Fighting the cancer disease burden

The number of cancer cases in India will multiply five times by 2025, according to a report by the World Health Organisation. Even after adjusting for population growth, new cancer cases are rising by 30% per unit population, according to several assessments on the disease trend in the country.

The reasons could be tobacco and smoking-related habits, environmental pollution, increased consumption of processed meat and food, besides obesity, lack of physical exercise. The existing infrastructure for treatment of cancer needs a little more intervention from stakeholders to fight rising mortality due to cancer.

Factors affecting the availability of the right infrastructure for treatment of cancer are:

Doctor-patient ratio: There is a mismatch between the number of cancer patients and that of oncologists. Data released by the Medical Council of India puts it at 1:1,674 against the WHO norm of 1:1,000.

An IIHMR report notes that there are only 200-250 comprehensive cancer care centres - 0.2 per million population in India vs 4.4 per million population in the US. There is also a vast discrepancy between rural and urban oncology care.

Healthcare as an industry is spearheaded by intensive information and manpower. Improvements and advances only in medical technology is insufficient to improve the quality of service delivery. It is because the skill of doctors and other healthcare workers is not being continuously enhanced and utilised.

The onus is collectively on medical institutions, professional bodies, industry associations, government agencies and health technology suppliers to become an active part of the healthcare ecosystem. Professional associations across all genres and healthcare fields need to become more proactive, along with industry bodies, in regulating the continuing medical education in line with desired outcomes.

Health insurance: The delivery of affordable and equitable cancer care is one of India's greatest public health challenges. The treatment cost for cancer has gone up exponentially in recent years, making it inaccessible for cancer patients to access care at the top hospitals due to narrow insurance plan coverage. There is a need for comprehensive medical insurance against cancer. This insurance must also cover newer anti-cancer drugs taken at home (orally), prescribed only by oncologists.

Early detection: Early detection will not only increase the chances of survival but also reduce the cost of treatment for patients, but infrastructure for early detection is scarce.

Low awareness of cancer signs and symptoms among people is another reason for delay in diagnosis. There is an urgent need for improved screening methods in India to avoid the last-stage cancer burden on oncologists. Making cancer screening/diagnosis affordable and convenient at an early stage should be a priority.

The WHO recommends three steps to early diagnosis:

1. Improve public awareness of different cancer symptoms and encourage people to seek care when these arise. Some symptoms are: non-healing ulcers, abnormal bleeding, new lump, fever, weight loss and fatigue, changes in bladder and/or bowel habits, and difficulty in chewing or swallowing.

2. Invest in strengthening and equipping health services and training health workers so they can conduct accurate and timely diagnostics. These include: for men: physical examination, rectal examination, S. PSA, S. CEA; for women: mammography, gynaecologist examination (with Pap smear), physical examination and to teach self-breast examination.

3. Ensure people living with cancer can access safe and effective treatment, including pain relief, without incurring prohibitive hardship. It is impor-
tant to provide economical palliative care for pain relief or any other symptomatic treatment.

India is undergoing transformation in providing cancer treatment. But, to cope with the existing availability and accessibility gap, there is a need for more cancer specialists and better treatment options.

With economic development a focus, improving healthcare must be a priority, too. Hence, a larger share of the GDP should be invested in healthcare. Having advanced diagnostics will help bring down mortality due to cancer. These are need in both urban and rural areas. This will improve outcomes of rural patients and will reduce burden on urban cancer centres.

(The writer is a Mumbai-based oncologist)

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