Mapping challenges in India's fight against cancer

The latest report of the NCRP mentions that India’s cancer burden could increase from 1.39 million in 2020 to 1.57 million in 2025. Tobacco-related cancer is likely to account for 27.2 percent of all the cancers. This is followed by cancer of gastrointestinal tract (19.8 percent).

Cancers of lung, mouth, stomach and oesophagus were found to be the most common in men. In women, cancer of breast and cervix uteri were the most common.

The number of new cancer cases in the northeast region (NER) is likely to increase to 57,131 by 2025 in comparison to the estimated 50,317 in 2020, according to a new report released on the World Cancer Day on February 4, 2021.

The estimated incidences of cancer from 2016 to 2018 was highest in Uttar Pradesh (270053) followed by Bihar (145051), Maharashtra (144032), West Bengal (117220), Madhya Pradesh (98403), Tamil Nadu (86180) Gujarat (80820).

Uttar Pradesh also has the highest mortality because of cancer (136579) followed by Bihar (73361), Maharashtra (727620), West Bengal (59154), Madhya Pradesh (49713) and Tamil Nadu (43422).

Cancer burden continues to grow to pose a tremendous financial and emotional pressure across families. Is the health apparatus of India robust enough to tackle the burden? Can the health infrastructure of the country address the requirements for cancer? Are the interventions available to the economically weaker sections?

There is an urgent need to widen the interventions to reduce the cancer burden and address the inequalities that affect cancer prevention. There is also a need for proactive initiatives from all the concerned stakeholders to assess the efficacy of the existing measures. Strategies for managing the cancer burden entails an accurate understanding of the disease and the potential impact of the programmes. The International Classification of Diseases (revision 11) lists more than 600 types of cancer, most of which require unique diagnostic and management approaches.

Shortage of trained manpower, insufficient state-of-art facilities, insufficient early detection facilities especially in rural areas, absence of proper data for cancer mortalities are some of the challenges that India faces in tackling the disease.

Cancer as a disease cannot be seen in isolation. While multi-speciality cancer-specific hospitals can help in easy screening and early detection, what is more important is to arm the general hospitals with cancer facilities. The treatment facility has been envisaged for all the 22 new AIIMS by providing state-of-art diagnostic, medical and surgical care facilities

The Central and State governments, private and government hospitals have to evolve a common platform to reduce the cancer burden. There is a need to spruce the existing health infrastructure, especially in rural areas.

The Central government is implementing the Strengthening of Tertiary Care for Cancer Scheme, under which setting up of 19 State Cancer Institutes (SCIs) and 20 Tertiary Care Cancer Centres (TCCCs) have been approved.

The spectrum of cancer treatment spreads across surgery, radiotherapy, chemotherapy and palliative care. This can be either alone or in a combination.  While facilities for surgery, chemotherapy and palliative care is available at the district hospitals and medical colleges, the radiotherapy facilities are limited. Currently, there are around 855 radiotherapy machines in the country and this is not enough for managing the cancer burden of the country. There is a need for at least 1380 such machines in the country (@one radiotherapy machine per million population)

The Cancer Country Profile 2020 of WHO estimates that cost per person per year in India due to cancer would scale from $1.5 in 2020 to $4 in 2030. In ten years the cost would more than double because of the parallel increase in medical care expenses. There is a positive aspect also—there will be a five fold spiral in the number of lives saved from cancer in India from 2020 to 2030.

Cancer research in India has evolved over the years but a lot more needs to be done. Modern therapies are very expensive, so research into repurposed drugs and drug combinations and also novel drugs and more effective drugs with fewer side effects is required.

From mapping new therapeutic targets to identifying the potential candidates for cancer drugs and improved methods for early detection, researchers in India have designed new ways to treat the disease. This is however not much.  Enhancing funds for cancer research can motivate scientists to work in this area.

Besides, India needs to spruce its infrastructure and tighten the regulatory policies for promoting cancer research. There is a need to create a pool of trained manpower both in basic and clinical cancer research and multi-disciplinary collaboration between researchers and clinicians.

The National Cancer Tissue Biobank (NCTB) at IIT Madras is unique and first of its kind community-based venture in India.  Jointly funded by the Department of Science and Technology, Government of India and IIT Madras this routinely collects tissue samples from patients suffering from different types of cancers. Such kinds of banks should be expanded on a larger scale to address the challenges that are related to cancer detection, treatment and management in India.

Early detection is the key to cancer prevention. The cancer burden can be reduced through early detection of cancer. Any delay in cancer treatment can be detrimental and increase mortality. The pandemic and the lockdown that followed threw a fatal effect on cancer patients because many patients deferred their treatment and a follow-up.

A review of 34 studies published in the BMJ mentions that cancer treatment delay is a problem in the health systems worldwide. The data from the study showed that a four-week delay is associated with increased mortality and further mortality was reported for longer delays. An eight-week delay in breast cancer surgery would increase the risk of death by 17 percent and a 12 week delay would increase the risk by 26 percent.

A correspondence note by experts from the Tata Memorial Hospital titled Cancer Management in India during COVID-19 acknowledged that the pandemic created major dilemmas for providers in all areas of health care delivery, including cancer centers. The constraints created by the pandemic entailed making some difficult choices, which included drawing up prioritisation criteria to guide treatment decisions.

An editorial in the Asian Pacific Journal of Cancer Prevention maintains that the coronavirus outbreak has affected the cancer care delivery system.  There was, however, no direct evidence to support changing or withholding chemotherapy, targeted therapy and immunotherapy in cancer patients. Some patients could have switched from intravenous chemotherapy to oral drugs to minimise the risk of infection.

The flattening of the corona curve in India comes as a respite for most of the cancer patients.