GI and Breast cancer: Latest advancements
I think the latest advances in both, GI and Breast cancer, the overall outcome has improved significantly over the last five years. This is related to quite a few things, it is related to escalating care in some patients and de-escalating care in some patients. By de-escalating, I mean that we now are able to look at the cancer deeply at a gene level and see that which patient needs more treatment and which patient needs less treatment. I think that is better for quality of life as well and also for cancer survivorship for our patients. The patient reported outcome measures I think are a huge breakthrough, they don’t cost much. Drugs may lead to survival benefit but the patient reported outcome may also lead to survival benefit.
The other thing which has been a major breakthrough is the number of new drugs that have come about for both GI and breast cancer. The challenge that we have in India is that most of these drugs are either not accessible or too expensive. So I think we need to do something to try and bring the costs of these drugs down. Also as a medical community we need to make sure we get the drugs approved which actually makes a difference to the patient. And only two things make a difference, better quality of life and living longer. So if the drugs do not do that, I don’t think they should be approved. So we need to set the bar higher for approval of drugs.
Cancer care in UK and India
Having spent two decades in the UK and also been associated with some major cancer centres in the country, worked in both the private and public sector. I feel that the care is being delivered at an exemplary level both in the UK and India. What, in India, we lack is peer review and constant delivery of care for every patient at every level because we do not have universal health coverage. The UK as a country has universal health coverage, so every patient gets the best treatment. What attracted me to the UK was the transparency and the accountability within the system and adherence to guidelines for each and every patient. The site specific oncology, The Royal College of Physicians does not allow you to treat more than two to three types of cancer so automatically you become a world expert or authority in that.
There are challenges in the West as well, in the delivery of care but overall I feel that in India we can learn a lot by trying to bring some of these qualities that are present in the National Health Service. Main thing would be universal health coverage and transparency and accountability in our system. If we do not know what our benchmark is, how are we going to improve upon it?
We have a National Cancer Registry which covers only 10% of the population. But in the UK, we know what the outcomes are, I know what the five year cancer survival rate for breast cancer is, it is about 85 to 90%. In India based on silos of reports that we have had, the five year survival rate in the North East is 25% whereas it is 60% in the rest of the country. Huge disparities in the delivery of care within the country. Also within the country we have huge disparities between centres of excellence vs. a centre which is in a tier two city. So I think we need to be learning from every patient that we treat so each cancer centre has to have a mandate to deliver certain key deliverables and matrices to be called a cancer centre.
Funding structure in the UK is fantastic because the National Health Service is funded by the Government, the research is funded by the Government, you know research cures cancer. We do research in India which is specific for our patients to be able to learn and improve our cancer outcomes. The funding has to increase for the healthcare within the country, the amount of GDP we spend on healthcare is minuscule compared to what other countries spend.
I realise that the Human Development Index in countries like Sri lanka and Bangladesh is better than ours. So you know which is very sad and we really need to do something to increase funding not just for service but we have to do it for service, education and research. Because all three will have to go hand in hand and in parallel. I strongly feel that we need a National Cancer Director who will drive all of this across the board.
Need for screening in villages
70% of our countrymen live in the villages and we have to try and shift the needle to early diagnosis. We have to diagnose cancers early and we can only do that if we do some sort of screening like clinical screening in the villages. The government has actually started an initiative, you know they do clinical screening for breast, cervix, head and neck cancers for anybody who is above 30 years of age.
I think this needs to be filtered down at a PHC level, community health centre level and the people who can do this are Asha and Anganwadi workers. I have worked very closely with them, we train them actually through my charity NICCI (New India Cancer Charity Initiative) where we would give them a questionnaire because they go to everybody’s house. We did a cap study, knowledge, attitude and practices study to find out what people are actually eating and what their habits are.
I feel that we have an amazing system in place with the Panchayats with the Gram Pradhan and the PHCs. We can utilise the system we already have, I know they are overburdened with the immunization schedule. By giving them a small incentive which I was able to do with once a month training sessions, one can actually work with them to diagnose cancers early by training them to give a clinical examination and by talking to them about early signs of cancer because that would actually increase the awareness amongst the people in the villages as well and we can diagnose cancers early.