the rise in India and centers of excellence, albeit few, are evolving. Furthermore, the concept of close family ties in India result in better psycho-social support for many patients.

Will pancreaticcancerindia.com change all the above? It will evidently not. What it will do is provide a forum for patients and the pancreatic cancer medical community in India. It will enable oncologists, pancreatologists, general practitioners, radiologists, pathologists, palliative specialists, nurses, patients, families and others to interact freely with each other about their concerns. It will also provide up to date and, as far as possible, locally relevant information on all aspects of pancreatic and peri- ampullary cancers. For this to happen it would need active participation from all the aforementioned stakeholders. Many of us would have to take time out from our already overcrowded lives to contribute to this effort. The editors will take the lead, but cannot take the effort forward entirely on their own. Many of our esteemed expert colleagues, both in India and abroad, have kindly agreed to participate.

The website is beginning its journey as an information and interaction resource. There will be sections dedicated to patient and professionals. The information has been subdivided into various subheads (e.g. `Interesting Cases') to make its assimilation more enjoyable. The information includes diagnosis, staging, surgery, chemotherapy, radiation therapy, palliative care and nursing issues, targeted therapies, clinical trials, translational and basic research. The website thus, is partly an e-journal. We invite participation (including patients, lay people and healthcare professionals) from all interested individuals under all heads (including guest editorials) in this website. It may be noted that this website is not designed to provide actual management decisions in individual cases- this is best left to treating physicians. Nevertheless the editors will make every attempt to answer any queries of colleagues and patients in this regard, to the best of their capabilities.

While the current mandate of the website is the above, it is possible that it may break new ground in the future. It is possible that some of us may be motivated to create new resources like a non-governmental organization. It may enable pancreatic cancer specialists to lobby effectively with agencies like the Indian Council of Medical Research to focus greater attention on this disease. It may also spur many of us to overcome our resistance to cooperation and collaborate to produce good quality data from this part of the world.

The website has been possible with the help of an unrestricted educational grant from Roche Scientific Company (India) Pvt. Ltd. We are thankful to them for this grant. It will be our endeavour to ensure complete editorial freedom and integrity over the scientific content of the website.

We wish all of you a very happy monsoon and look forward to interacting with you in the near future.

• Dr. Shailesh V. Shrikhande
• Dr. Sudeep Gupta
• Dr. Umesh Mahantshetty
• Dr. Shyam Aggarwal
• Dr. Adarsh Chaudhary