There are less than 1,600 cancer specialists in the country to treat an estimated one crore cancer patients, and the situation is likely to worsen with an expected 20 per cent jump in the number of cancer cases by the end of this decade, according to government data and prominent doctors’ associations.
The doctor-patient ratio gap is unlikely to be corrected any time soon unless dramatic measures are taken since many of these specialities are relatively new and the number of seats in these superspecialities is limited. Gynaecological oncology for example sees only one new specialist every year. There are only four seats in DM paediatric oncology approved by the Medical Council of India and six seats in DNB paediatric hemato oncology run by the National Board of Examinations (NBE).
The statistics are particularly alarming given that the National Health Profile released recently by the Union Health Ministry predicts that by 2020, India will have a more than 20 per cent spike in cancer cases, with the increase being higher in women than in men. The National Health Profile predicts that the total number of male cancer patients will jump to 6,22,203 in 2020 from the current 5,22,164. The number of female cancer patients will touch 6,98,725 by 2020 from the present 5,64,619.
While India has a shortage of medical personnel in general, the gap in the number of oncologists, experts say, is relatively bigger and India has a tough battle on its hands if it needs to meet the optimum of one cancer specialist for every 100,000 population.
“It is true that the shortage of cancer doctors is out of proportion with the shortage in medical manpower in other specialities. There are some 1,500 oncologists in India (medical, radiation and surgical). There are 50 pediatric oncologists and 30 gynaecological oncologists. Though they are not all concentrated in the metros — Nashik has four medical oncologists, Indore has five — there is no denying that there is a problem that we can only manage if we look for innovative solutions,” says Dr Purvish Parikh, director, precision oncology, at Asian Institute of Oncology, Somaiya Hospital and president of the Indian Society of Paediatric and Medical Oncology.
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Even premier cancer treatment centres in India do not have the kind of doctor-patient ratio that their western counterparts do. For instance, MD Anderson Cancer Center, Houston, USA sees the same number of new cancer patients as Mumbai’s Tata Memorial Hospital. Yet it has 250 medical oncologists in the breast cancer department whereas there are only three medical oncologists at TMH.
The challenge for India also is the fact that many of the cancer-related specialities are too new. Surgical oncology started off in 1984 at the Adyar Cancer Institute with 24 students and it was only recently that gynaecological oncology branched out as a separate discipline of its own.
“The facilities for training surgical oncologists are concentrated in a few cities — Chennai has two, Thiruvananthapuram has two, Hyderabad and Ahmedabad have one each and then of course there are Mumbai and Delhi. There are 15 centres in all and naturally treatment facilities are concentrated in these cities. It is too new a speciality, therefore, will take time to penetrate into the smaller cities,” says Dr R Rajaraman, consultant surgical oncologist at Apollo Hospital Chennai and president of the Indian Association of Surgical Oncologists.
An additional fallout of the limited training facilities in India for cancer specialists has been that many are forced to train abroad and subsequently choose to practice and settle there.
Dr Vipin Batra, executive director of NBE, admits there is an emergent need to massively scale up training opportunities and India wasted too much time waiting for a miracle that has not happened.
“There is not even a consolidated national cancer registry. A lot of cases go unreported because of lack of surveillance, making population based interventions difficult to plan. There are hotspots for cancer care in cities like Hyderabad, Chennai, Pune, Bangalore, Delhi and Mumbai but for the rest of the country, where doctors are not so easily available, preventive oncology is the only thing that can make things better,” Dr Batra says.
India has an existing programme against non-communicable diseases — the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke — that has an element of screening for cancer but the latter has been a virtual non-starter because of lack of trained personnel, say officials in the Health Ministry.
Among the innovative solutions that cancer specialists say India needs to adopt immediately are the western practice of nurse practitioners who have been trained to take a call on treatment in the absence of a qualified doctor and training the rural health workers in cancer treatment so that once a patient has undergone radiotherapy and chemotherapy at a bigger centre, care in the later phase can happen at respective homes.