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cover ) Cancer care is

cover ) Cancer care is an essential component of all health systems. The economic burden of cancer is considerable and is increasing signficantly. According to American Cancer Society Report, the total economic impact of premature death and disability from cancers worldwide was $895 billion in 2008, representing 1.5 per cent of the world’s Gross Domestic Product (GDP). This figure increased to approximately $1.16 trillion as per the World Cancer Report 2014 by International Agency for Research on Cancer. Yet, with only limited knowledge available, we are far from analysing the spendings associated with cancer care. Considering the immense impact of cancer on patients and their families, in terms of physical health and financial health, there is an urgency to identify more evidence about the cost efficacy of cancer care. The India story With limited sustained funding and only a few centres of expertise in India, the domestic situation is much worse in comparison to the global scenario. Indian Council of Medical Research (ICMR), in its 2016 projection, said that the total number of new cancer cases is expected to be around 14.5 lakh and the figure is likely to reach nearly 17.3 lakh new cases in 2020. Data also revealed that only 12.5 per cent of patients come for treatment in early stages of the disease. The fact that often cancer is diagnosed only at critical stages adds to the already steep economic burden that the ailment poses on the nation. The situation is worsened when people with a genetic predisposition to cancer, for instance incidence of breast cancer in close relatives, also feel no necessity to get screened. The cost angle Sandeep Kothari, Vice Chairman, Bhagwan Mahaveer Cancer Hospital & Research Centre (BMCHRC) says, “Cancer treatment can turn out to be a nightmare in terms of costing. One of the major reasons for this is wide treatment protocols which vary across a broad range, depending upon the site of cancer and the stage at which it is detected. In a country like India where a majority of cases are reported at the third and fourth stage, the treatment can cause a hole in the pocket as most often, depending on their type and stage of cancer, patients will require more than one form of treatment which leads to increase in treatment cost. Dr Ninad Katdare, Consultant - Surgical Oncology, Global Hospitals, Mumbai further explains, “Even though numbers of cases are rising at an alarming rate, the per capita income is not increasing proportionately. Nor are the patients from low socio-economic strata able to afford insurance. A s urvey done at All India Institute of Medical Sciences (AIIMS) in 2011 among patients with the most prevalent cancers like head and neck, cervix and breast reported that the average monthly per capita income of households was `1749. Half the households had monthly per capita income of less than `1000.” Another expert, Dinesh Madhavan, Director Healthcare Services, HCG Enterprises pointed out a few other factors, including lack of domain specific practice among most centres and minimum focus on innovation which contributes to rising cost of cancer care. He elaborates that due to lack of newer and better indigenous technologies for cancer management, most of it has to be imported, thus increasing dependency and multiplying cost. Zoya Brar, Founder & MD, CORE Diagnostics also highlighted, “The recent years have seen a major leap in developing technologies to screen for and diagnose various cancers. Advances in pathogen detection, imaging and even personalised medicine treatments have unfortunately also added to the rise in the cost of cancer care in the country.” Moreover, in a nation like ours, insurance penetration is relatively modest and most of the medical aids involve high out-ofpocket expenses. This has a multifold negative impact on the financial situation of any cancer patient adding to the existing loss of productivity due to the disease Loss of productivity Although the cost associated with treatment of cancer is predominant, another considerable economic impact of cancer is in terms of loss of life and productivity. Thus, there is an urgent need to come up with effective measures to battle this beast. Fortunately, the multi-faceted nature and the magnitude of the problem has caught the attention of healthcare stakeholders. Collaborations to conquer cancer The loss of productivity and life can only be managed by innovation and extensive research, but escalating costs of treatment can definitely be handled through joint efforts put in by multiple sectors. Agreeing with the idea, Madhavan shared that the way forward in cancer lie in meaningful collaborations between public and private enterprises or between private enterprises. The benefit of this and its aggregation will ensure that cancer treatment is addressed appropriately to create better access and outcome that leads to a better quality of life. He opines, “The next few years of collaborative work will need to be in research, centralised physics, innovation, sharing of resources, protocols, data analysis, early detection, precision medicine, empathy and accessibility. If we ensure to work together, the current cancer burden of over 1.2 million plus newly diagnosed cancer patients can be better managed and ensure the quality of life. If not, the burden of these 1.2 million patients and those already under treatment will be a stark reality.” Empowering the public sector In 2011, World Bank reported through World development indicators that India spent an estimated 3·9 per cent of its gross domestic product (GDP) on 22 EXPRESS HEALTHCARE February 2018

( FOCUS:CANCER CARE healthcare (both public and private funding) and only 21 per cent of which was contributed by the public sector. Though the contribution is relatively low, the sector can be revitalised to improve cancer care significnatly. On the positive side, the Government of India has instigated some commendable initiatives, for instance the National Cancer Grid (NCG). NCG, funded by the Government of India through the Department of Atomic Energy, is amongst the largest cancer networks in the world. It aims to work towards uniform standards of care by adopting evidencebased management guidelines, which are implementable across these centres. Dr Katdare also added, “This plan is to bring parity of cancer treatment in various tiers of the society and provide uniform cancer in all parts of the country. The public domain in the form of the regional cancer centres like Tata Memorial Hospital, WCI Adyar, RCC Trivandrum etc are also doing great work. They are also establishing many other branches of Tata Memorial Hospital in various parts of the country.” Other central schemes to financially support specific population groups include Health Minister’s Cancer Patient Fund (HMCPF) is for patients living below the poverty line; Health Minister’s Discretionary Grants to assist poor patients and Central Government Health Scheme (CGHS) for retired Central Government employees & dependents. Even railways offers completely free travel to cancer patients and air concession of 50 per cent is offered to patients traveling for treatment. Kothari also highlights, “Medicines used for the treatment of cancer are highly expensive and it is extremely difficult for many patients to afford them. In addition to opening exclusive cancer centres across states, the Health Ministry is also planning to reduce the cost of expensive medicines, while putting the least pressure on pharma companies in terms of the price margins. This model will result in the government’s own retail system for cancer drugs, like the Jan Aushadhi stores, where generic medicines are sold at much lower prices compared to the branded ones. This way the government plans to ensure availability of quality medicines at affordable prices to all’. Also the government has decided to extend CGHS kind of model to other cancer patients as well.” V Thiyagarajan, MD, India Home Health Care also informed about the EXPRESS HEALTHCARE 23 February 2018

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