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Oncology trends in Indian healthcare landscape

Dr Ramakant Deshpande
Thursday, September 1, 2022, 08:00 Hrs  [IST]

The cancer cases in India have increased to an annual incidence of 14 lakhs in the population of 140 crores with over 70 per cent dying due to the disease within two years. Three to four times this number are prevalent patients, undergoing treatment or having recovered recently. We are also the third country after China and USA with the maximum number of cancer cases. The Indian Council of Medical Research (ICMR) estimates that there will be 12 per cent rise in cancer cases in India by the next 5 years. The top 5 cancers affecting both populations in India are breast, oral, cervical, lung and colorectal cancers. Head and neck cancers form almost 30-35 per cent of presentation in most regional cancer centres, noticeably more in the north and northeast India due to inherent habits. Earlier tobacco and alcohol were considered the main reasons for cancer. Smoking as well as smoke-free tobacco like eating it, using snuff, etc and even secondary exposure contributes to increased incidence of lung cancer. In addition, today there are various other factors like sedentary lifestyles, obesity, increase in urban pollution, including kitchen emissions of unhealthy fumes, unhealthy eating habits, lack of exercise, etc which have possibly contributed to this rising incidence of cancer. Thirdly, we are also witnessing a paradigm shift in the age group for cancer incidence with more young people getting affected with aggressive disease with lethal implication due to the prevalence of the predisposing reasons. A shift into the tissue types of diseases too is being seen like the incidence of adenocarcinoma is increasing in lung cancer, and lower oesophageal cancers. Fortunately the small cell variety of lung cancer being the most malignant manifests in less than 10 per cent of lung cancer patients and has the worse prognosis with its rapid propensity of spread.

Surgery, chemotherapy, radiation and novel therapies like immunotherapy, genetic therapy are some of the commonly used anti-cancer methodologies to improve survivals and also quality of life. Today in a developed country like US, 70 per cent of cancer patients can expect to be completely cured, in China the same figure being 60 per cent and in India, it being 50 per cent. Treatment methodologies have become safer, faster, accessible and more procedure oriented over the years. Conservation of organs (breast, stomach, rectum, etc) is the norm while sticking to radicality, reducing operative trauma by minimally invasive techniques - Laparoscopy/Thoracoscopic/Robotic resections. Reviving critical patients by intensive care, nutritional and organ support, prolonging longevity and quality of survival by targeted and immunotherapy in even advanced cancers minimising collateral organ damage. Saving organ functions, improving treatment results by evolved techniques of radiation (cyberknife, proton therapy) are some of the current standards of care. Many of today's patients would have been labelled as too advanced for treatment in the past but now can go on living with excellent quality of life for many years with modern treatments. Targeted therapies like Gefitinib in EGFR positive tumours in stage 4 cancer of lung can prolong the life of the patient from the earlier 1 year to nearly over 5 years. Same is the status with many other targeted therapies and possible immunotherapy too, cost being the limiting factor though this will change over a period of time. This has a greater impact in India as the incidence of cancer in India is in the 4th or the 5th decade when the individual is still the pillar of the family unlike in western countries where the highest incidence of cancer is in the 6th or 7th decade. The socio-economic impact of an appropriately treated and cured cancer is therefore very high in India.

Preventive check-ups can detect cancer in early stage thereby improving survivals and even reducing cancer related mortality. This data can be confirmed by well-designed screening programmes for lung cancer and colon cancers. Vaccinations exist today to reduce possible incidence of uterine cervical cancer and personalised vaccines are being developed for breast, colon and prostate cancers for reducing chances of recurrence after definitive treatment of the primary disease in selected stages. Specific killer cells (T-cells) can be developed to attach themselves to antigens on the surface of tumour cells, killing them and sparing the normal cells. ECDNA Targeted Therapy (Extra chromosomal DNA) which warns the presence of cancer can be used as a market to target and attack the cancer cells. Evolution of resistance traits in cancer, high cost of cancer treatment, difficult accessibility and superstition along with ignorance, logistics, non-compliances are some of the roadblocks for better results.

The way forward is to find economical and affordable ways of cancer management delivery to people, to identify people susceptible to cancer by programmed clinical or genetic  screening, implementing in time protocols for preventive treatments and make facilities available, accessible and affordable. Remote control delivery of medicines using drones or even offering surgery through Robotics in remote areas would help and is likely to be the norm in the future. Eventually gene therapy or tissue engineering can improve survival further. Gene editing like CRISPR can be paired with genomic data and machine learning algorithms to target problematic cancer genes and knock them out utilising the approach of synthetic lethality. This is not a drug with its own side effects but is a novel treatment approach used to disable cancer. Cancer preventable surgeries like bilateral mastectomy which Angelina Jolie underwent due to presence or a cancer predicting gene, BRCA1, can actually bring down the sufferance from cancer. On a larger scale, understanding about food and out microbiome can offer predictive biomarkers and precision diagnostics to detect cancer among other diseases. Correction of these abnormalities can bring down the incidence of cancer itself.

We are probably at the most exciting period in mankind wherein advances in science and art are converging towards cancer management by synthesizing advances in biology, genomics, molecular biology, immunotherapy, artificial intelligence and machine learning are bringing down mortality and improving quality of survival all at an affordable cost.

(The author is chairman of ACI Hospitals)


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