Shaukat Khanum Memorial Cancer Hospital & Research Centre



Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) is a state-of-the-art cancer centre located in Lahore, Punjab, Pakistan. It is a project of the Shaukat Khanum Memorial Trust, which is a charitable organization established under the Societies Registration Act XXI of 1860 of Pakistan. The institution is the brainchild of Pakistani cricket superstar, Imran Khan. The inspiration came after the death of his mother, Mrs. Shaukat Khanum, from cancer.

Mission Statement
To act as a model institution to alleviate the suffering of patients with cancer through the application of modern methods of curative and palliative therapy irrespective of their ability to pay, the education of health care professionals and the public and perform research into the causes and treatment of cancer.

History
Imran Khan made a nation-wide appeal for the collection of funds from a match between Pakistan and India on November 10, 1989 at Gaddafi Stadium, Lahore which raised Rs. 2,902,600. This was followed by a series of more than 50 successful fund raisers held throughout the world. Pakistan's win under Imran's captaincy in the 1992 cricket world cup in Melbourne helped fundraising efforts. He was able to collect one and a half million pounds in just six weeks after the World Cup when the same amount had taken 2 years to collect earlier. He donated his entire prize money of 85,000 pounds for the project. In 1994 when the project required more financing for the ongoing construction, Imran Khan launched a mass contact campaign in which he toured 27 cities in the country and collected Rs. 120 million. During the entire campaign for the construction of the hospital, over a million individual donors from ordinary citizens to the rich and famous pitched in. Everything from cash to jewelry and valuables was donated.

Designing and execution of the master plan was overseen by Dr. Nausherwan K. Burki, MB, PhD, FRCP, FCPS, FCCP, of the University of Kentucky Medical Center, Lexington, Kentucky, USA in collaboration with an international team of cancer physicians and research workers. Designing and architectural services were provided by Arrasmith, Judd & Rapp, Architects in Health Planning of Louiseville, Kentucky, USA. Architectural details were handled by Messrs. Nayyar Ali Dada & Associates of Lahore. Local engineering was performed by Messrs. Progressive Consultants, Lahore. Ground was broken in April 1991 and the hospital opened its doors on December 29, 1994.

Board of Governors
The Hospital is a project of Shaukat Khanum Memorial Trust - a non-profit legal entity established under the laws of Pakistan. The Board of Governors formulates overall policy and consists of bankers, researchers, businessmen and physicians. The Hospital is managed by a professional team from clinical, administrative and nursing backgrounds.
 * Mr. Imran Khan, Chairman
 * Dr. Nausherwan Khan Burki
 * Mr. Ashiq Hussain Qureshi
 * Mrs. Aleema Khanum
 * Dr. Uzma Ahad
 * Mr. Rashid Khan
 * Mr. Ahsan Rasheed
 * Mr. Sarfaraz Rehman
 * Mr. Zain Hussain Shabbir
 * Mr. Farrukh Irfan Khan
 * Mr. Mujahid Hamid
 * Mr. Imtiaz Hydari
 * Mr. Mansur A. Javed

Clinical Departments

 * Medicine Details
 * Surgery Details
 * Anesthesiology Details
 * Medical Oncology Details
 * Pediatric Oncology Details
 * Pharmacy Details
 * Radiation Oncology Details
 * Nuclear Medicine Details
 * Radiology Details
 * Pathology Details
 * Research Details
 * Nursing Details

Research at SKMCH&RC
Research is needed to develop better ways of detecting and treating cancer and to improve cancer care. Over the coming years, SKMCH&RC's expanding knowledge of cancer genetics will have a major impact on its ability to predict an individual’s level of risk of developing cancer, to detect and diagnose cancer early and to select treatments which are most likely to be effective. Ultimately, the genetic revolution may lead to ways of preventing cancer. The genetic revolution provides major opportunities for identifying people at risk of cancer and for developing better treatments. At the moment such studies are limited in Pakistan.

SKMCH&RC's research is organized in three different streams: i) epidemiology, which seeks to understand the lifestyle and environmental causes of cancer; ii) molecular biology, which will enable the development of better ways of predicting treatment responses and disease outcome i.e molecular markers; and iii) clinical trials, which is primarily focused on the evaluation of existing and new therapies. The Management Information Systems (MIS) Department has developed a state of the art hospital information system. Through this system, the research team has been able to handle the logistics of a large hospital, documenting a wealth of patient information.

SKMCH&RC's objective is to explore the bridge between laboratory and clinic though the support of translational studies in areas of diagnosis, prognosis and treatment. It is important to maintain research concerned with cancer in local population, addressing issues of prevention through studies on the effects of genetic make-up, environment and lifestyle.

The research section has been developed over the last 5 years, and, recently, received a donation to refurbish the 3rd floor of the Hospital into a Research Wing, housing a suite of research laboratories, a data management and epidemiology division, as well as a clinical research section responsible for clinical trials.

The team of researchers is expanding and several projects are underway. Currently, Basic Sciences Research is divided into three main areas of interest and several projects are being conducted:

 (1) Identification of genetic risk factors in the development of cancer 


 * Prevalence and spectrum of BRCA1/2 germline mutations in Pakistani Breast and/or Ovarian Cancer families.


 * A study to evaluate the association between germline genetic variation and disease risk and outcome  in ovarian carcinoma in Pakistan.


 * The role of p53 mutations in the development, progression and outcome of breast cancer in Pakistan.


 * Genetic causes of colorectal cancer in the Pakistani population.

 (2) Tumor virology 


 * Human Papillomavirus Associated with Esophageal Cancer in Pakistan - A Retrospective Analysis.


 * Human Papillomavirus in Cervical Cancer cases from Pakistan.


 * Transcriptional profiling of Hodgkin’s Lymphoma; relationship to EBV status, histological subtype and geographical locale.

 (3) Infections and Cancer 


 * PCR assay for detection & quantification of fungal infections in patients with AML, ALL & Myelodysplastic Syndrome.

Hospital Cancer Registry
The Hospital Cancer Registry at SKMCH&RC is a data system designed for collection, management, and analysis of detailed data on patients registered at the Hospital. This Cancer Registry has been functioning since the inauguration of the Hospital in December 1994. Every year, the Registry generates cancer statistics according to sex, age, topography, and morphology, etc. From December 1994 till December 2004, the International Classification of Diseases, Ninth Revision, Clinical Modification, was used to code the diseases. On January 2004, the Registry implemented the International Classification of Disease for Oncology, Third Edition (ICD-O-3) to code the cancer cases.

The computerized Cancer Registry is an integral part of the Hospital Information System (HIS), which has been developed with Oracle Corporation software through the collaborative efforts of the Registry staff and Management Information System (MIS) staff.

RESULTS

During the last ten years, a total of 24,758 neoplasm cases were registered at SKMCH&RC (of which 687 were benign and 24,071 malignant), with nearly equal distributions seen among males and females (49.9% and 50.1%, respectively). About 87.9% tumors were found in adults whereas 12.1% were diagnosed in children. The top three malignancies among females were cancer of the breast, cancer of the ovary& uterine adnexa, and leukemia, whereas in males, they were leukemia, non-Hodgkin’s lymphoma, and cancers of trachea, bronchus & lungs.

In adults, malignant neoplasm of the breast, oral cavity, and non-Hodgkin’s lymphoma, were established as the leading malignancies, whereas, in children, the three commonest malignancies were categorized as acute lymphoblastic leukemia, Hodgkin’s disease, and non-Hodgkin’s lymphoma.

In the year 2004, a total of 2,577 malignancies were added to the Registry database. The ranking of the top three malignancies for the year 2004 was the same as for a ten-year period extending from December 1994 to December 2004. The Registry uses the American Joint Committee on Cancer (AJCC) staging manual for staging all available cancer sites. TNM categorizes cancers in stages 0, 1, 2, 3, 4, and also as unstageable. Among 2,577 malignant cases, 0.5% cases were staged into stage 0, 13 % in stage I, 21% in stage II, 20% in stage III, and 21% in stage IV. In case of 11% of the patients, no AJCC stage was defined and 14% of the cases were unstageable.

Details of these reports can be seen here.

About Nursing
Professional nursing practice at SKMCH&RC is promoted through membership of the Pakistan Cancer Nursing Forum affiliated to the International Society of Nurses in Cancer Care and through membership of the Asia Pacific Hospice Network.

Nursing at SKMCH&RC offers much more than the traditional image of nursing. Nurses provide care to patients receiving complex treatment for their disease through surgery, radiation therapy, chemotherapy and nuclear medicine processes. In addition to informing patients about their disease and its treatment, nurses provide emotional support.

A large part of what they do is patient education. Patients are advised on what to expect during their stay and after they are discharged. It also includes teaching them about what drugs they will be taking and the side effects of those drugs, blood transfusions, how to look for signs of infection and bleeding and dietary changes. Team Nursing and Nursing Documentation are seen as very important as they foster team spirit and improve the quality of care given to patients and their families.

The Nursing Division is ISO-9002 Quality Management Certified and working towards JCIA, therefore is continually striving to improve its practice and thereby its quality of care to patients and their relatives.

Complete information about SKMCH&RC's Nursing Division is available here

Philosophy of Nursing Division

 * Nursing is a universal need for all human beings and an essential service in health care.
 * Nursing recognizes the uniqueness of each human being and aims to provide care which is holistic and individualized and covers physical, psychological, social, spiritual and cultural needs.
 * Nursing is both an art and a science and works in collaboration with medicine and other health professionals.
 * Nursing should be non-judgmental providing equal, high quality care underpinned by research.
 * Nursing recognizes that patients with cancer and their families require on-going support and that nurses are in a unique position to provide encouragement, reassurance and hope through difficult times.
 * Nursing recognizes that through communication, understanding and empathy patient's difficulties can be shared.
 * Nursing promotes the patient's independence through education and ongoing support and discharge planning provides for the transition from hospital to community and home and is an integral part of the patient's plan of care.
 * Nursing should act as the patient's advocate in appropriate situations, whilst recognizing social, cultural and religious norms.
 * Nursing promotes the concept of life-long learning and nurses should continually strive to keep their knowledge base up-to-date and accept responsibility for their own actions and decision-making.
 * Nursing recognizes that nurses need support to provide this care and aim to provide a caring supportive working environment.

Professional Structure
The Nursing Division is headed by the Director of Nursing/Nursing Education. There are five grades of clinical nursing staff - Clinical Nurse Managers, Team Leaders, Senior Staff Nurses, Staff Nurses and Trainee Staff Nurses. A competitive salary package is available for all levels of Nursing Staff.

The nursing environment includes:
 * Inpatient Departments that cover Adult and Pediatric Oncology
 * Peri-operative Nursing
 * Intensive Care Nursing
 * Surgery
 * Internal Medicine
 * Radiation Nursing
 * Nuclear Medicine Nursing
 * Pain Management
 * Palliative Care Nursing

In the busy Outpatient Department, The Chemotherapy Day Suite and The Emergency Assessment Room, nursing provides a comprehensive service to support adult and pediatric patients.

Specialist roles in nursing have being developed to support and advance nursing practice - roles in Infection Control, Nursing Risk Management/Evidence-Based Practice, Breast Care Nursing. These new roles aim to improve the quality of care to patients and their families.

Philosophy of Nursing Education
At SKMCH&RC, it is believed that Nursing Education
 * Values the students as an individual.
 * Encourages active participation of students in the learning process.
 * Defines goals and objectives clearly, which can be achieved and evaluated.
 * Incorporates the model of adult-learning that is to build on existing knowledge and skills and that which facilitates and promotes self-directed learning.
 * Recognizes the need of study, therefore is facilitated by appropriately qualified teachers.
 * Initiates and encourages a multidisciplinary approach to care of the patient with cancer.
 * Provides constant monitoring and evaluation of the curriculum/course/workshop to progress and ensure high quality education and clinical teaching.
 * Encourages patient and family education and where appropriate ensures their active participation in setting realistic goals.
 * Identifies high standards of care which are consistently being achieved and maintained.
 * Encourages research, evidence-based practice and quality assurance for improving patient care.

Professional Development
All nurses must complete a series of workshops designed to enhance their practice, including Induction and Orientation Programme, Core Competencies in Cancer and Palliative Care Nursing, Basic Cardiac Life Support, Cytotoxic Drug Administration, Pharmacology and Drug Calculations, Health Assessment, Infection Control, Nursing Risk Management & The Diploma in Oncology/ Cancer Nursing. In the Intensive Care Unit & Operation Theatre - staff (nurses & technicians) complete an inservice skills - based program of core competencies.

Some Significant Milestones
July 2001 Accreditation of Diploma in Oncology Nursing with Pakistan Nursing Council and Affiliation with Post-Graduate College of Nursing of the Punjab

November 2001 Inauguration of Pakistan Cancer Nursing Forum affiliated to International Society of Nurses in Cancer Care

December 2001 ISO 9002:1994 Accreditation of selected Departments of the Nursing Division

March 2004 ISO 9001:2000 Accreditation of all Nursing Division Departments.

December 2002 Dedication of Institute of Health Sciences Building Begum Mir Nursing Faculty – School of Cancer Care

March 2003 First National Nursing Management Symposium held to mark the formal opening of the Begum Mir Nursing Faculty

November 2004 First Annual Prize Giving and Awards Ceremony to mark 3 years of Nursing Educational Activities - consolidated efforts.

Expansion in Services and Faculties
 * ICU Expansion …from 4 – 7 beds in February 2004
 * Increase in IPD 1 and IPD 2 bed capacity up to 82
 * Extension of Chemotherapy Department opening hours 8am – 12:30 MN
 * Extension of Assessment Room opening hours 8am – 12:30 MN
 * Expansion of OPD
 * Preparation and launch of Stem Cell Transplantation Programme 2006

Creation of Specialist Roles in Nursing
 * Pain Management and Palliative Care Nursing
 * Breast Care Nursing
 * Nursing Risk Management
 * Infection Control

Collaborative exchange programme with UK
 * Specialist Nurses from UK to – SKMCH&RC
 * SKMCH&RC nurses to
 * The Royal Marsden Hospital, London
 * St. Helena Hospice, Colchester
 * Kings College Hospital, London

SES (Senior Experten Service) Germany
 * Collaborative Programme
 * Visiting Senior Nurses to SKMCH&RC

Directors and Assistant Directors of Nursing (1994–2006)

 * Ms. Barbara Messer
 * Ms. Della Anwar Ali
 * Ms. Liza McConnell
 * Ms. Helen Davey
 * Mr. David Forrester
 * Ms. Bernice Tavener (Acting Director)
 * Ms. Virginia A. Gumley (Director of Nursing/Nursing Education 2001 - To Date)