While the Indian population is suffering from Cancer and to deal with it, there is a substantial need for the development in the area of cancer treatment and research in India. Finding a cure for cancer is what the world looking at. Sharing the same vision to fight the battle of cancer and provide the top-notch treatment to the suffering patients, Dr Rakesh Kumar Vyas (Medical Director) – MD (Radiation Oncology), Balco Medical Center shares his stance by answering certain questions below.

1. Can you please elaborate on the Cancer care scenario in India?

India currently has over 25 million people living with cancer. Of this in the year 2018 alone, over 1,157,294 people were diagnosed with cancer and 784,821 died as a result. While these are staggering figures, most agree that the number of people not diagnosed or diagnosed but not at present in the national registry is significantly higher. The National Cancer Grid is an initiative of Tata Medical Centre, Mumbai to get all hospitals treating cancers on the same platform. As of 2018, it had less than 150 centres, including public and private sector facilities, registered on it. The gap in demand and supply of cancer care, thus, is massive.

The reason corporates are not eager to start cancer hospitals is the profile of cancer patients. Typical cancer patients are not affluent, and due to the delay in diagnosis, do not normally present themselves at a stage at which the disease can be treated and cured. From a population perspective, cancer treatment needs more outreach, public education, screening programs and early detection strategies that public and private players should collaboratively implement.

With limited facilities available, public hospitals are shouldering the majority of cancer treatment and the private hospitals are catering to a thin slice of the patients. However, with the launch of GOI’s flagship health care scheme Ayushman Bharat, it is anticipated that progressive private treatment facilities will become available to the underprivileged sections as well.

2. How easy or difficult it is to conduct research on cancer in India compared to the west?

India has the potential to be a leader in research owing to the large patient population, but that is not happening to the extent that it needs to happen. One reason for this is that the centres with most patients are also the centres with the busiest doctors. However, the scenario is changing slowly. Some studies from India are now the basis on which the international bodies make their recommendations. More private hospitals are recognizing the importance of research and making it a part of the performance evaluation of doctors.

The biggest challenge remains to fund. While observational studies are good and can make incremental changes, the big impact is made by basic research and research on treatment methods. Both these are time-consuming, laborious and resource-intensive and with no certainty on return on investment. Research in these areas is presently being conducted by large pharma companies and by Governments. Ideally, the research should be led by the hospitals, collaboratively involving academia and industry, adopting a multi-disciplinary approach. But this is far from reality.

3. What do you think needs to change in Indian academia to boost cancer research here?

We need to make research attractive and feasible for academicians as they are best suited to produce the results required by the field. To make it attractive we should give incentives for trials rather than just medical journals and peer-reviewed publications, and even higher incentives for trials that lead to new drug discovery and treatment protocols.

To make it feasible, funding in research, as well as training & manpower for research, will be needed. Research is a specialized activity and needs specialized manpower for example in data collection, documentation, photography, statistical analysis and clinical trials. Training in research methodology will also be needed for clinical staff and can be incorporated in the clinical curriculum from the undergraduate level which currently is not the case. Furthermore, academia should reach out and embrace major hospitals as then it would be possible to work constructively and collaboratively.

4. What are the latest technological advancements in cancer treatment in India?

Advancements are in two clinical areas: diagnosis and treatment. In diagnosis, molecular diagnosis and imaging technologies like PET-MRI scanning are pushing the boundaries of how cancer is diagnosed and is thus affecting treatment decisions.

In the area of Surgical Oncology, minimally invasive surgery, including robotic surgery, is at the forefront of technology. New technologies like 3D printed implants are making reconstruction personalized to a degree never before imagined. In Radiation Oncology, Proton Therapy is allowing better targeting of a tumour with lower side effects. In Medical Oncology, the frontier is targeted therapy. This modality is the current best hope for the cure of cancer and is considered the future of oncology.

5. How has the medical profession evolved in relation to cancer treatment in India over the years?

The medical profession has moved from destructive treatment for cancer to more and more preservation of form and function. In surgery, the treatments are becoming more targeted with lower disfiguration. Examples are minimally invasive surgeries and modifications of radical surgeries. Breast conservation instead of removing the entire breast is another example of the same approach. Surgeons now remove less normal tissue and yet are equally or more effective in removing cancer. Reconstruction has also changed along the same lines. The focus is now to preserve aesthetics as well as functionality. 3D printed models are used to guide reconstruction using technologies like CAD. In addition, surgeons are now designing 3D printed prosthesis that can replace the tissue that has been resected.

In radiation, this trend has led to better-targeted treatments. In medical oncology doses and regimen have been altered to deliver the same results with lower side effects. In addition, with the advent of targeted therapy, the oncologist now aims to damage only the tumour leaving all the rest unharmed. In a similar vein, Palliative care has now become an integral part of cancer treatment. Whether or not cancer can be treated, the aim of the modern oncologist is that the patient should remain pain and symptom-free at all stages of life and the patient’s quality of life is enhanced.

End of life care, patient involvement in decision making, and psychological counselling to patients and their families form another new approach to care.

With more and more integration of treatment, it is not surprising that the oncologists are talking to each other more than ever. Tumour boards have evolved from decision making to shared learning and a tool for continuous education. Virtual Tumor Boards are a sign that oncologists are now seeking help wherever they can find it.

6. What are the funding gaps for treatment of cancer in India, who does it reflect in the rural space?

As is apparent from the numbers of patients and the hospitals dedicated to treating them, the gap is enormous. The public facilities, as well as non-profits, are full, and yet many poor patients struggle to get treatment. Insurance-based government schemes such as Ayushman Bharat are expected to take off the pressure to a certain extent. However, it does not resolve the gap challenge.

Majority of the resources are concentrated in Tier-I cities, very few located in the rest of the country and none in the rural areas. There is an enormous challenge to locate these in non-urban settings due to reluctance on the part of good, qualified manpower to relocate to these areas as they lack even adequate social infrastructure.

7. Why have you established your advanced cancer centre in Chhattisgarh?

Worldwide, India ranks amongst the top three countries in terms of cancer incidences and mortality. For the year 2018, in India, it has been reported that 1,157,294 new cancer cases were detected and there were 784,821 mortalities attributed to this dreaded disease. It is estimated that cancer incidence is increasing at a CAGR of about 3% and the trend is likely to continue in the future.

In India, in comparison to developed countries, there is low penetration of infrastructure and shortage of oncologists. Even within India, the availability of resources in Chhattisgarh is even lower and the majority of oncology facilities are located in Tier- I cities.

From the above, it is evident that there is a significant shortfall and thus the importance of establishing a 170-bed cancer tertiary care hospital at Naya Raipur, Chhattisgarh cannot be overstressed. This cancer centre, equipped with state-of-the-art diagnostics, modern clinical labs, since its inauguration in March 2018, is in the forefront of providing world-class affordable cancer treatment.

Balco Medical Centre (BMC) is also the outcome of Vedanta Group’s philosophy to give back to the societies they operate in, as they firmly believe the community is a part of their success. BMC is closely located to the big industrial complexes of the group in Chhattisgarh and Odisha. Thus, BMC was established as a not-for-profit company with service as its prime motto.

8. What is the disease pattern you have tracked in the patients, particularly in cancer care? How is the centre beneficial to the tribal belt of Chhattisgarh and Odisha?

Most of our patients fall in three categories: cancers of mouth and throat, cancers of breast and cancers of the cervix. In our practise, we find that we get many more advanced cases than early cancers. There is a reluctance to seeking treatment in this area because they are worried about the side effects of treatment and unsure of the efficacy even after enduring the side effects. This leads to a vicious cycle of avoiding treatments and presenting late for treatment.

BALCO Medical Centre is the first modern, integrated dedicated cancer treatment facility in the region. As it operates on a non-profit model, it can serve the people of Chhattisgarh at lower rates than the alternatives (which are not in proximity). As the motive is public service and eradication of cancer rather than just trying to cure it, Balco Medical Center is at the forefront of early detection and awareness camps. We go to not just private and public hospitals, but also to social groups and employees of organizations and talk about the importance of prevention, early detection and treatment of cancer. We believe that these messages are as important as the treatments we give at our hospitals and over a period of time have the potential to save lives as people learn to avoid cancer or detect it early.

9. What are your future plans for expansion of Balco Medical Center?

There are more than 100 cancers that include cancer of brain, lung, skin, etc. Currently, we treat about 85% cancers and progressively we would like to be able to treat any type of cancer. Concurrently, BMC would also like to focus on research and academics in the oncology space and be at the forefront in this field. BMC aims to be one amongst the best cancer hospitals in India and then in the world.

As cancer detection and treatment involves every human organ, BMC already has substantial capability to treat many other diseases. However, without losing the primary focus on oncology, a few other specialities could possibly be introduced in due course of time.