The future of Oncology in India looks exciting – here is why?

India has emerged as one of the most promising destinations for affordable cancer care treatment. The Indian healthcare sector is rapidly changing and today many patients are looking at India as a destination for quality cancer care at affordable prices. This blog is my take on providing a balanced and optimistic picture of the oncology space in India.

 Introduction

 Cancer is one of the leading causes of death worldwide, with over 14 million new cases diagnosed each year. The International Agency for Research on Cancer (IARC) estimates that globally, 1 in 5 people develop cancer during their lifetime, and 1 in 8 men and 1 in 11 women die from the disease. These new estimates suggest that more than 50 million people are living even after five years of being diagnosed with cancer.

 According to the WHO, cancer has been a leading cause of death worldwide and it accounted for over 10 million deaths in 2020. Cancer mortality rates, however, have been steadily declining over the past few decades thanks to advances in early detection and treatment. In fact, survival rates for many types of cancer have doubled or even tripled since the 1970s.

However, there continue to be significant disparities between higher and lower-income countries, with GLOBOCAN 2020 predicting that countries classified with "Low or Medium Human Development Index (HDI)” will have the greatest relative increases in cancer incidence by 2040. At the same time, socially disadvantaged population sub-groups — particularly those living in Low and Low Middle Income Countries (LMICs) — experience poorer health which includes higher proportions being diagnosed at an advanced stage, poorer access to effective and affordable treatments, and lower survival rates. These disparities extend across the whole cancer care continuum, from prevention to diagnosis, treatment, survivorship and end-of-life care. The reasons for this are multifactorial, ranging from socio-cultural acceptance and beliefs, poorer awareness, access to necessary diagnostics, lower spending capacity and provider-related factors; in particular, weak and fragmented healthcare system, lack of organised referral systems, uneven distribution of resources and variation in availability of adequate healthcare professionals, contributing to poorer outcomes. Furthermore, socio-economically disadvantaged cancer patients in LMICs, and their families, are at risk of further impoverishment due to catastrophic out-of-pocket healthcare costs and lost productivity, forcing them to divert resources from other areas, including their children’s education, further trapping them into a cycle of poverty. With increasing life expectancy, the incidence of cancer in these populations is only going to increase. In fact, the current trends show that LMIC cancer related mortalities are going to overtake those in the developed countries in this decade itself. Although India does fall in the LMIC group, the landscape of oncology care in India is rapidly changing.

 The Indian Government’s investment in cancer care

 The government of India has made a significant investment in cancer care, with the goal of making India the best destination for cancer care. The government has committed to investing $1 billion over the next five years to improve cancer care infrastructure and access to care. The National Cancer Control Program had initially invested in 5 Regional Cancer Centres (RCC) for 5 regions for India. Now this has expanded to 28 RCCs and the government has ambitious plans of establishing 49 more in the next 3 years. This would provide access to quality cancer care to the marginalised population of the country without having to travel across states to access treatment. In addition, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) started in 2018 received 4.7 Lac claims in the first year of its functioning. This constitutes 9% of overall claims and 34% of tertiary care claims in the PMJAY. The AB-PMJAY currently covers 50 Cr people (10.74 Cr families) for an amount of 5L per annum, and the government plans to cover 40Cr more people under the scheme at a small annual premium. This means that people can not only access quality care near their homes, the government pays for their treatment as well. These regional cancer centres also serve as educational institutes, where more oncologists are trained and they can then offer services in other geographies across the country.

The oncology space is also catered to by most corporate hospitals and standalone doctor-owned cancer hospitals. This ensures that no matter what the economic status of the patient, there is cancer treatment available to all. Of course, there are lacunae and differences in the expertise and quality of care. Because of lack of audit within the country, the treatment standards vary. While apex institutions like Tata Memorial Centre has made efforts to provide and promote evidence-based guidelines for cancer treatment in the Indian context, the adoption of these guidelines is not necessarily the same across the country. Having said that, given the size and regional differences in the country, the efforts made by the government and private sector to address cancer care are commendable.

 Why is the Indian Oncology space exciting?

 ·        Infrastructure: India has some exceptionally well equipped cancer centres offering state-of-the-art treatment at a fraction of the cost of developed countries. In addition, many Indian hospitals have tie-ups with leading international hospitals, which ensure that patients receive the best possible care.

·        Availability of trained healthcare personnel: India has a large pool of highly skilled medical professionals, including medical oncologists, cancer surgeons, radiation oncologists, interventional radiologists, palliative care specialists, etc. India also has a large number of cancer patients, so there is a great deal of experience in treating the disease.

 ·        Cost of treatment: The cost for procedures like surgeries, radiation and chemotherapy is much lower in India compared to developed countries due to the availability of a large pool of trained oncology professionals and nursing personnel.

·        Availability of affordable medicines: India is one of the largest manufacturers of quality medical oncology products in the world. India houses the second largest number of USFDA approved plants in the world, outside of the USA. Many Indian pharmaceutical companies produce generic versions of expensive cancer drugs that are available at a fraction of the cost compared to developed countries.

·        Work ethic: The Indian medical teaching program is a grueling one, where all healthcare professionals work ceaselessly towards patient care, without having a rigid fixity towards working hour regulations. This makes us exceptionally hard working and resourceful work force that delivers quality results even in resource challenged environments.

Conclusion

When it comes to cancer treatment, India does not trail behind. Most cancer facilities in the country offer treatment choices comparable to those offered by most developed countries. Cancer therapy is also substantially less expensive in India as compared to other countries. Most cancer hospitals in the country offer all of the therapies indicated by the NCCN (National Cancer Co-Operative Network), adhering to all of the NCCN criteria. There are a number of world-class hospitals to choose from. Considering all of this, the future of cancer therapies in India looks luminous; an area where we can improve is research. With most of the focus being on providing care at low cost, the resource and capital intensive part of oncology - research - suffers and this is one area where we as an oncology community need to focus our energy on.