Led by the Union for International Cancer Control (UICC), World Cancer Day is observed every year on February 4 to raise awareness, improve education and catalyse personal, collective and government action to save millions of preventable cancer deaths. Further, it seeks to “reimagine a world where access to life-saving cancer treatment and care is equitable for all — no matter who you are or where you live”.
In keeping with this theme, this year, UICC has launched a three-year campaign to create more equitable access to cancer services with the theme – ‘Close the Care Gap’. In the first year — 2022-23 — the campaign is “all about understanding and recognising the inequities in cancer care around the world”.
“By 2030, it is estimated that 75 per cent of all premature deaths due to cancer will occur in low- and middle-income countries. Importantly, this care gap is not only between high- and low-resource settings. Disparities exist within most countries among different populations due to discrimination or assumptions that encompass age, cultural contexts, gender norms, sexual orientation, ethnicity, income, education levels and lifestyle issues. These factors potentially reduce a person’s chance of surviving cancer – and they can and must be addressed,” Professor Anil d’Cruz said in a press statement.
Explaining further, Dr Shilpi Sharma, Senior Consultant, Head and Neck Oncosurgery, Narayana Superspeciality Hospital, Gurugram added, “This year’s theme focuses on the inequity in the distribution of cancer care. Inequity is not just the unequal distribution of resources but unjust and avoidable differences in cancer care. These barriers could be cultural, educational, financial, socio-economic, geographical and gender or age-related discrimination.”
As we observe the day today, let’s know more about these inequities widening the cancer care gap in India.
Unavailability of healthcare workers and services
Lack of access to healthcare workers and services continues to be one of the biggest hindrances affecting cancer in the country. Highlighting the same, Dr Shabber Zaveri, Consultant – Surgical Oncology, Manipal Hospital, Old Airport Road, said, “In India, the number of healthcare providers available to treat cancer is inadequate considering the large number of cancer patients. We have only around 4000 oncologists for our entire 1.3 billion population. Most of the cancer care centres are overcrowded and patients wait for a long period to get their treatment.”
According to Dr Zaveri, this problem is much more exacerbated in rural areas. “Around 70 per cent of cancer patients live in rural areas with no or minimal cancer care facilities. Approximately 95 per cent of cancer care centres are located in urban areas. Commuting to the urban area, accommodation, and financial difficulties are the main logistical challenges faced by the rural people. Additionally, cancer treatments require multiple visits for weeks together making travel more challenging.”
The expert further stressed on the dearth of latest diagnostic techniques and treatments in India. “There’s a notable limitation as compared to the developed countries. Sophisticated treatments like radiation therapy, usage of monoclonal antibodies and immunotherapies are not affordable by many patients.”
Socio-economic factors affecting cancer care
In addition, socio-economic factors like education and financial constraints devoid many of timely and adequate cancer care in India, the experts noted. “India spends less than 2 per cent of GDP on its healthcare. Out of pocket expenditure remains the main mode of payment for more than three fourth of cancer expenditure in our country. Even though there are government centres, they are overburdened and patients have to wait for days to months before starting treatment leading to a significant delay in treatment,” Dr Sharma said.
She added: “Even though a fair number of private hospitals are providing excellent quality cancer care, these centres are beyond the reach for many because of financial reasons. People who live in rural areas or small cities have to travel for long distances to get access to basic cancer care which subsequently delays their timely treatment, making the situation even worse. Similarly, lack of education results in lack of awareness leading to delay in detection of cancer.”
To recognise these socio-economic inequities, Dr J B Sharma, HOD and Senior Consultant, Medical Oncology, Action Cancer Hospital highlighted the importance of hearing and acknowledging the impact of these factors on cancer survivors to think of better ways to deal with. “Everyone should get a fair chance to live a healthy life, have better access to healthcare especially the cancer services, no matter what their education status, financial status, where they were born, where they live, where they work.”
Covid-19 and cancer care
According to a study by Institute for Health Metrics and Evaluation (IHME), the ongoing Covid disease pandemic has certainly slowed down cancer care progress. These delays and decreases in cancer diagnosis and treatment protocols have major impacts on the lives of cancer patients. A Lancet study stated that all cancer services dropped significantly between 2020-21 in India.
“During these 2 years of the pandemic, what we have observed is that many newly diagnosed cancer patients in 2020 avoided hospital visits and thence the treatment, or shifted to alternative treatment modalities, due to the delay in the treatment they became an advanced stage and lost the opportunity of cure,” Dr Kanika Sharma, Radiation Oncologist, Dharamshila Narayana Superspeciality Hospital said.
She asked cancer patients to not abandon the treatment at any cost and get vaccinated on a priority basis unless stated otherwise. Quoting research by American Journal on Epidemiology, she said, “More people will die due to cancer than Covid in these coming years. So, the crystal clear indications are to get timely treatment with adequate safety measures for all cancer patients.”
Importance of palliative care
Experts note that palliative care — a special approach to caring for anyone with a serious illness such as cancer — can go a long way in helping cancer patients. There, however, is a lack of palliative care facilities in the country, making it another factor affecting cancer care.
Explaining the term, Dr Sharma said, “When cancer patients cannot be cured of cancer, we try to control their symptoms to improve their quality of life. This is called palliative care. This is aimed at reducing the suffering by achieving pain and other symptoms control. It is an important aspect in cancer management which is not often talked about.”
Agreed Dr J B Sharma and added, “This does not necessarily mean the last stage of the disease. The survivors, in any stage of the disease, must be supported enough to lead a quality life with minimal suffering. Even mere talking about diagnosis, treatment, prognosis, and expenses can be a part of palliative treatment.”
Despite its importance in cancer care, India is still far behind in providing palliative care to patients. “Many more professionals need to be trained in this aspect. With the increasing ageing population and increasing cancer cases a greater number of palliative care centres need to be established,” Dr Zaveri stated.
How can the cancer care gap be bridged?
Experts stressed the importance of increased investment and strengthened healthcare system by the government and policymakers. “Efforts should be made to improve cancer care access to the whole population in a uniform manner irrespective of geographical and socio-economic barriers. Simultaneously, we should work towards increasing awareness in the general public to improve the understanding of cancer so that myths, misconceptions and stigma are minimised. This eventually will percolate into prevention, early detection and timely treatment of cancer,” Dr Sharma said.
Dr Zaveri noted that most cancer patients are not covered by insurance in India, making them pay from their own savings. “Schemes such as the Ayushmann Bharat scheme and the universal healthcare insurance program are made available by the government to help people with poor economic backgrounds who require cancer care. More such schemes should be encouraged even in the public sector. It is quite important to spread awareness among people regarding these schemes so that they can get enough support and coverage for cancer care,” he told indianexpress.com.
For Dr J B Sharma, unity is the key in bridging this ever-widening cancer care gap in the country as combined efforts can play a major difference. In addition to providing financial help and spreading awareness, he also captured the need for better services and facilities. “There is a need to aim for preventive and early detection services. A less costly and more effective health network is the key! Advanced equipment for treatment and necessary drugs should be made available to all at fair costs all across the country,” he concluded.