Opinion Cancer cases are growing – India’s health agenda can’t ignore that

So, let me do that. India is undergoing an epidemiological transition — non-communicable diseases (NCDs) like diabetes, hypertension, kidney disease and cancer have overtaken the infectious disease burden. There are almost 1.4 million new cancer cases, expected to rise to two million by 2040. Cancer is the third-largest cause of death in our country after cardiovascular disease and chronic respiratory diseases. It is diagnosed very late in India, which is why only 30 per cent of cancer patients survive five years after diagnosis. Cancer is not treated in most district-level hospitals, and often cancer patients and their families sell their homes, lands and assets to come to cities for treatment. There aren’t enough radiotherapy machines, trained technicians, oncologists or cancer nurses in India. Our cancer patients struggle to get adequate palliative treatment when they are sick. At the governance level, cancer is clubbed with diabetes, heart disease, and stroke vying in a common programme that gets only 20 per cent of the health expenditure despite being the cause of 60 per cent of all deaths.

The idea behind writing this article is not to alarm or scare but to highlight the work that is cut out for us. Environmental factors, lifestyle changes, dietary preferences, and genetics are playing a part in the rising cancer epidemic. But there are preventable causes of cancer that we need to talk about. Almost 40 per cent of cancers in India are due to tobacco, 20 per cent are due to infections and 10 per cent are due to factors like poor diet and no physical activity. India has a screening programme for oral, breast and cervical cancer, but the current screening rates are less than one per cent. Thus, the media and civil society must create awareness and generate demand for cancer screenings. We need campaigns to reduce stigma and dispel myths about cancer. We need to reiterate that cancer is not a death sentence and the cancer treatment available in our country is among the best in the world.

In the recently concluded World Oncology Forum, 2023 at Ascona, Switzerland, cancer experts across the globe spoke about how far the global cancer community has come with regards to cancer — cancer awareness is increasing, vaccines against HPV and Hepatitis B are showing results, international initiatives on breast cancer and cervical cancer are making an impact, but there are several roadblocks. Most importantly, cancer has an equity problem. Gender, education levels, race, sexual orientation, socio-economic status, and urban-rural residence play a part in determining outcomes. For example, according to the International Agency for Research on Cancer, the survival rate for a cancer patient in Europe and North America is 90 per cent, in India it is 60 per cent and in South Africa, it is only 40 per cent. More money is being spent on new cancer drugs that show marginal results while essential cancer drugs are inaccessible in low and middle-income countries (LMICs) where 70 per cent of cancer deaths occur.

But many initiatives from India’s own Tata Memorial Centre are providing solutions to challenges in India and beyond to high-income countries and low- and middle-income countries (LMICs). A recent paper on a pool-procurement initiative of National Cancer Grid, a network of more than 250 cancer centres in India, helped reduce the prices for cancer drugs by 82 per cent. Another paper by the institute showed how 1/10th of the recommended dose of the immunotherapy drug nivolumab is also effective for advanced head and neck cancer. Further, models like the District Cancer Care Programme, by oncologist Dinesh Pendharkar, operational in nine states, can be scaled up so that cancer patients can be treated for free near their homes, saving enormous time and money.

Already with the launch of Pradhan Mantri Jan Arogya Yojana, which provides free health insurance up to Rs 5 lakh to households below the poverty line, a large number of cancer patients can now seek treatment. But we have a long way ahead. A study of 12,000 patients in seven centres showed that despite the scheme, cancer patients end up paying Rs 331,177 (US$ 4,171) per year in out-of-pocket expenses mostly for diagnostics and medicines in outpatient expenses, not covered by the scheme.

Cancer champions like Magsaysay winner Ravi Kannan and M R Rajagopal of Pallium India show the difference humane and empathetic care can provide. Kannan’s work showed the importance of looking beyond just medicine to help cancer patients by providing food, lodging, free treatment and ad-hoc employment for caregivers while Rajagopal’s work created a cadre of community volunteers who ensure anyone with palliative care is attended to.

We need similar initiatives by the government and civil society that are patient-centric, decentralised and affordable to the poorest of cancer patients. We need better awareness screening and diagnostics and more healthcare funds and staff. This will happen when we change the way we address cancer as a community and group of experts. We cannot wish away the burden, we need to tackle it head-on.

The writer is an independent health journalist and was invited to cover the 2023 World Oncology Forum in Ascona, Switzerland by the European School of Oncology.