Cancer is one of the leading threats to public health in India. An estimated 2.25 million people live with the disease in the country, with more than 1.15 million new cases registered and an estimated 784,821 deaths recorded last year. Despite this, the country’s cancer infrastructure is sorely lacking – as phrased by a parliamentary panel, it’s “highly inadequate.”
The country is home to the third highest number of cancer cases in the world behind China and the United States and cases are predicted to rise in the coming years. To cope with demand, the country will need 7,300 oncologists compared to around 1,250 at present. Its oncologist deficit sits alongside a shortage of facilities. Just 62 dedicated cancer care centres service the entirety of the country’s cancer patients. As such, it is unsurprising that as many as 83 percent of India’s cancer patients are failed on their treatment – and lawmakers have drawn attention to this and the need for cancer infrastructure to be upgraded.
A report by the parliamentary standing committee on science and technology, environment, forest and climate change has urged that the Tata Memorial Centre (TMC) model for cancer care be followed, calling for “an expanded role for the Department of Atomic Energy in cancer treatment in India through an enlarged network of the [TMC] in Mumbai.” (The TMC falls under the purview of the Department of Atomic Energy). The panel, chaired by Rajya Sabha MP Jairam Ramesh, submitted its report to Rajya Sabha chairperson and Vice President Muppavarapu Venkaiah Naidu on Monday.
“[The] TMC has proposed that common and less complex cancer care facilities should be provided close to patients’ homes to create minimum disruption in their lives and that of their families,” the committee said. They recommended “wider adoption of ‘Hub and Spoke’ model proposed by [the TMC] across the country.” The hub and spoke model, as explained in a BMC Health Services Research article, “arranges service delivery assets into a network consisting of an anchor establishment (hub) which offers a full array of services, complemented by secondary establishments (spokes) which offer more limited service arrays, routing patients needing more intensive services to the hub for treatment.”
“The committee also finds a correlation between inadequate cancer care facilities and cancer deaths in the country,” the lawmakers said. It pointed to a mortality rate of 0.68, which can be attributed to late diagnoses in many cases allowing the cancer to progress to a stage where it advanced enough that treatment becomes difficult and survival outcomes are slashed.
Cancer infrastructure, the committee observed, needs to be upgraded in the “especially under-served parts of the country” and in regions where cancer incidence is high such as “in all north-eastern states — higher than the national average for several types of cancer, and showing a consistently rising trend over the past few years”. In addition, Empowered Action Group (EAG) states – those with lower socioeconomic indicators compared to the rest of India – are anticipated to see a rise in cancer cases in the coming years. Efforts are much-needed in those states to ensure access to cancer screening and care.
Acknowledgements of the gap in cancer care in India from government agencies have been iterated in the past. “Treatment for cancer is very expensive,” National Health Authority (NHA) chief executive officer Dr Indu Bhushan commented earlier this year. “We want to include treatment for all [types] of cancer in our health packages which are cost-effective, proven and beneficial to the patients,” referring to the Centre’s flagship health insurance scheme Ayushman Bharat.
Optimising cancer care and achieving improvements in patient outcomes does require an effort to enhance cancer infrastructure. With this action recommended, it remains to be seen how policymakers will proceed and whether greater benefits can be enjoyed by the millions of cancer patients in India at present and the millions more to come.