Renewed challenges in cancer care – learnings from the COVID pandemic

Disruptions in cancer care due to the pandemic have led to delays in screening, diagnosis, treatment scheduling and appropriate therapy services, causing disease progression and poor prognosis.

cancer, cancer patients, radiation therapy, linear accelerators, cancer awareness
Nearly 4.5 million Indians suffer from cancer and are in various stages of treatment and follow-ups, with an average of 1.5 million cases being added every year.

By Dr. Ratna Devi

Thousands of people worldwide have been affected by the coronavirus pandemic and its spread has impacted the healthcare system of nearly 186 countries.  Cancer care in India has also been significantly affected. With 95% of care centres present in urban areas and 70% of the population still living in villages, travelling for treatment has been a major stumbling block during the lockdown. As per some estimates, new consultations in cancer hospitals dropped by 49.1%, as cancer patients, being a vulnerable group, continue to be fearful of contracting the virus.

Nearly 4.5 million Indians suffer from cancer and are in various stages of treatment and follow-ups, with an average of 1.5 million cases being added every year. As per WHO’s Globocan 2020, nearly 8,00,000 deaths in India are attributed to cancer.  Cancer is the second largest cause of death in our country after cardiovascular diseases.

Disruptions in cancer care due to the pandemic have led to delays in screening, diagnosis, treatment scheduling and appropriate therapy services, causing disease progression and poor prognosis. In fact, this has set our cancer targets back by a decade and nearly 1,00,000 cancer patients per month are expected to remain undiagnosed.

As the situation normalises, we expect a surge in cancer cases, involving those who have deferred treatment or remain undiagnosed and are now at a more complex stage of the disease, placing additional strain on the cancer care system.

Fear and stigma still hinder optimal cancer care

Irrespective of the pandemic, even with a renewed focus on cancer care and screening methods by WHO, a high standard of cancer care remains significantly impeded by stigma and fear. Despite awareness campaigns, most patients who suspect cancer do not reach an oncologist on time. Breast cancer, for example, is completely curable if detected at Stage I. However, social stigma, negative perceptions of the disease and anxiety about disfigurement prevent the patient from reaching out to their family, peers or general practitioners. The fear of the treatment and its cost contribute to the patient’s reluctance to begin and sustain treatment. Due to their inability to cope, patients may turn to traditional forms of treatment and when they finally reach out to an oncologist, the disease has often progressed beyond the curable stage. Additionally, not all patients opt for specialised cancer centres for treatment, due to financial constraints or inability to tolerate the severe side effects of therapy.

As cancer treatment continues to make enormous progress, newer and targeted therapies help reduce the tumour burden without impacting the patient’s life as adversely as with earlier treatment modalities. A diagnosis of cancer is therefore no longer akin to signing a death warrant. Each type of cancer is different, each aspect of cancer care—its nature, therapy options, treatment time, cost of treatment, impact on day-to-day activities—can be thoroughly explained by the doctor/trained counsellor to ease the patient’s fears and mentally prepare them for the course of treatment and its effects. A holistic awareness programme that sets the patient’s expectations at every step of the journey is essential. Cancer patient support groups can play a huge role as they stand shoulder-to-shoulder with the patient, offering him/her both mental and emotional support.

Technological breakthroughs in cancer care

Technology has impacted every aspect of healthcare, including cancer care. Telemedicine has made digital consultations and counselling possible even in the remotest areas of the country. Moreover, virtual training helps in upskilling doctors, electronic patient records have decreased the need for bulky files, less invasive and precise diagnostic systems are easily available, remote monitoring systems have made real-time alerts and follow-ups seamless and therapy has become more precise and effective, decreasing the adverse effects. On average, 50%, 40% and 10% of cancer treatment are attributed to surgery, radiation therapy and chemotherapy, respectively, either in isolation or in combination. In India, radiation therapy is a part of cancer treatment in nearly 2/3rd of the diagnosed patients.  Precision radiation therapy with sophisticated machines such as linear accelerators has enabled targeted treatment of cancerous cells possible while protecting healthy tissue. However, the lack of skilled manpower, accessibility to and cost of these cutting-edge treatments remains a challenge.

Need for Private-Government Partnerships (PGPs)

The pandemic has exposed the lack of equitable cancer care across the country. Advanced therapies are available only at a few government-run institutions or private institutions present in urban areas. Strengthening the existing cancer care network with PGPs and appropriate policy changes is essential to ensure that everyone has access to appropriate treatment irrespective of geographic location or ability to pay. A committed and cooperative action amongst all states must be encouraged to provide the patients with requisite care, regardless of their socioeconomic status. All aspects of care such as improved screening, diagnosis and therapy must be made available not only in Tier I but also in Tier II and III cities and rural areas.

Though cancer therapy has advanced significantly, the need for a robust system that helps reduce the time from diagnosis to treatment still exists. Efforts in this direction will ensure that cancer is detected at a stage where it is largely curable. Eradicating the stigma around the condition, creating awareness and providing support via a peer network will ensure that the treatment is completed successfully. Lastly, PGPs and policy changes can improve the overall cancer care system ensuring that no patient diagnosed with cancer is turned away due to lack of affordability or facilities.

(The author is CEO, DakshamA Health, Director PAIR Academy . Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)

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