Manikandan Bala, Senior Vice President, TIMEA & Asia Pacific, Direct Sales Strategies & MD India & SA, Elekta in an interaction with Kalyani Sharma highlights that India urgently needs to strengthen its infrastructure for cancer treatment by maximising the adoption of precision radiotherapy technology across the country to effectively manage the country’s rising cancer burden
What is precision radiotherapy? Why it is the need of the hour?
Radiotherapy is one of the most critical treatment options available in cancer care management alongside surgical and medical oncology. The discipline of radiation oncology has existed for decades, only getting better over time. The ‘precision’ in radiotherapy is an outcome of the advancements achieved through innovation in technology. If I could broadly categorise, radiation therapy has two primary goals: to deliver the clinically planned dose at the targeted tumour in the most effective manner and to protect the organs at risk around the tumour.
This is why precision is key. Any compromise could have a direct impact of the desired outcome. Over the years, improvements in treatment planning systems and equipment capabilities have enabled the care givers to accurately define target volumes and deliver planned doses with sub millimetre accuracy.
Let us understand some of these advancement with practical examples. During the course of treatment delivery, the patient is expected to remain still. Now breathing is an involuntary bodily function that tends to move the tumour with each inhalation and exhalation, very realistically interfering with the radiation target. This puts the surrounding organs at some risk. With advancements such as Active Breathing Coordinator, we are able to address this challenge with great efficiency.
Today we are at a point where we can, with diagnostic clarity, in real time, track the tumour while the patient is being treated and adapt the treatment on requirement. This is now possible through technology like Elekta Unity, our MR-Linac. As recently as five years ago this was unheard of as the technology simply didn’t commercially exist. We are working tirelessly with our clinical partners to make this possible and make it available to our community across the country. In the next couple of months, we should have our first system up and in service to the nation.
What according to you are some of the prevalent challenges in India’s overall cancer care infrastructure?
The distribution of radiotherapy machines per million population in India is very low, at less than 0.5 per million. In contrast the developed countries have 4 per million. That’s a staggering 8-fold disparity. To further add to this disparity, while most of the India population lives in rural India, the concentration of these facilities is around the urban cities. For most patients, the treatment is still out of pocket. All these add up to the challenges of availability, accessibility, and affordability.
Then there is the lack of trained manpower to operate these machines as we move into interiors of this vast country. What does this mean? There are not enough treatment centres to cater to our population’s requirement. If one needs care, they will need to travel long distances to receive their treatment adding significant physical, emotional, social and economic pressure on the patient, as well as his/her family. The lack of trained manpower could have a direct implication on the treatment outcome.
These are some of the core challenges. The other challenges are to do with data and informatics. Availability of actionable data, consistency in data, ability to integrate with registries and use of it to build predictive models.
India urgently needs to strengthen its infrastructure for cancer treatment by maximising the adoption of precision radiotherapy technology across the country to effectively manage the country’s rising cancer burden.
What measures has Elekta taken towards strengthening the cancer care ecosystem?
We are working closely with the government on public-private partnership (PPP) projects at government facilities to enable affordable clinical excellence and cutting-edge technology access closer to patient’s homes. Basis our observations, a large majority of the existing technology available in India was primarily designed keeping the developed markets in mind. Hence, while advancing cancer care technology solutions in India, we are ensuring collaboration with clinicians and partners to continuously develop innovative, outcome-driven and cost-efficient solutions that are in sync with the on-ground requirements.
Last year, we also launched our strategy, ACCESS 2025, with a vision where everyone has access to the best cancer care. Through this strategy, we intend to scale-up access to precision radiotherapy, enhance clinical decision making via analytics, and build a seamless cancer care experience for patients.
Innovation holds the key to enhance the cancer care ecosystem. In line with this, through our comprehensive digital solutions suit, we can streamline actionable data integration & collection, run predictive analysis, enable framework to integrate with cancer registries and enhance patient centricity. Our AI based solutions can also predict any potential machine breakdowns and proactively either digitally solve the issue or in some cases assign service personnel to the hospital even before the systems fails. These are some measures we’ve taken to ensure the sustainability of the cancer care ecosystem.
We have leveraged technology to provide cloud-based centralised planning systems. What this means is that whether you are in a tier 3 city or a metro, the treatment delivery plan quality remains the same.
Taking into account the lack of skilled man power, there is a need for consistent up-skilling initiatives for field professionals to be aware about the latest innovations and best global practices. We are closely engaging subject matter authorities to regularly run such online programs to encourage knowledge sharing within the industry professionals, facilitating continual learning and up-skilling.
Essentially, in order to strengthen the overall cancer care ecosystem, it is critical to focus on some key areas like access, innovation, digital infrastructure, and up skilling.
How do you look at India’s present and future cancer care infrastructure?
While the government is driving commendable initiatives, which have led to improvement in cancer care, programs and policies built on strong public health paradigms must be implemented in order to close these gaps in the system. Upgrading existing resources and expanding the number of cancer centres can be effective in India. Undoubtedly, a comprehensive approach is the need of the hour to address not only present but also future challenges involving cancer care in India. On the other hand, by increasing the adoption of modern, precision radiotherapy technology, it is also possible to shorten treatment times, address hard-to-treat cancers, and if scaled, also reduce the cost of treatment. At Elekta, we are committed towards building hope for those with cancer. Collective and targeted efforts synergising government, policy makers, private players, and civil society is essential to ensure prevention, early-stage detection and equitable access for cancer care in the country.
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