Dr (Prof) Santanu Chaudhuri, Chairman – Radiation Oncology, Nayati Healthcare speaks to M Neelam Kachhap about the challenges in radiation oncology in India
What is the most interesting part of being a radiation oncologist?
The most interesting part of being a radiation oncologist is being associated with a branch of oncology which deals with technological advancements each day. Advancement of technology has equipped us with techniques which can treat the tumour in a targeted manner without or minimally radiating the surrounding structures or organs which are normal. This is an ever evolving speciality, developing each day.
Being a clinical oncologist, I can contribute to the non-surgical management of cancer patients. Pain and palliation is also an important area of my practice. Nayati Multi super Specialty Hospital, Mathura sits in a belt where we have a very high incidence of cancer. Due to poor awareness and late detection, we get more than 60 per cent of cancer in late stages. Radiation oncology plays an important role in these patients of stage 3 and stage 4, where intent radical and palliative treatment provides a good quality of life improvement.
In early stages, radiotherapy alone or in combination with chemotherapy or targeted therapies gives excellent results. In organ preservation radiotherapy can be used radical setting alone, or with combination with other forms of cancer treatment.
What challenges do you face in your everyday practice and what do you do to overcome those challenges?
Nayati Healthcare operates in tier-II and tier-III cities and towns. The main challenge that we face is lack of education and knowledge amongst the masses about cancer. In order to address this challenge, Nayati Healthcare recently unveiled ‘Hope for Cancer’. This is a unique initiative to create awareness and engage with the community to educate them on early detection and prevention of cancer. Our practice other than the main treatment includes majorly, educating the patient and the relatives about the disease, its manifestations, the treatments and the side effects. We are spreading the awareness amongst masses that if detected at an early stage and with timely proper treatment, there is hope for all cancer patients and their families. We also educate them about associated myths about cancer and its treatment.
What is new in radiation oncology in India?
The quality consciousness in our patients who are affording, has educated them enough in today’s electronic world to understand what is best for them. Patients now come to us asking for the most advanced treatments available in the world for their disease like IMRT, VMAT, and IGRT etc. For such advanced treatment techniques, highly specific immobilisation and simulation are needed. 4D CT and PET-MR Fusion have become routine in our practice nowadays.
Other than this, Stereotaxy has become clinically very useful in certain subgroup of patients. SRS/ SRT and SBRT are also being used often in selective cases of brain and body where high conformation of target area is required.
Advancement in brachytherapy including image guided (MRI/ CT) brachytherapy is also an area of high precision.
The support services in an oncology set up enumerated below are very important in order to provide a multi-modality approach to cancer management.
- Dedicated palliative medicine and cancer pain management services.
- Preventive oncology services
- Dedicated day care services
- Radiosensitisers, radioprotectors and concomittent therapies
- Biologically targeted therapies
- Multi-disciplinary Tumour Board
- Oncological emergency services
- Lymphoedema management
- Stoma clinic
- Counselling support
- Onco e-library
- Evidence-based treatment following international protocols
Is India slow to adopt new technology?
Not at all. In my career, I have travelled extensively to many internationally acclaimed cancer management centres, but of late, I see that the technological advancement and the knowledge base in India is as strong as any place in the world. It had been very fast in the last decade in selected pockets as economics plays an important role in a cancer centre setup.
You practice in a tier-II city how is that different from tier-I city?
Firstly, in a tier-II city most of the patients are those, who due to paucity of facilities used to go to tier-I cities for their treatment. Nayati multi-super specialty has reversed the trend by taking treatment to the patients. The need for cancer care and cure is nowhere greater than in Uttar Pradesh, which is faced with the challenge of highest incidence of cancer in the country and to address this challenge in a comprehensive yet humane manner; we have launched the Nayati Centre of Excellence for Cancer. Since our hospital has all specialties under one roof, cross referrals will not be a problem, as cancer patients’ issues are normally multi prong.
Secondly, in tier II cities, the awareness of the disease is poor. So the practice in addition to the treatment involves counselling and educating the patients about the disease and its management.
How do you see the field changing in the coming years?
Radiation oncology is an evolving and developing speciality, mostly due to high dependency on technological advancements. In the coming few years, from the Indian context, I think the following areas need to develop for further advancements:
- More post graduate trainings for doctors, physicists and technicians
- Technological upgradation with even more advanced technologies like Tomotherapy, Cyber-knife and proton therapy.
- Advancement in field of cancer research
- Due to huge volume of advanced cancer cases, standalone palliative care centre need to come up.
- Mobile early detection facilities have to be made available.
- Domiciliary care improvement.
- Tele networking with other major cancer centres of India and abroad.
- Technology transfer and human resource transfer programme between us and other oncology centres of excellence.
- Promote medical tourism