Cancer is one of the most prevalent non-communicable diseases in India. The number of Indians suffering from cancer is projected to rise to 29.8 million in 2025 from 26.7 million in 2021, according to a recent report by the Indian Council for Medical Research (ICMR). The Covid-19 pandemic severely affected cancer care in India as screening fell sharply and patients missed regular checks and tests, leading to a huge backlog of those in urgent need of treatment.

Although cancer treatment in India is on a par with the best in the world, it’s not affordable for many people. While the world is still looking for a magic potion to cure cancer, an immunotherapy drug, Dostarlimab, hit the headlines across the world this year for eliminating colorectal cancer in a group of patients in New York. It is being hailed as a miracle drug, although it is not the panacea for all cancers.

The Tata Memorial Hospital also showcased its comparatively cheaper innovation with another immunotherapy drug to prolong the lives of patients with head and neck cancer.

Recently, the authorities gave the go-ahead for the Serum Institute of India’s (SII’s) quadrivalent human papillomavirus (qHPV) vaccine against cervical cancer. According to SII, the vaccine is likely to cost ₹200-400 per dose and will be available in a few months. Cervical cancer is the second most common cancer among women in India.

In addition, there are discussions in the public domain that a few pharmaceutical companies in India and start-ups are likely to offer cell therapy-based treatment for cancers at a fraction of global and US prices. While these examples of innovation offer hope to many cancer patients, there is a need to build a more efficient and innovation-centric ecosystem involving technology, people, patient communities, strategies, and collaborations to address various issues in cancer care, including the development of new drugs.

Need for comprehensive care

Cancer care must be accorded high priority because it extracts a huge economic price. India recorded a total productivity loss of $6.7 billion in 2012 due to cancer, representing 0.36 per cent of GDP, according to a study published a few years ago in the Journal of Cancer Epidemiology.

The focus must also be on patient-centric models of treatment to bring down the cost of cancer care which pushes thousands of people into poverty.

Chemotherapy for breast cancer costs around ₹1.7 lakh in India and the addition of newer forms of therapy could add between ₹20,000 and ₹2,00,000 per cycle depending on the type of breast cancer.

Recently, a parliamentary panel suggested that the government consider waiving GST on cancer drugs and take stringent measures to check the prices of medicines and radiation therapy. It remains to be seen if its proposals are given due consideration.

In particular, post-treatment follow-up should also be made more patient-centric. Telemedicine tools need to be used to review treatment progress and recovery status to lessen the burden of travel on patients to far-off centres. Since cancer patients need extensive post-hospitalisation support, there must be provisions to make available suitable undergarments, lymphoedema compression sleeves and prosthesis for breast cancer survivors. More support groups need to be created for their healing and rehabilitation.

The Indian pharma sector, which went into overdrive during the Covid pandemic to produce affordable vaccines and drugs, must show a similar zeal for innovation to produce cancer drugs that can be easily accessed.

For innovation to be fruitful, there must be open communication between industry and the all key stakeholders for market growth, better product approval processes, and the development of new and innovative therapies. There is also the need for government support to streamline regulation and speed up approvals without compromising on quality.

India has a huge potential to become a global innovation hub for cancer care.

But it is essential to create an entire ecosystem of innovation linking the collaborative efforts of several stakeholder groups such as pharma companies, start-ups, entrepreneurs, and academic and clinical researchers. These stakeholder groups’ efforts must also be backed by growth enablers such as financing, infrastructure and supporting policies.

Academia is vital to innovation because it provides the foundation of strong talent and research base. Clinical research institutions and hospitals also have a big role to play in supplementing research capabilities to drive innovation.

Since medical institutions/colleges serve as the major hubs of biomedical research, the expertise of doctors and access to a large volume of patient data can significantly improve research outcomes.

Start-ups that have now emerged as a catalyst to boost the pharma industry innovation ecosystem are using AI and ML to screen cancer cases which can significantly help doctors to detect and treat tumours early, more so in rural areas where people are handicapped by a shortage of oncologists and medical care facilities.

The use of tele-radiology can extend the scope of services into understaffed remote areas of the country. A well-trained radiographer or technician can take an X-ray or ultrasound and transmit them electronically to a nodal centre for detailed diagnosis. Telemedicine has also ushered in a level of comfort for village women who can discuss confidential issues and ask questions without hesitation to a doctor on screen, 100 km away.

Insurance, awareness

Health insurance also must be woven into the cancer care ecosystem. The Pradhan Mantri Jan Aarogya Yojana has become a game changer for millions of underprivileged Indians who were not covered by health insurance earlier. However, 30 per cent of Indians still do not have any health insurance and this gap must be plugged.

Education, awareness and screening can help in the early detection of cancer which increases the chances of successful treatment and longevity. The pandemic has brought about considerable behaviour change with respect to tests and screening and this must be sustained. For early detection of cancer, it is important to recognise any out of ordinary or warning signs and take prompt action for quick diagnosis. Increased awareness among the general public can boost the overall reporting rate of the disease and address the key challenge of advanced stage detection.

There are various kinds of screening tests like physical exams and history, laboratory tests, diagnostic procedures, imaging procedures, and genetic tests to detect different types of cancer.

Preventive health checkups are also important in detecting cancer in time for successful treatment. It must be remembered that up to 40 per cent of cancer-related deaths are avoidable. This in itself is reason enough to make cancer prevention awareness a priority area.

The writer is Chairperson, Delhi Branch, Indian Cancer Society