As I walk into Cytecare Cancer Hospitals in Yelahanka, Bengaluru, I was able to smell coffee. Shouldn’t I be smelling disinfectant, I found asking myself.
As I sit down with Suresh Ramu, Co-founder and CEO of this cancer hospital, I am still mulling the novel layout of this hospital. Soon, Suresh Ramu provides me a peek into why this hospital promises to “fight cancer the right way” and the minds that are helping make it a hospital with a “difference”.
Suresh Ramu explains: “Worldwide $105-110 billion was spent in 2016 on biopharma research and development. Of this, about $70 billion was spent on cancer R&D alone, which gives you an indication of the magnitude of research happening in cancer, compared to all other therapeutic areas. How much of that do we see in India, its private hospitals, cancer hospitals, the cancer departments of hospitals? Very, very little. Probably less than 1 per cent of the patients in India get to participate in this R&D. But patients who travel abroad to get treated, look for this opportunity. Cancer is a chronic disease. So you treat one cancer of a patient and cure it...there is survival for a few years. But it returns either as the same type or as a different type. So, the approach (for treatment) for the second and third time cannot be the same as in the first instance. A lot of research happening today is based on the options available for patients to participate in newer drugs or newer approaches, which we don’t have in India, or have very little of it. And to enable that, the DNA of the hospital should say ‘I need to capture that data; I need to think of what options I can give; what is the absolute cutting edge that is available for the patient.”
Throughout the conversation, he dwells passionately on the importance of research and data culled from it for the right treatment of patients in India. For, “Indian (cancer) patient data is quite different to the US (cancer) patient data. If we do these studies, we would be able to customise the treatment.”
This passion for research stems from his decade-long stint with Quintiles Transnational, where he was V-P and Head – India, for Clinical Development, managing all aspects of clinical trials in India.
The 150-bed Cytecare Cancer Hospitals, which completes one year of its existence in November, has already treated over 2,500 patients. And stories of very satisfied patients are many.
Suresh Ramu says that Rs 150 crore has already been invested through private capital (HNIs, family offices and “some of us”). “These are people who understand healthcare, who understand research.” All investors are long-term players, and are not looking at Return on Investment (RoI) immediately, he pointed out.
Hub-and-spoke model
The company plans to grow through the hub-and-spoke model, setting up four-five hubs and some sub-centres which will cater to continuity of care. For instance, patients could get, say, chemotherapy or follow-up, from these sub-centres without having to travel to the main hospital. For hubs, it is looking at Pune, Chennai, Gujarat, and the East, “which has a lot of demand”. For sub-centres outside Bengaluru, it is looking at Tumkur.
“We will raise subsequent rounds of funds for the next hubs.”
Suresh Ramu shares an interesting incident, when the idea of setting up this hospital with a “difference” received a boost; a radiation oncologist from the US who visited the hospital in its initial days liked the idea so much that he promised – and invested – half-a-million dollar without even being asked to invest!
According to Suresh Ramu, cancer treatment has come a very, very long way in the past 40-45 years. But in India, the metrics of the outcome of cancer treatment – that is, overall survival and progression-free survival – are much worse compared to the developed countries, even though India has access to the right expertise, and technology.
Organ site approach
“We miss certain things in terms of ‘approach’ and ‘governance’ of cancer care. So, for the approach part, we (Cytecare) look at it from an organ site approach, where there are dedicated teams for each type, large classification of cancers. So we have a group, for example, for ‘head and neck’ cancers. There are over 17 different sites, or locations, within the ‘head and neck’ region itself, like the oral cavity, nasal cavity, ear. So, that’s the word-play on organ site (Cytecare) approach.”
The word ‘cyte’ is derived from the Greek word, ‘kytos’, which means cell. The hospital represents care at the cellular level.
‘Governance of care’
The second aspect, according to Suresh Ramu, is the ‘governance of care’. “I don’t put (just) one person to treat that (one) patient. I put a team. We have the medical oncologist, the radiation oncologist, the surgical oncologist and the pathologist, among others, to work together for that one patient (through the multi-disciplinary tumour board). So, you are sure that not only are you putting in all the expertise, but you are also governing the level of care. Because, in India we need two things – expertise, and to make sure that we are doing the right thing. There’s definitely a trust deficit in healthcare, and by the governance process we feel we can address that trust deficit and bring the best for that one patient.”
Elaborating on ‘governance’, he says that the outcome of cancer treatment for the same stage of cancers in India is half as in the US. Yet on the brighter side, published data from institutions like the Tata Memorial Hospital, Mumbai, “which I have great regard for”, show that even with the kind of burden that they handle, their outcomes are twice as better as that of government hospitals and even some private hospitals.
“That is possible because of two reasons, which we have adopted at Cytecare. One is ‘approach’, the organ site approach. And that is true for the top 150 centres of the world; and Tata Memorial Hospital is one of them, for sure. There are dedicated teams for each type of cancer. And the other is ‘governance’ - the multi-disciplinary tumour board, which reviews each case.”
Cytecare thus, is trying to do things differently to achieve outstanding results. And the reassuring smell of coffee from the cafe at the entrance, is yet another way of doing things “differently”.
Treatment is expensive
Suresh Ramu accepts that cancer treatment is expensive. The drugs used, and the imported equipment, which attract 30 per cent customs duty, add to the costs. “If the government can do something for centres of excellence, it would help,” he says hopefully.
But research can help cut costs, he says. Here, certain combination of treatments can help cut costs. For instance, if certain biomarkers were used at the beginning of the treatment process than later, it could not only cut costs but also increase survival, Suresh Ramu says.
And since Cytecare follows such ‘governance’ rules, Suresh Ramu feels “We will be able to demonstrate that even as a private hospital, our costs of treatment and overall survival are significantly superior to what exists in the market. This will take time, but this is our approach.”
Awareness on cancer
Cytecare is also doing its bit to help expand awareness among the people about the various aspects of cancer and its early detection. “I am very enthused by the response of children in some schools,” he says. “We have seen that teenagers in the age-group of 13-18 are able to communicate and influence their family members on the awareness about cancer and the benefits of early detection, and insurance cover.”
Suresh Ramu sees things changing for the better in India. “India gets about 1.7 million reported cases of cancer every year in a population of 1.2 bilion people. The US has almost the same number of cases detected every year in a population that js about one-third of India. So, one can argue that we are genetically less predisposed to cancer; or that we are detecting far less than what actually exists (more likely the latter). (Yet from the rising number of patients coming to the hospital, it is evident that) detection rates are improving. People (now) have access to diagnostics in semi-urban areas. Healthcare in India is improving. Awareness is improving. But we have a long way to go.”