Making breast cancer care accessible to all

Breast cancer is the most common of all cancers among women and also the most complex to treat but very rewarding in terms of cure/response to treatment. However, this high-quality treatment infrastructure remains restricted to metro cities.

Access has to be made universal across tier 2 and tier 3 cities and villages where even basic amenities and technologies such as radiology equipment are hard to find. The scarcity of trained personnel apart, the remote public is also not enlightened about their options even if they can afford it.

Some seek treatment by coming to the nearest Metro city but this adds to the cost, which would include stay in cities and loss of earnings as well. There are, however, a few suggested ways to tackle this situation:

'Hub and Spoke' model: Hospital groups, especially those which already have well-established and recognised metro and tier one centres, have to open 'spokes' in smaller towns and for this, the government should incentivise them by offering affordable infrastructure taxes, electricity and other services.

These spokes can serve the local population and create access for the rural population that surrounds them. Such a model also ensures that overall costs remain low for medical facilities while growing opportunities to create and sustain thousands of local jobs.

Utilising telemedicine: Telemedicine is the use of digital tools to enable timely access to professional consultations in remote locations. A recent survey revealed that patients with advanced cancers (including breast cancer) who used an online tool to report symptoms to their doctor in real time saw a five-month increase in survival compared with patients who did not use the tool. These patients also reported an improved quality of life.

Through such optimal, intelligent use of telemedicine, we can provide the same standard of care that patients would otherwise receive in a traditional face-to-face visit with their doctor. Though the telemedicine model is still in its nascent stage in India, it has immense potential to address cancer care delivery gaps in India.

The telemedical tool will also help in managing surgeries in the smaller cities better by managing the post-operative phase better. Skilled surgeons from cities anywhere can also pool their cases in such telemedicine-enabled centres and go operate there with the local teams. Over a period of time, the centre could flourish and surgeons can join there directly as the workload will attract good talent.

From being a spoke, it will evolve into the next hub. And from these hubs, further spokes in the smaller cities can develop. This would catalyse the development of quality infrastructure and services which not only help patients with cancers but the society in general. It is also very ergonomic and not force-fitted.

Government financial aid: We have certain central and state government schemes to provide financial assistance to poor patients, like the Prime Minister's National Relief Fund and the SAST Scheme. These provide financial protection to families living below poverty line - covering surgery, chemotherapy and radiation therapy. However, given the immense burden of the disease in the country, we need greater funding and government aid to enable hospitals and private institutions to provide cancer care at a reduced cost to patients.

Public-private collaboration: Encouraging such partnerships, especially in rural areas, is needed where the existing government infrastructure can be buffered through private investment to bring both basic and the latest diagnostic and treatment options to patients. The government can utilise its extensive reach in remote regions of the country, while the private health sector can contribute with technical expertise and financial resources.

In recent years, we have made some noteworthy advancements in breast cancer diagnostics and treatment, which include the development of advanced genetic tests that can screen patients for breast cancer genes, the growing use of a 'personalised medicine' approach (such as targeted therapy) and shorter courses of radiation therapy at higher doses for patients with early-stage breast cancer.

As we continue to grow our understanding of breast cancer and improve our diagnostic and treatment approaches to the disease, we must first ensure that we provide existing medicines and treatments to patients across the country. This, in my opinion, is the first step towards quickly and effectively bridging the existing gaps in cancer care delivery in India.

(The writer is Senior Consultant, Medical Oncology & Hemato-Oncology, HCG & Vikram Hospital, Bengaluru)