Sixty eight per cent of cancer patients in India die of the disease. But the prognosis is even worse. In the next 15 years, the number of deaths due to cancer will nearly double from the present 8.8 lakh annually to 13 lakh. Also, the incidence of cancer itself is likely to go up by 21 per cent from the current 14 lakh annually to 17 lakh by 2035.
Given that at present only one third of all cancer cases are treated in the public sector, India is staring at a mind-boggling problem ahead if it doesn't take steps to improve treatment and more importantly, improve the access to that treatment, in terms of both affordability and geography.
Flagging these statistics, a department related parliamentary standing committee on science and technology, environment, forests and climate change has recommended the Mumbai-based Tata Memorial Centre's hub and spoke approach be replicated across the country. Under this approach, a regional medical centre with specialised facilities is developed as a hub for cancer treatment, while lesser specialised hospitals around it are identified as the spokes. The more common forms of cancer can be treated at the spoke centres, while the more complicated cases are taken up at the hubs.
The TMC, which is the country's oldest and biggest cancer treatment facility, has entered into a Memorandum of Understanding with the Punjab government and successfully created the hub and spoke centres in the state. It is a model that the committee recommends be replicated across the country. The committee, headed by senior Congress leader Jairam Ramesh, submitted its report to chairman of the Rajya Sabha, M. Venkaiah Naidu, on Monday. The committee was constituted to look into the expanded role of the Department of Atomic Energy, through the TMC, to look at solutions for the rising cancer burden in the country. The TMC receives an annual footfall of 5.5 lakh patients annually, which include both new and follow up cases.
Noting that the cancer treatment infrastructure in India is grossly inadequate, the committee felt that a lot more inputs have to be put in by both government agencies as well as private sector, through their CSR initiatives to address the gap between disease burden and treatment facilities in the country. According to the projection, if a hub can take care of four crore patients, and one spoke can handle between 50 lakh to one crore cases, India needs to develop 30 hubs and 130 spokes across the country. This means augmentation of infrastructure in hospitals identified as hubs and spokes. The committee was particularly concerned about the incidence of cancer in the north east, which is much higher than the national average, and where, due to poor access to treatment, the burden is much higher. It mentioned a heat map prepared by the TMC on the patients coming to its centre and noted that patients from distant lands like Arunachal Pradesh also headed to the centre in Mumbai. Traveling so far for treatment impacted incomes of entire families. Indeed the TMC report actually says that despite Ayushman Bharat, in the last year, two thirds of cancer cases were still treated by the private sector. The report states that six crore Indians are pressed below the poverty line due to the “catastrophic healthcare related expenditure on cancer”.
The report says that with an expenditure of Rs 650 crore to set up each hub and Rs 120 crore as annual recurring expenses, India needs to spend Rs 13,000 crore over 12 years to develop all the hubs. Similarly it needs to spend another Rs 22,000 crore for developing the spokes over the next 12 years. It recommends that TMC, under DAE, be tasked with setting up the national network of hubs and spokes. Similarly, the panel noted that there are only 500 institutes in the country offering radiotherapy, and only 700 radiotherapy machines in the country. The need is for a minimum of 1,200 machines. It, therefore, felt that the approach to dealing with the burden of cancer needs to be multi-pronged, encouraging indigenous technology, as well as Made in India initiatives, while at the same time, getting collaborations between private and public sectors.
