India's cancer burden is rising rapidly, but for a majority of Indians, cancer care is inaccessible and expensive, and disease detection late. In 2022, India had more than 14.1 lakh new cancer cases and over 9.1 lakh deaths due to it, according to the World Health Organization (WHO). As per reports published in February 2024, the risk of developing cancer before turning 75 in India was 10.6%. Also, seven out of 10 cancer patients in India die due to the disease. In developed nations, only three to four patients succumb to it. The reason for such high death rates is inadequate treatment infrastructure.
In India, the infrastructure for cancer treatment is limited to just about 100 towns and cities. A major issue is that most of India's cancer patients stay in towns and rural areas, while the bulk of healthcare resources are in larger cities. In fact, 40% of the infrastructure for cancer care is concentrated in the top 10 metros. Naturally, on average, a cancer patient has to travel for six to seven hours to reach the nearest treatment facility. Healthcare experts also point out that making cancer drugs available in interior parts of the country is one of the biggest tasks for the healthcare system.
Ruby Ahluwalia, founder of Sanjeevani: Life Beyond Cancer, an organisation that provides care, counselling and rehabilitation to cancer patients, says that there is a need for a holistic support system for cancer patients. "The doctor-patient ratio is approximately 1:2,000. Primary healthcare staff at government hospitals usually have little knowledge about cancer diagnosis. There is a lack of focus on spreading awareness about prevention and early detection."
Government Hospitals Need A Boost
Government or public hospitals lack the infrastructure for cancer treatment. There are only around 5,000 beds in government hospitals for lakhs of cancer patients. It's not uncommon to see long queues at hospitals like AIIMS. As per one report, at AIIMS Delhi, of the 70,000 cancer patients who register for treatment, only 37,000 are able to avail of it. Currently, there are 25 AIIMS hospitals in the country, of which only 12 are functional.
In private hospitals, there are around 2,500 beds assigned for cancer patients. At charitable institutes like Tata Memorial, Mumbai, 70% of patients are treated free of cost or at a nominal cost. Around 65,000 patients are treated on a yearly basis here. The Centre's initiative of pooled procurement of essential cancer medicines has led to around 82% cost savings.
In all, roughly only around 30% of cancer patients are able to avail of treatment in government hospitals. The rest are left at the mercy of private hospitals, or worse, nothing. "Sadly, we still do not have sufficient hospitals in both government and private sectors to treat the burgeoning numbers of cancer patients. Many patients still have to travel to Tier-1 cities for advanced treatment. We need comprehensive cancer care centres in districts to serve the population," says Dr Aditya Kulkarni, senior consultant, GI- Hepatobiliary Cancer Surgery and Robotic surgery, Ruby Hall Clinic, Pune.
The National Cancer Grid
The National Cancer Grid (NCG) was set up in August 2012 to link cancer care centres across India. The Central government-funded NCG had the primary mandate of working towards establishing uniform standards of care across the country by adopting evidence-based management guidelines, exchange of expertise, and collaborative research cross centres. As part of NCG, modern technology-based cancer treatment is available at 298 hospitals in the country, of which only 50 are government hospitals. The rest are run by private hospitals and trusts. This network treats over two-thirds of India's cancer patients.
The Debilitating Costs Of Cancer Care
Given that a large number of patients come from economically distressed backgrounds, the cost of cancer drugs is a big deterrent to their access to high-quality treatment. As per a study, the cost of cancer treatment on average is around Rs 61,216 per hospitalisation session. High out-of-pocket expenditure can result in calamitous spending for households and can potentially push families into poverty. This is especially true in a country where a large segment of the population relies on daily wages or is part of the informal sector.
According to the American Society of Clinical Oncology Publications, approximately 40% of cancer costs are met through borrowing, sales of assets, and contributions from friends and relatives; these costs exceed 20% of the annual per capita household expenditure in 60% of Indian households that have a cancer patient.
Radiotherapy works well but is expensive. As per WHO, one tele-radiotherapy machine is required for 10 lakh population on average. As per that estimate, India should have 1,300 machines, but it has only 700. As many as 70% of cancer patients can be treated by radiotherapy. But since radiotherapy is expensive, only 20% of cancer patients are able to access it.
"The cost of cancer treatment depends on many factors, including the type of cancer, the stage of disease and the treatments needed. Advanced treatments like cyber knife radiosurgery or robotic surgery are costly, as are newer chemotherapy agents," says Dr Kulkarni.
As Ms. Ahluwalia rightly points out, "Cancer is a diagnosis that opens up multiple fronts for a patient. All of them need to be addressed for the cancer experience to become easier. Medical treatment is just one of the tools required by a patient to get cured of cancer."
In AIIMS and other government hospitals, the waiting period for patients has to be reduced. Treatment of patients needs to be prioritised based on the seriousness of their condition. Experts recommend establishing cancer care centres instead of cancer hospitals as they have specialists to address all fronts a cancer patient faces. Controlling the cost of cancer drugs and equipment, public-private partnerships in treatment and research, and addressing manpower shortages at primary health centres in villages and district headquarters, are some immediate steps that the Central and state governments have to take to arrest the tide.
(Bharti Mishra Nath is Contributing Editor, NDTV)
Disclaimer: These are the personal opinions of the author