Tata Trusts: Transforming Cancer Care Delivery in India

Introduction

India has a huge burden of cancer, with an estimated number of about 2.25 million living with the disease. Approximately, 13 lakh new cancer patients are registered annually, with over 8 lakh cancer-related deaths [1]. Cancer cases in India increased at an average annual rate of 1.1–2% from 2010 to 2019. According to an analysis by the Institute for Health Metrics and Evaluation (IHME), University of Washington, the growth rates are among the global highest [2]. The northeastern states, including Assam, have the highest cancer incidences and mortality. The incidence of cancer in Assam is 90.2 per 1 lakh population against the national average of 81.2 per lakh. Furthermore, 70% of the cases reported are in the late stage of the disease, leading to high mortality (40–50%) [3]. The problem of high incidence and late detection is aggravated by a dearth of infrastructure and skilled workforce to treat the disease, concentrated urban cancer care resulting in patients having to travel far off distances to seek treatment and care, leading to high out-of-pocket expenses and consequently, high drop-out rates along the treatment pathway. Besides this, unhealthy lifestyle habits and a lack of awareness contribute to an increased risk for cancer.

Tata Trusts

Tata Trusts are among India’s oldest, non-sectarian philanthropic organizations. Since its inception, it has played a pioneering role in transforming traditional ideas of charity and introducing the concept of philanthropy to make a real difference in communities. Through grant-making, direct implementation and co-partnership strategies, the Trusts support and drive innovation in the areas of natural resources management; education; healthcare and nutrition; rural livelihoods; water, sanitation, and hygiene; enhancing civil society and governance; media, arts, crafts, and culture; and diversified employment. The Trusts engage with competent individuals and government bodies, international agencies, and like-minded private sector organizations to nurture a self-sustaining ecosystem that collectively works across all these areas [4].

For more information, please visit www.tatatrusts.org.

The Tata Trusts Cancer Care Initiative

Tata Trusts have a rich experience in building institutions of national importance. They pioneered cancer hospitals in India with the establishment of the Tata Memorial Hospital (TMH) in Mumbai in 1941, followed by the development of the Tata Medical Center in Kolkata in 2011 [5]. The Trusts have also been instrumental in the nation’s battle against cancer by donating critical equipment in heavily burdened areas, providing individual grants for medical relief and supporting many institutions in the field of oncology, including treatment, screening and early detection, training, and capacity building and research.

However, despite multiple initiatives undertaken by the Government, Tata Trusts and several other like-minded institutions, India still has a huge burden of cancer. The Trusts have partnered with various State Governments. They are developing a network of state-of-the-art healthcare facilities closer to people’s homes to treat the most common cancers, thus eliminating the need for long-distance travel to avail comprehensive diagnostic and full-fledged treatment facilities at affordable costs.

Infrastructure development is being complemented by a robust Public Health Program in collaboration with various state governments to spread awareness about cancer, promote health-seeking behavior and activate screening programs (with a focus on oral, breast and cervical cancer) and early diagnosis, leading to timely treatment. Research as a focus area will promote a dynamic system which evolves with the changing epidemiology and needs of the people.

Alamelu Charitable Foundation

Alamelu Charitable Foundation (ACF) is a not-for-profit company incorporated under Section 8 of the Companies Act, 2013, that is engaged in setting up and equipping cancer care hospitals at different locations in India to make cancer care treatment more easily accessible and affordable, particularly to patients from the economically weaker sections of society.

For more information, please visit www.alameluhealth.org.

Assam Cancer Care Foundation

The Assam Cancer Care Foundation (“ACCF”) is a joint initiative of the Government of Assam and the Tata Trusts to set up a first-of-its-kind grid to bring high-quality cancer care closer to patients and thus reduce their financial burden.

For more information, please visit www.assamcancercarefoundation.org.

Distributed Model of Cancer Care

The Trusts’ ‘Distributed Model of Cancer Care’ has four key pillars:

• i)Enhanced Access
  This pillar focuses on taking care closer to people’s homes through a step-down model and human resource development.

  • A)
    The step-down model has four levels: level 1 (L1), level 2 (L2), level 3 (L3), and level 4 (L4) centers.

These facilities will benefit not only people in states where these centers are located, i.e., in Assam, Andhra Pradesh, Uttar Pradesh, Jharkhand, Maharashtra, Odisha, and Karnataka but also people from adjacent areas and states.

Levels and facilities	Implemented projects	Projects undergoing
L1 centers comprise of apex facilities, which are equipped with an entire array of oncology services, like radiation, medical, surgical, nuclear medicine and allied facilities including high end lab services and research facilities.	Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi (MPMMMCC) is the first Apex Centre under the model, jointly set-up by the Trusts, the Tata Memorial Centre (TMC) and Banaras Hindu University (BHU).	An apex institute is underway at the State Cancer Institute (SCI) Guwahati, Assam.
L2 centers comprise of hospitals equipped with comprehensive oncology services and allied facilities, some of which are linked to Government Medical College Hospitals.	Three such centers have been launched—Dibrugarh Cancer Centre, and Barpeta Cancer Centre in Assam, and the Sri Venkateswara Institute of Cancer Care and Advanced Research (SVICCAR) in Tirupati, Andhra Pradesh. The Trusts have augmented the capacity of two existing L2 centers—the Indian Railway Cancer Institute and Research Centre at Varanasi, Uttar Pradesh and the Meherbai Tata Memorial Hospital, Jamshedpur, Jharkhand.	Four more L2 centers are coming up, one each at Ranchi (Jharkhand), Chandrapur (Maharashtra), and Silchar and Diphu (Assam).
L3 centers include diagnostic and day-care radiotherapy and chemotherapy units.	Five such centers have been set-up in Assam at Tezpur, Jorhat, Lakhimpur, Kokrajhar, and Darrang. Two nuclear medicine and radiation therapy units have been set-up at: Cachar Cancer Hospital and Research Centre (CCHRC), Cachar, Assam, and Yenepoya Medical College Hospital, Mangalore, Karnataka.	Foundation Stones have been laid for seven level 3 centers at Assam (Dhubri, Nalbari, Goalpara, Nagaon, Sibsagar, Tinsukia, and Golaghat).
L4 of the model covers the outreach initiatives, including palliative care, which, over a period of time, will help in bringing down the cancer case load, and also improve the early to late detection ratio from 30:70 to 70:30.

• B)Human Resource Development

  To ensure the availability of highly skilled and specialized healthcare professionals to operate these units, a comprehensive sourcing and upskilling strategy has been deployed to recruit different types of healthcare professionals through multiple channels like medical and nursing colleges, referral networks, recruitment portals, and consultants.

  Oncology fellowships and certificate programs have been rolled out to build a cadre of oncology-trained professionals from non-specialized professionals. Programs recognized by the National Skill Development Corporation (NSDC) and the Atomic Energy Regulatory Board (AERB) have also been identified for cross-skilling and up-skilling the workforce.

  • ii)
    Affordable Care
    The hospitals are in the process of being empanelled with various state and central government insurance schemes. To ensure a uniform standard of care, the units will be guided by the National Cancer Grid (NCG), a network of 260+ cancer centers, research institutes, patient groups, and charitable institutions.
  • iii)
    Uniform High-Quality Care
    To successfully implement the Distributed Model of Cancer Care, the NCG guidelines and pathways are being adopted across the centers. Technology is being used to link all the centers, to provide services like virtual consultations, remote radiology and pathology reporting, and virtual tumor board.
  • iv)
    Prevention, Early Detection, and Palliative Care
    Prevention, early detection, and palliative care efforts focus on down-staging and reducing the cancer burden in the state. Various initiatives are being conducted to address grass-root level issues related to awareness about cancer causes, prevention, screening, diagnosis and treatment, and palliative care.
    Collaborations with the National Health Mission (NHM) ensure the smooth execution of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) in sub-centers (SCs) and health and wellness centers (HWC) by training and hand-holding the healthcare professionals and front-line workers for screening and awareness.
    ‘Health Screening and Awareness Centres’ called ‘Swasth Kiosks’ have been set up in collaboration with Government Medical College Hospitals/District Hospitals to provide free-of-cost screening and awareness services to patients and their family members. Ten such kiosks are operational—one each in Guwahati, Barpeta, Tezpur, Dibrugarh, Diphu, Silchar in Assam, Chandrapur in Maharashtra, Ranchi in Jharkhand, Tirupati in Andhra Pradesh and Cuttack in Odisha.
    The Sri Venkateswara Institute of Cancer Care and Advanced Research (SVICCAR) in Tirupati operates a Mobile Medical Unit (MMU) that is equipped with a mammography machine and offers free-of-cost screening for non-communicable diseases (NCDs) and oral, breast, and cervical cancers.

Expected Impact

• Cancer care will become more accessible to the population of the identified state and adjoining regions and states.

• Due to accessibility, a three-fold increase in diagnosis and reporting of cases is expected.

• This increased accessibility will also lead to a 50 to 75% reduction in travel time for treatment.

• A significant reduction in travel, stay, and out-of-pocket expenses are expected.

• Due to consistent community outreach activities, the current mix of early to late-stage diagnoses is expected to change from 30:70 to 70:30.

• Fellowship and training programs designed will help to develop a strong cadre of oncology professionals.

Declarations

Conflict of Interests

The author’s institution (Yenepoya Deemed to be University) has received a grant-in-aid from the Tata Trust Cancer Care initiative to develop a comprehensive cancer care center.