Closing the cancer care gaps

We have made significant progress in our understanding of cancer biology, standardisation of treatment protocols, development of newer diagnostics, innovative drugs, better rates of survival and improved quality of life. However, challenges like ensuring uniform delivery of care persist. There are gaps in availability of resources, finances, awareness and learning that continue to affect cancer care.

The Covid 19 pandemic has disrupted normal life. Over five million people have died. Compare this to cancer mortality of 10 million deaths every year, which goes almost unnoticed. Even more alarming is the projection that cancer related deaths could increase to 13 million annually. This calls for efforts to increase cancer awareness, prevention, early detection and innovative therapies. The real challenge, however, is to deliver a standard cancer care for everyone irrespective of their circumstances.

Head and neck cancer or ‘Indian cancer’, which includes cancers affecting mouth and throat, is one of the most common cancers in India with an estimated 500,000 new patients every year. These are group of cancers predominantly caused by tobacco. Since these cancers commonly affect people from lower socio-economic strata the deficiencies in care are glaring. An astounding 90% of them are associated with tobacco chewing/smoking. Therefore, effective tobacco control reduces the numbers drastically.

Cancers detected in early stages have a good outcome and treatment protocol is less intense. Unfortunately, in India 80% of the head and neck cancers are diagnosed in advanced stages. As symptoms are evident quite early, early detection is relatively simple.

There is compelling evidence to suggest that opportunistic screening among the high-risk population helps in early detection and lowers cancer-related deaths. Creating awareness about symptoms and community level screening are effective measures. Technology and social-media are effective means to create awareness.

Mobile devices with camera provide an opportunity for oral screening. Photographs of lesions captured during community screening can be transmitted to experts at remote locations and lesions flagged by the experts can then be evaluated further.

Equitable distribution of cancer care is a challenge. A comprehensive cancer care requires a multidisciplinary approach supported by resource-intense imaging facility, radiotherapy machine, chemotherapy suite, and operation theaters. These resources are concentrated in metros with limited availability in rural areas. In recent years, both the public and private sectors have invested in improving the rural healthcare. However, achieving uniformity across all regions is still some time away. In the interim, technology can provide access to quality care for patients located in remote areas.

A systematic approach with effective use of technology for communication between the patient, local care providers and remotely located experts can prove a game changer.

Affordable health care is an elusive goal. A diagnosis of cancer is not only devastating but financially draining. The cost includes the treatment-related expenses and other indirect costs such as loss of employment, hospital visits, special dietary and support requirements.

Lack of resources is primary reason for cancer patients to discontinue the treatment mid-way. Insurance coverage for oncology care without exclusions is needed. Tobacco users, often denied insurance, must also get coverage albeit at a higher premium.

To ensure that cancer treatment is not discontinued for lack of funds, bridge funds can be created with the help of NGOs, CSR funds and private donations. Similarly, drug banks should be set up in rural areas to provide high-end drugs at an affordable cost. Oncology-specific educational programmes for doctors, nurses and technicians are also an important need.

While it may seem that there are wide gaps in cancer care, challenges are not insurmountable. We need a strong resolve to bridge the gaps in cancer awareness, prevention, early detection and ensure that a high quality cancer care is accessible to all.

(The writer is Senior Consultant, Head and Neck Oncology, at a Bengaluru-based hospital)