It's not just the spectre of developing cancer itself which is scary for India; it's state of cancer care in the country that is more ominous. And there are reasons to feel scared, outlines a major study on cancer care in India that is being released on Saturday.
One of the reasons for the excessive burden of deaths from cancer in India is the existence of huge gaps between the demand and supply for cancer care: 95 per cent of the medical colleges in India do not have comprehensive cancer care services comprising surgical, medical and radiation oncology departments in the same campus.
Currently, there are only 2,000-odd medical and radiation oncologists in India – one per 5,000 newly diagnosed cancer patients – and in almost all remote or rural areas even the most basic cancer treatment facilities are non-existent. As a result, urban cancer centres are overcrowded and under-resourced, leading to long waiting times, delayed diagnoses, and treatment that comes too late for many patients.
The Lancet Oncology three-part Series "Cancer burden and health systems in India and Commission Challenges to effective cancer control in China, India, and Russia" will be presented at the ongoing 6th Asian Oncology Summit and 10th Annual Conference of the Organisation for Oncology and Translational Research, at Kuala Lumpur, Malaysia.
Breast cancer is the most common cause of cancer deaths overall, and the most frequently diagnosed cancer in women, accounting for more than one in five of all deaths from cancer in women. Fewer than 30 per cent of cancer patients in India survive for more than five years after their diagnosis, and given limitations of data, the true proportion could be lower than this. About 40 per cent of all cancers in India are attributable to tobacco.
Although India has a relatively lower incidence of cancer (around a quarter of that in the US or Western Europe), the rate of deaths from cancer, adjusted for age, is similar to that in high-income countries. Every year, around one million new cancer cases are diagnosed and around 600,000-700,000 people die from cancer in India, with this death toll projected to rise to around 1.2m deaths per year by 2035.
Less than a third of patients with cancer in India currently survive for more than five years after diagnosis. Over two-thirds (71 per cent) of deaths from cancer in India are in patients aged 30 to 69, in their prime productive years, meaning that the disease already has a huge negative economic impact on the country – not only due to the high costs of treating cancer, but also due to the costs of lost productivity through illness and premature death.
Moreover, very low levels of public funding for healthcare in India mean that more than three quarters of cancer costs are paid out of pocket directly by the patient or care givers. While medical insurance schemes have been expanding in recent years, these schemes were not designed to address the cost and complexity of treating cancer, and there is a pressing need for insurance schemes that cover the financial burden of cancer adequately. Furthermore, there is big regional imbalance in cancer care facilities and numerous patients from northern, central and eastern regions of India have to travel very long distances to the south or western regions along with their care givers and live under very harsh conditions for many months, adding to the high mortality and financial bankruptcy.
What experts say
Prof Mohandas Mallath, Tata Medical Centre, Kolkata
Lead author of the Lancet Paper on delivery of affordable and equitable cancer care in India
The need for political commitment and action is at the heart of the solution to India’s growing cancer burden. The extent to which death and illness from cancer will actually increase in the next 20 years will depend a lot on the investments made in future decades in tobacco control, healthcare delivery, cancer research, clinical trials, and increasing the public awareness as to how we can all help to reduce the risk of cancer by eliminating risky behaviours such as smoking, vaccinating those at risk of cancer causing infections and following a healthy diet and lifestyle.
Dr Vishal Rao US, Director, Cancer Prevention Project, Institute of Public Health (IPH)
The ratio between the number of cancer specialists to patients is very high. There are no specific-cancer statistics for India, just rough estimate. As per the Cancer Registry Programme, Karnataka has about 1.5 lakh cancer cases at any given time in and about 35,000 new cases every year. About 80 per cent of the patients belong to rural and semi-urban regions. Since they do not have specialist hospitals in their areas they come to cities. The National Cancer Control Programme which is concentrated more on urban areas needs to change its vision. The government should come up with India-specific solutions with a focused vision and stress on clearing the rural cancer cases.
Delivery of affordable and equitable cancer care in India
- More than three quarters of cancer expenditures in India come directly out of patients’ pockets, leading to catastrophic health expenditures with a cancer diagnosis. India must urgently tackle financial protection of its citizens through a variety of fiscal tools and measures.
- Most (92%) patients from rural households in India first present with cancer to private practitioners, over three quarters (79%) of whom have no medical qualifications
- While medical insurance schemes have been expanding in recent years, these schemes were not designed to address the cost and complexity of treating cancer, and there is a pressing need for insurance schemes that fully cover the financial burden of cancer
- India needs to provide affordable and equitable cancer care to all of its citizens; this means training sufficient healthcare professionals, providing proper publicly funded facilities and ensuring insurance schemes for the most vulnerable in India – the poor, children, women and the elderly.
- Quality of care needs to be better regulated with established metrics for evaluation, both in the government and the private sector.
