Cancer care services are sub-optimal in both urban and rural areas of India. Universal Cancer Conquest (UCC) was launched in 2015 to build a strong rural healthcare infrastructure for cancer care and a comprehensive cancer care ecosystem in both rural and urban areas. UCC co-founders Dr Sachin Chopda and Ajay Balai, and Niraj Bora, director, finance review how their model has evolved so far and their expansion plans as they seek a second round of funding soon
The sight of cancer patients and their relatives living on pavements outside Delhi’s AIIMS or Mumbai’s Tata Memorial Hospital, saline bottles et al is a tragic but common sight. Hordes of cancer patients and their caregivers are forced to make this journey from smaller cities to major metros due to the skewed distribution of cancer care in India.
According to a research paper in The Indian Journal of Medical and Paediatric Oncology, titled Delivery of cancer care in rural India: Experiences of establishing a rural comprehensive cancer care facility, though nearly 70 per cent of Indian population lives in rural India, nearly 95 per cent of cancer care facilities are in urban India.
The result is that though the incidence of cancer in rural India is nearly half of that of urban India, the mortality rates are double. They conclude that if cancer care has to be improved, more centers have to be developed in the smaller cities and in rural India.
This is exactly what Dr Sachin Chopda, Ajay Balai and Niraj Bora set out to do when they set up Universal Cancer Conquest (UCC) in 2015: build a strong rural healthcare infrastructure for cancer care and a comprehensive cancer-care ecosystem in both rural and urban areas.
There is no question that these services fit a growing need in India. According to the report released by the ICMR and the Bengaluru-based National Centre for Disease Informatics and Research this August, the number of cancer cases in India is estimated to be 13.9 lakh this year and may increase to 15.7 lakh by 2025, with its prevalence being marginally higher among women.
The initial days
UCC is the result of one of the founder’s own experience with the lack of organised cancer treatment facilities. A few years ago when a family member was diagnosed with cancer, Ajay Balai faced a number of challenges in the whole process of treatment, tests and diagnosis. Going from one centre to another proved quite a challenge. “While going through this experience, I realised how difficult this process must be for someone from a non urban area. Geographically concentrated centres compels patients from small towns to travel long distances for diagnosis, treatment and follow ups. This is when I decided to work on a cancer care model that creates a single roof solution to bridge the gap between quality cancer care services and patients.”
Balai cancelled his return to the US, founded UCC which was incubated under the Pushpam group in Pune, Maharashtra.
Picking up the narrative, Niraj Bora, director, finance, UCC pointed out, “Balai observed that a lot of services are scattered, and awareness among the general population is far below the required level. The problems he faced during the treatment phase made him realise that cancer care is highly under-penetrated in India as other healthcare services.”
Realising the supply–demand gap between rural and urban areas, Balai came together with Bora and the third partner, Dr Sachin Chopda, co-founder and one of the promoters of the Pune-based Pushpam Group to start UCC and provide end to end cancer care services with rural and online presence.
So what is the treatment model that UCC follows? Was it modeled on existing systems of cancer care in rural areas?
Expanding on this aspect, Bora said, “The model is based on the fact that India has less than 4000 oncology specialists for a country with a population of 138 crore. Forget about rural access, even tier 2-3 cities do not have the expertise. An ICICI Securities report points out the need for comprehensive cancer care centres. India has only 200-250 such centres, or just 1 for every six million people. So UCC intended to bridge the gap with its CCP model to improve accessibility and convenience with its end to end cancer care treatment.”
While UCC was incubated under Pushpam Group, Pune with Dr Chopda helping it to grow and pivot the UCC model till now, Balai said that the company later raised a seed round and has been bootstrapped till now.
Lives touched by UCC
Balai narrated that in the past five years, UCC has pivoted from basic hospital tie ups to the hub and spoke model recently, which includes small hospital tie ups with basic infrastructure to cater to rural location patients, and create more awareness. Lately, they have also started an online second opinion portal for cancer care, through which they have served patients in India and overseas.
According to Bora, over the past five years, UCC has touched base with more than 5000 patients and detected another 5000 potential patients through screening. Their local small hospital tie ups in rural areas have reduced patients’ travel time and cost. Many of their cases referred from outside their network, take their chemotherapy sessions in the CCP centres, for which they had to previously travel to a city every time for a session. These sessions are now easily accessible to them. Additionally, UCC also ships medicines periodically to them as per prescription so that they don’t have a problem getting it at the town level, says Bora.
The past five years has given UCC some insights into the incidence of cancer in these areas. As Dr Sachin Chopda comments, “Though we have not noticed any specific trends around the disease, we have seen a number of new types of cancers that are being detected. These new cancers have several advanced treatment modalities. Over the years, we have also noticed that cancer has now become a lifestyle disease and this a generic trend across the globe.”
One of the other points to be noted is the change in conversations around cancer. Though there is still a lot of stigma attached to the disease, the conversation around cancer is slowly evolving, according to Dr Chopda.
With scientific and technological advancements, there is a lot of hope and awareness around fighting the disease. With many startups working actively towards building awareness about cancer and its treatment, patients are now much more educated about how to deal with the disease. They are open to taking counselling sessions and seeking help, avers Dr Chopda.
The main issue is that early diagnosis is crucial in treatment of cancer and this has traditionally not been available in Tier 2-3 cities. Has UCC addressed this issue? Bora analyses that the problem starts with the lack of awareness of cancer related symptoms and the stigma attached to treatment around it.
He agreed that a majority of cancer related deaths happen due to late diagnosis. There have been cases where the patient is completely unaware about his/her condition until it’s too late. A number of patients who have been detected with cancer in early stages have made it through the treatment.
Bora pointed out that in rural areas, awareness around the symptoms and diagnosis are limited since not many medical professionals are specialised in oncology. One of the first steps for better cancer care is to bring more awareness about cancer and help them overcome the stigma around it. A grassroot level campaign to educate rural communities about the importance of early detection, treatment options and financial support will make a significant difference.
Stepping into this gap, Bora said UCC runs awareness campaigns online and offline with NGOs and independent camps which helps in creating awareness about the types and importance of early detection in cancer care. Many of these campaigns are also done in tier 2 and non-urban towns that helps create more awareness for cancer care.
So how does the UCC system work, once a patient has been diagnosed? Balai explains, “With the kind of tie ups we have, we cover insurance and non insurance patients as well. Patients covered under government schemes are also covered in our treatment. Typically the hospital bills the patient where in we work under a revenue sharing arrangement with the hospital. Second opinion portal (Samiksha) is under UCC where we cater to the patients directly.” He declines to disclose specifics of the revenue sharing agreements with hospitals.
According to Dr Chopda, what differentiates UCC from other cancer treatment centres and start-ups in this space is that “UCC is a holistic offering, we run oncology departments within hospitals and also run an online second opinion portal for cancer care. In urban cities, which is the main destination for medical treatment due to better infrastructure, we are tying up with the best of the hospitals to provide better / 360 degree cancer care services bringing together all cancer related services under one roof, which reduces the pain of the patient’s families.”
The model in the rural areas, is that “through our state-of the -art Cancer Care Point (CCP) centres—we offer diagnostics, radiation, surgeries and other allied treatments—target geographical locations where cancer cases are not easily detected due to low awareness about the disease, lack of healthcare infrastructure, and access to specialist doctors.”
The CCP centres have in turn partnered with leading NGOs in the rural areas to provide screening services and have successfully detected several asymptomatic cancer cases. Dr Chopda informs that CCPs are equipped to handle several forms of cancer treatment at the town level, thus cutting down the frequency of visits to expensive and crowded urban centres.
The UCC kiosks at the centres are equipped with the crucial facilities, including electronic medical records (EMRs), Samiksha (UCC’s second opinion portal, their digital avatar which connects their specialist oncologist panel to their CCP units) and video-conferencing, through which their oncologists can offer guidance and advice. In the case of complex treatments, the CCP specialists refer patients to the UCC centres in urban areas.
Seeking second opinions in cancer before deciding on treatment is an accepted practice and through Samiksha, UCC has served a few patients from outside India as well, said Dr Chopda.
Impact of COVID-19 pandemic
While Dr Chopda admits that there’s no doubt that COVID-19 has impacted cancer care delivery, he also points out that cancer is among those medical conditions where treatment cannot be stopped or delayed. When the pandemic started, a number of patients delayed/postponed treatment for a later date.
But over the last few months, they noticed that patients have realised that treatment is crucial and delay in getting the right treatment can significantly impact outcomes. Patients are now actively seeking treatment and UCC have had a busy Q1 because cancer care is an essential service, says Dr Chopda.
As a startup building cancer care infrastructure and a treatment ecosystem in small towns and in rural India as well as cities, UCC has done well but the need is much larger and it could have ramped up faster. It seems to have decided to grow slowly but comprehensively. In the five years since UCC was founded in Pune, Maharashtra it has spread to 10 small cities such as Shirdi, Baramati and Sangamer in Pune district. In Nashik district, UCC has have extended reach to over 70 villages in 5 kms radius from the CCP centres.
According to Balai, the UCC team is more than 12 people now, and would be expanded once they have new hospital tie ups and CCP centers onboarded. The expansion plan will start with Pune district and then Maharashtra state in next few quarters.
On the funding side, Bora revealed that UCC had raised a seed round earlier and is now looking for further capital to expand reach. The business model was pivoted and is ripe for expansion now, and he promised that they would be announcing something very soon on this.
One possible drawback in the UCC model so far is that according to Bora, it is not worked closely with or leveraged the National Cancer Grid so far, primarily working within their network of NGO partners and CCP centres. This is probably part of their expansion plans as well and could help improve their reach faster.
As no details of the revenue sharing arrangements were shared, it is difficult to say if UCC makes cancer treatment more affordable. Presumably this aspect is taken care of by the NGOs involved. Even so, easier access is a big advantage for cancer patients and their families, translating into less expense on travel and stay in bigger cities. This will also result in more adherence to follow up checks and therefore diagnosing relapses in time.
With the incidence of cancer only set to rise, UCC’s model seems to be providing cancer patients and their caregivers in Tier 2 and 3 cities as well as urban areas an invaluable service.