Monday, 20 May 2019

Better healthcare infrastructure, comprehensive planning for fighting cancer

12 February 2019 | Features | By Dr. Vivek Belathur

The delivery of affordable and equitable cancer care is one of India's greatest public health challenges.

Cancer cases in India will multiply five times by 2025 according to a report by the World Health Organization. Even after adjusting population growth, the new cancer cases have increased 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 in order to make it suitable to fight against increasing rate of mortality due to cancer. 

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

Grim picture of doctor-patient ratio

There is a mismatch between the number of cancer patients and the oncologists. The data released by the Medical Council of India gives a doctor-patient ratio of 1:1674 against the WHO norm of 1:1000. India will be facing a shortage of oncologists; The IIHMR report notes that there are only 200-250 comprehensive cancer care centers — 0.2 per million populations 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 utilized. It is a collective onus of medical institutions, professional set ups, industry bodies, government agencies and health technology suppliers including e-retailers to become an active part of the entire healthcare ecosystem of the country. Professional associations across all genres and healthcare fields need to become more proactive along with other industry bodies in regulating the continuing medical education in line with the desired outcomes.

Healthcare insurance is not able to help

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 the recent years making it inaccessible for the cancer patients to access care at the top hospitals due to narrow insurance plan coverage. Although the government of India has recently launched National Health Protection Scheme (NHPS) but the money allocated may not be sufficient to treat many cancers whose treatment costs are high.

Therefore, there is a need for comprehensive medical insurance against cancer. This insurance must also cover newer anticancer drugs taken at home (by mouth), prescribed only by oncologists.

Lack of medical facilities to track cancer at early stage

In urban areas, we have healthcare facilities with advanced treatment options like, i.e. radiation, surgical and chemotherapy.

In India unlike the west has no government health policy where either cancer prevention vaccines are given to the public or cancer screening programmes are available.

The most common reason behind delayed detection of cancer is that there is a lack of awareness and availability of infrastructure to diagnose cancer at early stage. However, the early detection will not only increase the chances of survival but also reduce the cost of treatment on patients.

Due to the lack of awareness of cancer signs and symptoms among the people, there has been a delay in the diagnosis. There is an urgent need for improved screening methods in India in order to avoid the last stage cancer burden on the oncologists. Making cancer screening/diagnosis affordable and convenient at an early stage should be the major concern of the stakeholders in the industry.

As recommended by WHO, the three steps to early diagnosis are:

  1. Improve public awareness of different cancer symptoms and encourage people to seek care when these arise. These 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, Gynaec Examination (with Pap smear), Physical Examination and to teach Self Breast examination to women.
  3. Ensure people living with cancer can access safe and effective treatment, including pain relief, without incurring prohibitive personal or financial hardship. It is important to provide economical palliative care for pain relief or any other symptomatic treatment.

India has been undergoing a lot of transformation in providing treatment of cancer in the country and even caters oncology services to international patients in many major hospitals across the country. However,for domestic patients to cope with the existing availability and accessibility gap, there is a need for more cancer specialists and better treatment options in the existing infrastructure in the state run government hospitals and in tier 2 cities. With economic development a focus, improving health care must be a priority too. Hence, larger share of the GDP should be invested in healthcare. Having advanced diagnostics at faster pace will help bring down the rate of mortality due to cancer in India. The facilities need to be improved not only in urban but also in rural India so that the diagnosis is early and patients do not have to travel to cities for treatment. This will improve outcomes of rural patients and will reduce burden on urban cancer centers.

 

Dr. Vivek Belathur, Consultant - Medical Oncology, Fortis Hospitals, Bangalore

 

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