Cancer-care-in-india

How India can reduce its cancer burden

6 minute read 11 Oct 2022
Related topics
Health
Life sciences
Life Sciences 4.0

India faces significant challenge of a sizeable cancer incidence burden which continues to grow further.

In brief

  • Estimates indicate India’s reported cancer incidence in 2022 to be INR 19 to 20 lakhs, whereas real incidence is 1.5 to 3 times higher than the reported cases.
  • High proportion of cases continue to be detected at late stages for major cancer types in India.
  • High burden of cancer incidence in India is resulting in a high economic burden on account of productivity losses and premature mortality.

Given the backdrop of a growing burden of cancer across India, EY and FICCI collaborated for Call for Action:  Making quality cancer care more accessible and affordable in India to highlight the need for more effective policy measures aimed at proactive cancer prevention and treatments.

The issue of high disease burden is compounded with late-stage detection caused mainly due to lack of awareness and low penetration of screening programs. India has a poor cancer detection rate of 29%, with only, 15% and 33% of breast lung and cervical cancers being diagnosed in stages 1 and 2, respectively, which is significantly lesser than that in China, the UK and the US.

While at one hand incidence is rising, deaths due to cancer has remained among the top 5 causes of deaths in India over the last decade. Estimates indicate that the total deaths due to cancer have been ~8 to 9 lakh in 2020, causing the mortality to incidence ratio for different cancer types in India being among the poorest compared to global counterparts.

Based on reported cancer incidence and mortality across age groups and years of potential productive life lost (YPPLL) due to the same, estimates indicate that the economic burden in terms of GDP losses is in the range of US$11B. (0.4% of national GDP) in 2020.

The same is projected to increase to US$36B to US$40B by 2030, driven by a projected increase in mortality, improvement in life expectancy and increase in GDP per capita.

Given the current state of rising cancer disease burden and sub-optimal quality of outcomes, there is a significant need to understand the current challenges and tailor make interventions across the different stages of disease management with a deep focus on:

1. Awareness and prevention – Modifying exposure to risk factors that potentially lead to cancer
2. Detection and diagnosis - Ensuring early detection and accurate staging of the disease
3. Treatment including palliative care - Driving multidisciplinary approach to treatment with focus on affordability, equitable access, quality of outcomes and palliative care

Cancer control framework

While the above represent core levers to drive cancer control by reducing incidence and improving quality of outcomes, expanding cancer registries and health information systems for collecting standardized and comprehensive data for informed and evidence-based policy decisions and research will form the foundation for enabling the levers to drive the change.

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Cancer awareness
1

Chapter 1

Awareness and prevention

Awareness landscape in India is dominated by tobacco and tobacco-related cancers. Knowledge of other common cancers such as cervical is low.


Few people in India seemed to be concerned about cancer compared to other countries, implying a general attitude of indifference towards cancer. As per the UICC global survey, only 43% respondents in India indicated that they were concerned or somewhat concerned about developing cancer in their lifetime compared to a global average of 58%.

Awareness level across organs (Based on multiple localised studies in India)

Uptake of screening for breast, cervical and oral cancer and HPV vaccination is very low despite moderate levels of awareness.

Primary prevention involves limiting exposure to carcinogenic risk factors. While there are several carcinogenic risk factors, modifiable risk factors such as tobacco, alcohol, obesity, infectious and environmental factors are amenable to prevention. While India undertook several policy measures to reduce exposure to risk factors, there is still significant progress required.

Cancer - Diagnosis and treatment
2

Chapter 2

Detection and diagnosis

It is crucial that cancer prevention and early diagnosis are prioritized by society, governments, and the healthcare ecosystem.

Despite the proven benefits of early identification for downstaging the disease as well as in achieving a reduction in mortality and morbidity, screening penetration of key cancers in India is very low: Across focus cancers being screened under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS), screening coverage is less than 5% of population which is negligible when compared with global peers. Capacity constraints in terms of physical infrastructure and workforce, lack of training of the methods for cancer screening among healthcare workers and deficiencies in referral mechanism are key roadblocks to the success of the programme. Additionally, lack of data capture to maintain longitudinal health records of population right from screening stage and ensuring tracking and follow up with patients for effective referrals is a key deterrent in the expansion and penetration of screening programs.

Prevent, screen and spread awareness with least anxiety, low cost and avoiding unnecessary stigma of cancer. Treat with goal of the basic choice, early access and modest cost

Dr. Rajendra A Badwe

Director, Tata Memorial Centre

Palliative Care in Cancer
3

Chapter 3

Treatment including palliative care

There is significant geographic skew in the presence of comprehensive cancer centers in the country.

Only ~175 districts in the country covering 40-45% of the population have Comprehensive Cancer Centres (CCCs)1 . Of the 470 to 480 CCs available in the country ~40% are concentrated in metros and state capitals. Severe gap continues in access to radiotherapy (RT) treatment in the country with RT per million population of 0.4 vis-à-vis WHO recommendation of 1 RT per million population.

Affordability of treatment

Treatment cost for cancer care is financially prohibitive and is almost 3x that of other non-communicable diseases (NCD). Additionally, treatment cost has been increasing with the cost of a single cancer hospitalization (in public or private facility) exceeding average annual expenditure of 80% population in 2017 vis-à-vis 60% population in 2014.

Baseline cost of comprehensive cancer treatment (INR-lakhs)

The complex challenges of the cancer control landscape in India are further worsened by the lack of comprehensive data w.r.t to incidence and mortality which is representative of the Indian population. The population and hospital-based cancer registries set up four decades ago, have so far been able to cover only 10% of the population of the country with several states such as Uttar Pradesh, Madhya Pradesh, Andhra Pradesh, Rajasthan, Telangana and Orissa having inadequate presence and penetration of registries2.

The challenges in the current system of cancer disease management in the country have been further corroborated by a survey carried out with 154 cancer patients and care givers. Gaps in the patient journey were characterized into seven key themes which need to be addressed to improve experience and satisfaction of cancer patients in the country:

Gaps in patient journey across seven key themes

How EY can help

Some of the most cutting-edge cancer treatment methods and technology are available in our country. However, we have a long way to go before we can ensure that cancer patients from every socioeconomic background receive the best possible care. In addition to treatment, we must also take into account leveraging technology to close the care gaps associated with accessibility and affordability. Telemedicine, electronic patient records, robotics, AI-backed upskilling methods, daycare chemo, home care etc., are some of the strategies that are already in place to address these care gaps.  

Additionally, capacity and capability building, resource stratification around models of care, and workforce planning have been popular themes for discussion and analysis. India has to further expand its complete cancer care infrastructure, including prevention, care delivery, skilled workforce, technology, and equipment, in order to increase its capacity and capabilities for treating and managing cancer. To make cancer care more effective and affordable for the entire population, we must improve workflow efficiency and treatment outcomes. Using its trademark ingenuity and frugality, India has an opportunity to find innovative solutions to bridge the existing care gaps for her citizens and to guide other developing and developed nations.

Comprehensive and integrated approach by a multidisciplinary team is the key to deliver best outcome for cancer treatment. What works for a patient will work for the nation. Collaboration among all stakeholders is imperative to effectively address India's growing cancer burden

Raj Gore

Co-Chair, FICCI Task Force on Cancer Care and CEO, Healthcare Global Enterprises Limited (HCG)


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    Summary

    To make cancer care more effective and affordable for the entire population, we must improve workflow efficiency and treatment outcomes. Using its trademark ingenuity and frugality, India has an opportunity to find innovative solutions to bridge the existing care gaps for her citizens and to guide other developing and developed nations.
     

    EY refers to the global organization, and may refer to one or more, of the member firms of Ernst & Young Global Limited, each of which is a separate legal entity. Ernst & Young Global Limited, a UK company limited by guarantee, does not provide services to clients.