Poor detection rates in major cancer sites with 29 per cent, 15 per cent and 33 per cent of breast lung and cervical cancers being diagnosed in stages 1 and 2
The reported cancer incidence in India this year is estimated to be 19 to 20 lakhs, whereas real incidence is 1.5 to 3 times higher than the reported cases as per the study by FICCI and EY on the state of cancer incidence in the country. The report titled “Call for Action: Making quality cancer care more accessible and affordable in India” suggests that India is faced with a sizeable cancer incidence burden, which continues to grow exponentially. The 2020 WHO ranking on cancer burden in terms of new yearly cases being reported, ranked India at the third position after China and the US, respectively.
In a global comparison for organ-wise incidence, the disease burden for head and neck, breast, cervix and ovary cancers in India is higher if not at par with other countries like China, the US and the UK. This is outlined by the fact that cancer of the head and neck are found to be progressing at a CAGR of 23 per cent, prostate cancer at 19 per cent, ovarian cancer at 11 per cent and breast cancer at 8 per cent which is faster than the overall growth rate of incidence. Six states, which represent 18 per cent of India’s population, have 23 per cent share of the country’s reported incidence burden and have the highest crude incidence rates. Kerala, Mizoram, Tamil Nadu, Karnataka, Punjab, and Assam report the highest overall crude incidence rates of cancers which is greater than 130 cases per lakh population.
Ashok Kakkar, Chair, FICCI Task Force on Cancer Care and Managing Director, Varian Medical Systems International India said, “For cancer prevention, early diagnosis and widespread public awareness will be integral and will serve as a beacon of light to strengthen India’s strategy for cancer care and other non-communicable diseases. While some of the most cutting-edge cancer treatment methods and technology are available in our country, we still have a long way to go before we can ensure that cancer patients from every socioeconomic background receive the best possible care.”
As per the report, cancer disease burden in India is characterised by poor detection with not more than 29 per cent, 15 per cent and 33 per cent of breast lung and cervical cancers being diagnosed in stages 1 and 2, respectively. Late-stage detection coupled with sub-optimal access to quality cancer treatment at affordable prices significantly impacts the outcomes for this disease in the country. As incidence rates continue to rise, deaths due to cancer has remained among the top 5 causes of deaths in India over the last decade. Estimates indicate that the total deaths owing to cancer have been ~8 to 9 lakh in 2020, causing the mortality to incidence ratio for different cancer types in India to be among the poorest compared to global counterparts. The sub-optimal access to quality cancer treatment often results in delayed access to care as is corroborated by a recent patient survey which highlights that 51 per cent patients take more than 1 week to conclude diagnosis and 46 per cent patients take second opinion due to lack of confidence in initial diagnosis and suggested treatment.
Srimayee Chakraborty, Life Sciences Partner, EY India said “To address the dual challenge of rising incidence and sub-optimal mortality to incidence ratio, it is imperative to drive mass awareness campaigns, focus on effective prevention and enable improved screening coverage as a primary response. Following this, the key is to tackle the disease the right way, the first time and at the last mile through a comprehensive approach that keeps patient at the core and is powered by multi-stakeholder partnerships, frugal innovation by providers and progressive policy measures underpinned by technology.”
Awareness and prevention: The report cites that only 43 per cent respondents in India indicated that they were concerned or somewhat concerned about developing cancer in their lifetime compared to a global average of 58 per cent.
Tobacco prevalence among adults: Tobacco usage is the cause of 30 per cent cancers in the country and despite relatively high awareness compared to other risk factors, its usage continues to be a major public health challenge in India. Several measures need to be taken by the government to limit tobacco usage like increasing taxation, evaluating a gradual ban on smoking in public places and other legislations to prohibit the long-term sale of tobacco.
Raj Gore, Co-Chair, FICCI Task Force on Cancer Care and CEO, Healthcare Global Enterprises Limited (HCG) cited “To make cancer care more effective and affordable for the entire population, we must improve workflow efficiency and treatment outcomes. Using its trademark ingenuity and frugality, India has an opportunity to find innovative solutions to bridge the existing care gaps for her citizens and to guide other developing and developed nations.”
The report also cites that there is a low population coverage (<2 per cent in India) for cancer due to lack of awareness and screening. Despite proven benefits of early identification, screening penetration in India is very low at less than 5 per cent with oral cancer as low as 0.2 per cent of the population. This calls for a quicker roll out of Health and Wellness Centres in the country which are staffed adequately with trained manpower, investment on continuous knowledge upgradation of Medical Officers and General Physicians on benefits and methods for screening, strong gate keeping mechanisms to ensure referrals are managed as well as creation of standard technology platform to maintain patient records on screening and treatment. Learnings from the latest experience of Arogya Setu and CoWIN can well be leveraged to make this a success.
Low density of comprehensive cancer care centers and radiotherapy (RT) equipments coupled with constraints in availability of oncologists – Only 175 districts out of more than 600 districts in the country have a comprehensive cancer centre and the country has only 0.4 million RT equipments as compared to WHO norm of 1 million RT equipments per million. Access to specialized care of oncologists is severely constrained in India with incidence per clinical oncologist (medical and radiation oncologist) at 315 compared to 120 in China and 137 in the US. Adoption of a distributed hub and spoke cancer care model in the country with mandatory inclusion of cancer program in all government and private medical colleges and select district hospitals will be a key to providing access in the country. This needs to be supplemented with investment subsidies such as Viability Gap Funding to attract private investment in capacity creation
Also given that the financial burden of cancer care treatment is the highest compared to other diseases with the cost of a single cancer hospitalisation exceeding average annual expenditure of 80 per cent population in 2017, insurance will play a key role in mitigating out of pocket expenditure. While insurance is essential it is not sufficient condition for making cancer care affordable to all because without an efficient healthcare system no economy can afford sustainable healthcare funding. Therefore, cost effectiveness catalysed by a culture of continuous improvement mindset, will be an essential tenet of future healthcare delivery model for the policy makers and providers. Also, it will be critical to ensure that insurance spends are rightly utilised through standardised care plans designed based on uniform treatment protocols that recognize the outcome benefits of modern and advanced treatment options available in the country.