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Important to balance benefits of cancer-related care with risks related to COVID-19: Dr Hari Menon

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While explaining how healthcare organisations have reinvented and adapted to the new normal to ensure that citizens get definitive cancer care during the COVID-19 crisis, Dr Hari Menon, senior consultant, haemato-oncology, Cytecare Cancer Hospital cautions that demographic changes alone will cause cancer cases to double over next two decades in India and therefore suggests three top measures that can accelerate the country’s fight against cancer, in an interaction with Viveka Roychowdhury

 How has the COVID-19 pandemic impacted access to cancer care in India?

The pandemic has altered every aspect of life worldwide. Understandably, the impact on access to cancer care in India was unavoidable – especially during the initial lockdown. However, over the last couple of months, healthcare organisations have reinvented and adapted to the new normal to ensure that citizens get definitive cancer care during the crisis.

It’s important to balance the benefits of cancer-related care with the risks related to COVID-19. At Cytecare, our primary concern has been to ensure that patients continue their treatment while alleviating their concerns about compromised immunity leading to infection. Here are a few measures that we took:

  • We were prompt to It’s important to balance the benefits of cancer-related care with the risks related to COVID-19offer tele-consultation services to help our patients stay connected with their doctors for guidance on their ongoing treatment including reference to local physician or oncologists, thereby ensuring continuity of treatment. The idea was to facilitate personalised treatment plans, based on the patient’s unique circumstances and challenges.
  • We introduced a dedicated COVID-19 infection risk screening at the hospital to mitigate exposure to other patients and the hospital staff, while taking proactive measures to move certain procedures to outpatient as well as reschedule non-urgent patient visits.

What is India’s burden of cancer cases and how is it projected to increase in the next five years?

According to the National Cancer Registry Programme Report, 2020, there are 1.39 million cancer cases in India currently. By 2025, the number is estimated to reach 1.57 million.

The report, released recently by the Indian Council of Medical Research (ICMR), finds that tobacco-related cancer contributes to 27.1 per cent of the total cancer burden – about 370,000 cases in 2020.

It is expected that demographic changes alone will cause the number of cancer cases to double over the next two decades. Currently, non-communicable disease is the second leading cause of adult death in urban India and fourth leading mortality cause in rural India.

What are the most prevalent cancers in India and do we have an epidemiological study of cancers to prevent them or lessen incidence in the next generation?

The term ‘cancer’ refers not just to one disease, but a collection of several diseases, with wide-ranging characteristics that usually call for varied treatments. In India, cancers of the lung, mouth, stomach, prostate cancer and oesophagus are the most prevalent among men, while breast and cervical cancer rank the highest in terms of prevalence among women.

The National Cancer Registry Programme’s Report, 2020, notes that cancers of the gastrointestinal tract (in men and women) account for about 19 per cent of the country’s cancer burden. The report also states that the incidence of breast cancer is rising, while cervical cancer is declining.

Another insightful study published in The Lancet Oncology last year had stated that cervical cancer could be potentially eliminated as a public health problem in India within the next 60 years given the promise shown by the vaccination programme against human papilloma virus (HPV) and cervical screening made more accessible.

Better and early diagnosis of cancer through screening and awareness campaigns has improved the chances of survival and quality of life. To what extent?

Early detection with specified treatment protocols is critical for better long term outcomes. Delay in diagnosis can lead to compromised outcomes to treatment. In fact, it also means giving more aggressive treatment inviting complications and impinging quality of life. A delay in detection will consecutively cause the cancer cells to spread in the adjacent areas of the affected region, thus increasing the morbidity. Also, in the absence of early detection and simultaneous treatment, the patient’s cancer-related disability increases, thereby dipping the chances of survival.

We have observed that early detection is particularly true for superficial cancers such as breast, head and neck and cervical cancers among others. We need to spread more awareness about the importance of screening programmes and invest in diagnostic facilities at local healthcare centers across the country.

Also, the five-year survival rate increases significantly when the cancer is detected at an early stage I or II, as compared to the more advanced stage III or IV tumours. Given the socio-economic inequalities in access to healthcare and the high out-of-pocket expenditure in India, these are important factors to consider.

It is a perceived notion that cancer afflicts the Indian population about a decade younger than their western counterparts. However, this may not be entirely true given that the older population are less inclined to come forward for treatment and may present at more advanced stage as compared to younger population. Therefore early diagnosis and treatment becomes all the more significant.

Are cancer care facilities, from screening, diagnosis, and treatment, accessible and affordable to all patients in India? Especially in rural areas? How successful have government schemes like Ayushman Bharat been while addressing these issues?

There’s no denying that India is grappling with inadequate infrastructure and poor access to healthcare. The country has merely 0.98 oncologists per million population.

It is also true that cancer treatments can be expensive most of the time because the treatment involves a comprehensive approach involving not only the management of the patient and his well-being but also supportive care management of disabilities that might be temporary or permanent and the need to get them back to main stream after a curative treatment has been implemented.

As the world’s largest fully government-financed health insurance scheme, Ayushman Bharat could be the game changer. Right now, there are about 150 oncology packages that cater to patients from economically disadvantaged sections of the society. Once Health and Wellness Centres (HWCs) under Ayushman Bharat succeed in screening effectively for cancers, detection and timely treatment can become a reality for the 1.3 billion population.

There are three top measures that can accelerate India’s fight against cancer:

  • Strategic investments in modern diagnostic services such as colposcopy, nuclear medicine and radiology
  • A pan-India “hub and spoke” model for cancer hospitals so that that patients don’t have to travel too far to get optimum treatment
  • Incorporation of essential oncology medicines for treatments under India’s National List of Essential Medicines (NLEM) thereby helping to regulate the prices and develop uniform standards

How has the National Cancer Grid worked to solve these issues? In terms of teleconsultation, reference network etc?

At a conceptual level, the National Cancer Grid represents a collaborative approach for addressing cancer at the national level. By bringing together institutions both in public and private sector under one roof, it can ensure uniformity in protocols and implementation of cancer care and treatment. The potential is immense and there is a lot of promise for this umbrella organisation to implement definitive therapy for cancer patients, while also addressing methods to improve cancer care in the future

What is the future of cancer care in India, at institutions like Cytecare Cancer Hospital? In terms of expansion and investment plans to reach more patients, cover more types of cancers, offer the latest treatment options in cancer care in India?

We know a lot more about this complex disease today than we did a decade or two ago, thanks to cutting-edge cancer research that is being conducted across the globe. Right from prevention and early detection to treatment of late-stage disease, there are several encouraging developments.

Diagnostic scans are getting more accurate and radiation treatments come with lesser side effects today. The development of immunohistochemistry (IHC), markers for various cancers, liquid biopsies and genetic tests have transformed the way we diagnose and tailor cancer treatments. Similarly, the development of newer drugs for targeted treatment and breakthroughs in stem cell research and gene therapy are paving the way for effective and personalised cancer care in the future.

At Cytecare, we are committed to building a more patient-centric cancer care system, with an organ-site approach. Our endeavour, since our inception in 2016, has been to get the finest multidisciplinary team of clinicians to work together with a holistic approach. Currently, we have a world-class team of 22 cancer specialists – the largest such team in India – that understands and evaluates each patient’s unique journey.

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