Abstract
Cancer burden in India is increasing. Cancer treatment today is multi-disciplinary requiring the coordination of many specialists for best outcomes. Bringing such expertise together to the district level is the greatest challenge for cancer care in any country, moreover in India. This article focuses on the step-wise journey to make comprehensive cancer care center in a small city.
Keywords: Care gap, Comprehensive cancer care, Decentralization of care, Unmet need
Introduction
Cancer burden in India is increasing [1]. Although cancer registry data in India has improved in the recent years, a large population of cancer patients still go unreported [2], more so in rural and semi-urban areas. Thousands of cancer patient in different parts of India travel hundreds of kilometers for the sake of cancer care. A visit to any one of the tertiary cancer referral centers in metros in India would give an idea of the real unmet need for cancer care in the interiors of the country.
Cancer treatment today is multi-disciplinary requiring the coordination of many specialists for best outcomes. Bringing such expertise together to the district level is the greatest challenge for cancer care in any country, moreover in India [3].
We started as a 30-bedded cancer hospital with two specialists in 2014 in Namakkal, an industrial town (and a district headquarters) in Central Tamilnadu. By 2020, we established a 100-bedded tertiary cancer hospital with multiple specialists in the field of oncology.
These are the following steps that we believe helped us establish a cancer institution.
Building the Team
Cancer treatment is multi-disciplinary. One of our most important achievements was to get like-minded clinicians committed in creating a difference at the grass root level. This, according to us, is the hardest part of the process. A long-term vision for the team is essential. In addition to doctors, building the clinical support team is crucial. Availability of trained medical personnel is very poor in our area, and we continue to have difficulties in this front. One way in which we are trying to change this, is to establish a staff training program, specific to the needs of our patients. This may include even volunteers, cancer survivors and NGOs.
Communication with the Community
Engaging local governmental and non-governmental organizations are crucial. In our experience, such collaborations send a positive message to the community. Our team continues to engage with schools, colleges, NGOs, self-help groups and industrial organizations to bring about awareness regarding cancer and its treatment.
Setting Achievable Goals
Infrastructure for cancer treatments is expensive and is the rate-limiting step in establishing a cancer facility. We were careful to take a step-wise approach towards the same. Our team started cancer surgery service in 2014, referring initially patients for radiation treatments to other centers. We established radiation oncology services at our hospital only in 2020. It took 6 years to build enough volume to sustain the investment required to run a linear accelerator. PETCT and robotic surgery service were initiated in 2021. Our DNB Surgical Oncology Program has been approved for the current year, now elevating the status of the institute to a teaching hospital. Strong leadership is needed to set these goals and strive to achieve them.
Academic Excellence
Active participation in cancer society meetings (IASO, AROI, ISMPO, ASI, ISO, etc.) has been important in bringing recognition for our institution. It has helped us form important partnerships with other institutions for clinical research, clinical collaboration and innovation. It also validates the work that is performed and also attracts young like-minded people to work at the institution. Our team has been instrumental in starting cancer societies in the region, creating a community among peers, to encourage patient discussions and collaborations beyond the boundaries of our institution.
Keeping Treatment Affordable
Caring about the costs incurred by patients is essential to succeed in a smaller place. A strong policy from the administration is needed to ensure a wider segment of patient population can be catered to. The focus on enabling treatment completion is an important metric to watch in such a setting. Adhering to “evidence-based guidelines” may be prohibitive due to costs. An individualized treatment strategy based on the financial and psychological status of the patient has helped us achieve high treatment completion rates. Another example, palliative metronomic therapy enables the bread-winner of the family achieve acceptable quality of life and helps him to continue his work and at the same time avoids undue financial strain to the household. However, we need to be careful to draw the line between “minimum standards” and inappropriate treatment.
Conclusion
To change the current cancer care scenario in India, decentralization of care is needed. With increasing number of trained oncologists, every year, the difference in cancer care will be evident only when one reaches out for dedicating his/her services through the peripheral centers.
Declarations
Conflict of interest
The authors declare no competing interests.
Footnotes
Publisher's Note
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References
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