Authors: Dr. Sandeep Bhalla, Associate Vice President, ECHO India and Dr. Haresh Chandwani, General Manager of Projects, ECHO India
Cancer is a significant health issue in India, with a growing incidence of new cases and deaths. According to the National Cancer Registry Program, over 1.5 million new cancer cases are reported in India every year, with an estimated 7 lakh deaths [1] (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392737/). The most common types of cancer in India include breast, lung, oral, cervical, and stomach cancer.
Cancer diagnosis and treatment in India face several challenges, including inadequate healthcare infrastructure, lack of awareness, and limited access to cancer care in rural areas. Moreover, the high cost of cancer treatment makes it difficult for many patients to afford quality care. According to a study, with almost 70% of the population of India residing in districts and cities lacking quality health care, the situation of cancer care is grave. India is currently equipped with only 394 RTU (Radiation Therapy Units) against a requirement of almost 1300 RTU, amounting to 0.38 RTU per million population as per World Health Organization. [2] (https://ascopubs.org/doi/abs/10.1200/jgo.18.86000)
To tackle the cancer burden in India, several initiatives have been launched by the government and non-governmental organizations, including cancer screening programs, awareness campaigns, and the establishment of cancer centers in different parts of the country. However, there is still a long way to go to ensure access to quality cancer care for all Indians.
Catalysing conversations to enhance cancer care
With an aim to identify critical gaps, and challenges in the field of cancer care and their potential remedies, ECHO India organized a nationwide symposium on oncology named - 'Reimagining New Horizons in Improving Cancer Care' on April 5, 2023.
The symposium brought together a diverse range of participants, including policymakers, renowned oncologists, experts, professionals, and stakeholders from across the country. This inclusive gathering provided a unique opportunity for policymakers to interact with leading oncologists and engage in discussions aimed at improving cancer care.
Dr. Sudarsan Mandal, Deputy Director General for Non-Communicable Diseases at the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, delivered a keynote address where he discussed the global burden of cancer. He emphasized the prevalence, incidence, and mortality rates of cancer globally and in India, as well as the various causes of this disease. Dr. Mandal also informed the audience about the inclusion of cervical cancer vaccination in the Universal Immunization Program.
Furthermore, Dr. Mandal shared that India has implemented various measures for the prevention and management of cancer. The implementation of population-based screening of common cancers, such as oral, breast, and cervix, under the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS) has been a significant step in this direction.
Dr. Mandal highlighted the mission mode approach to raising awareness for the prevention and control of non-communicable diseases (NCDs) and promoting a healthy lifestyle at all levels, including national, state, and district levels through NCD clinics and primary healthcare centers. The service delivery under Ayushman Bharat Health and Wellness Centres also includes the management of common NCDs, including common cancers such as oral, breast, and cervical cancer.
One of the key themes that emerged from the panel discussions at the symposium was the need to develop holistic cancer care infrastructure that not just treats the physical ailment but also addresses the emotional, and spiritual aspects of a patient to promote healing and improve their quality of life.
Another significant issue raised during the conference was the knowledge gap at all levels of the healthcare system, including primary, secondary, and tertiary care, which is a major reason for the high rates of cancer-related mortality and morbidity. The panelists emphasized the need for equal emphasis to be given to the capacity building of clinicians across preventive oncology, medical oncology, radiation oncology, and surgical oncology to address the cancer burden of India.
The symposium also highlighted the need to adopt a collaborative approach between government, non-government, and academic institutions to address the challenges related to cancer care. With the rapid pace of ongoing research, technological advancements, and the development of new treatments in oncology, healthcare professionals need to stay up-to-date with the latest information and guidelines. The panelists encouraged ECHO India, owing to its vast network and the proven effectiveness of the ECHO model, to support capacity-building programs on various aspects of oncology.
Panelists also emphasized the need to strengthen the primary and secondary healthcare systems of the country on basic elements of cancer care, which can promote early diagnosis, basic treatment, and early referrals to minimize advanced-level cases of cancer and reduce the burden on tertiary care centers. The oncologists acknowledged the importance of family support, survivorship, and patient navigation programs in reducing the cancer burden of the country. Experts highlighted that the lack of healthcare workers in the field of oncology can be addressed by building the capacity of various non-cancer healthcare cadres on cancer screening, patient care, and support.
ECHO India: Strengthening Cancer Care System through Partnerships and Innovations
To effectively bridge the skills gap and ensure access to specialized knowledge, the ECHO Model of capacity building emerges as a powerful tool. By leveraging this model, specialist knowledge can be democratized, particularly in the context of screening for prevalent cancers such as oral, breast, and cervical cancers. Additionally, the ECHO Model can play a crucial role in addressing the escalating burden of oral cancer through tobacco cessation programs, given that tobacco usage contributes to a staggering 95% of oral cancer cases.
ECHO India has proactively established strategic partnerships with esteemed government organizations like the Indian Council of Medical Research - National Institute of Cancer Prevention and Research (NICPR), renowned for their expertise and research contributions in the field. Furthermore, key private organizations such as CanSupport, and CanKids, have also joined forces with ECHO India, collectively working towards the shared goal of advancing cancer care and support services.
Virtual Tumour Board (VTB) Program
ECHO India has also forged a significant partnership with Tata Memorial Hospital in Mumbai, a prestigious institution within the National Cancer Grid (NCG). One noteworthy initiative stemming from this collaboration is the Virtual Tumour Board (VTB) program, which has been conducted on the ECHO platform since 2016. This pioneering program has empowered numerous healthcare professionals, including medical oncologists, surgical oncologists, gynecologists, and pathologists, to enhance their skills and foster mutual learning.
By leveraging the ECHO platform, the VTB program has created an interactive and collaborative space for these professionals to engage in multidisciplinary discussions, exchange knowledge, and collectively develop comprehensive treatment plans for complex cases. This innovative approach has not only facilitated continuous professional development but has also fostered a culture of collaborative decision-making and evidence-based practice among the participating healthcare experts.
Through the ongoing partnership between ECHO India and Tata Memorial Hospital, the VTB program continues to drive advancements in cancer care by harnessing the collective expertise of specialists, ultimately benefiting patients by ensuring access to the most informed and comprehensive treatment recommendations.
Psycho-Oncology: Illuminating the Vital Intersection of Emotional Well-being and Cancer Care
ECHO India's commitment to strengthening comprehensive cancer care extends to the vital field of psycho-oncology, which is a key focus area of their initiatives conducted in partnership with the esteemed Adyar Cancer Institute. Through these collaborative programs, cancer care providers have been empowered to enhance their confidence, expand their knowledge base, and refine their skills in providing crucial psychological care for cancer patients.
Recognizing the significant impact of psychological well-being on overall cancer management and patient outcomes, ECHO India's collaborative initiatives with Adyar Cancer Institute aim to equip healthcare professionals with the necessary tools and resources to effectively address the psychosocial aspects of cancer care. By participating in these programs, providers gain valuable insights into evidence-based practices, communication strategies, and psychosocial support interventions that can significantly improve the quality of life for cancer patients.
The partnership between ECHO India and Adyar Cancer Institute creates a supportive environment for multidisciplinary collaboration, fostering a holistic approach to cancer care that considers the emotional and psychological needs of patients alongside medical treatments.
ECHO India’s other key partners in the cancer care space include:
Tata Medical Center (TMC) Kolkata Homi Bhabha Cancer Hospital and Research Centre Malabar Cancer Centre Paediatric Hematology and Oncology Chapter (PHO) India
PHO India and CanKids are two ECHO partners that have been predominantly working on pediatric cancer.
ECHO India's cancer initiatives have played a pivotal role in the capacity-building efforts across a wide spectrum of healthcare professionals. These programs have not only empowered doctors and nurses but have also extended their impact to social workers and specialists such as psycho-oncologists, surgical oncologists, radiation oncologists, pathologists, and gynecologists. By addressing the diverse needs of the multidisciplinary cancer care team, ECHO India has fostered a comprehensive and collaborative approach to combating cancer in the country.
The landscape of cancer care in India has witnessed remarkable progress, reflecting the nation's unwavering commitment to improving healthcare outcomes for its population. With the establishment of specialized cancer centers, the integration of cutting-edge technologies, and a growing emphasis on holistic care, India has demonstrated significant strides in the battle against cancer.
Although challenges persist, the collective efforts of healthcare professionals, researchers, policymakers, and the incredible resilience of patients and their families provide a beacon of hope for the future. Through continued investments, collaborations, and a steadfast focus on early detection, prevention, and accessible treatment options, India has the potential to further transform the cancer care landscape, ensuring a brighter tomorrow for the countless lives affected by this formidable disease.
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