The cancer burden in India is increasing. Reports have found that the rate of cancer has doubled in India over the last 26 years, mainly due to population growth. The Indian Council of Medical Research (ICMR) estimates that India was home to 14 lakh cancer patients in 2016, with more growth since then. At present, breast cancer, cervical cancer, oral cancer and lung cancer contribute to 41 per cent of the cancer burden in the country.

Cancer care has been the focus for GOI for the last few years

The oncology protocols or treatment guidelines that were followed in India until recently did not originate in India i.e. not developed by the oncology fraternity in India. The National Cancer Grid, a consortium of cancer care centres, therefore met to revise and expand the international treatment guidelines. In 2019, the National Cancer Grid developed and released the Indian guidelines made for Indian patients, to standardize cancer care across the country.

Despite the growing cancer burden, India does not have adequate expertise and infrastructure in rural areas to support the required pace of diagnosis and treatment of cancers. The past few years have seen the sustained expansion of National Cancer Grid hospitals across the country. Further, the hub and spoke model envisaged by Tata Memorial Center, India’s leading academic cancer care hospital, is turning into reality. Treatment centres in Assam, UP, and other regions are opening up to take care of patients locally instead of forcing them to travel to Mumbai. Thousands of patients across the country continue to reach out to TMC NCG Navya Online, an artificial intelligence (AI) powered online expert opinion service, in order to get recommendations for NCG approved treatment plans for their individual cancers. This service by TMC and NCG continues to expand free of cost for low-income Indian patients. This levels disparity of access to cancer expertise and standardizes expert cancer care for every patient.

Cancer treatment in India remains expensive and remains out of the bracket of affordability for middle- and low-income groups. Therefore, the National Health Authority (NHA) has covered most poor patients for cancer care through their public health insurance scheme- Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). In collaboration with the National Cancer Grid, Ayushman Bharat will expand the access of poor Indian citizens across the country to high-level, guideline-appropriate care.

Artificial intelligence methods in India are expediting the speed of new cancer research, diagnostics and therapeutics. Applications of AI in cancer have extended to digital pathology, digital radiology, and expanding access to expertise for patients in remote locations.

New Paths in Cancer Treatment

In synergy with the government’s efforts, cancer treatment has undergone a paradigm shift over the past ten years. As we move into the next decade, advanced cancer is now thought of more as a chronic disease, with treatment aimed at controlling symptoms, and increasing quality and quantity of life for many years. The life expectancy of patients with metastatic (widespread) solid tumours (cancers of the prostate, breast, lung, head and neck, skin) etc. used to be measured in months even recently. Currently, the availability of immunotherapies and molecularly targeted oral therapies have become mainstream in India, to the point where many patients with advanced solid tumours are able to live well for a few years instead of a few months. The battle to control these cancers continues to wage with major advances in India for the next decade.

In 2020, two centres in India are taking up promising trials of CAR-T cell therapy. In this novel kind of treatment, immune cells (T- cells) from the body are trained to recognize and attack cancer cells, thus fighting cancer using the body itself instead of toxic chemicals such as chemotherapy. Currently, patients in India, who need this cutting-edge therapy must travel to China, Israel or the USA to control advanced/relapsed blood cancers. Tata Memorial Center has been engaged in collaborative research to trial and pilot CAR-T cell therapy in India, which might be available in 2020. Similarly, Biocon in Bengaluru has also started the process of developing CAR-T cell therapy.

Throughout India, image-guided radiation therapy for precise targeting of tumours and reduction of toxicities has become widely available. For patients with cancers, it is difficult to treat locations such as the eye, brain, spinal cord, or for tumours in children. Apollo Hospitals recently opened Proton Therapy Centre giving cancer patients access to a specialised form of radiotherapy that is extremely precise in destroying cancer cells. This is another welcome addition for patients who previously had to travel abroad to receive proton therapy.

In sum, 2020 is the beginning of a promising decade in cancer care. The medical research community has solidified approaches to early cancers with combination surgery, chemotherapy, and radiation therapy, often delivering high rates of cure when cancer is detected early. The challenge of the next decade is to develop indigenous methods of delivering CAR-T cells, immunotherapies, and molecularly targeted therapies, and using them in the right combination and sequence in order to extend the quality and quantity of life meaningfully for patients with advanced solid tumours as well. Health policy innovations such as public insurance schemes from Ayushman Bharat, national treatment standards and guidelines from the NCG, and artificial intelligence-based health technologies like TMC NCG Navya Online will continue to deliver the most appropriate treatments in the hands of patients around the country.