Led by the Union for International Cancer check (UICC), World Cancer Day It is celebrated on February 4 each year to raise awareness, improve education, and catalyze personal, collective, and governmental action to save millions of preventable deaths from cancer. In addition, it seeks to “reimagine a world where access to vital services cancer treatment and care is equal for everyone, no matter who you are or where you live.”
In keeping with this theme, this year UICC has launched a three-year campaign to create more equitable access to cancer services with the theme: ‘Closing the Care Gap’. In the first year, 2022-23, the campaign is about “understanding and acknowledging inequalities in cancer care around the world.”
“By 2030, an estimated 75 percent of all premature cancer deaths will occur in low- and middle-income countries. Importantly, this care gap is not just between high- and low-resource settings. Disparities exist within most countries between different populations due to discrimination or assumptions spanning age, cultural contexts, gender norms, sexual orientationethnicity, income, education levels, and lifestyle problems. These factors potentially reduce a person’s chance of surviving cancer, and can and should be addressed,” Professor Anil d’Cruz said in a press release.
Explaining further, Dr. Shilpi Sharma, Senior Consultant, Head and Neck Oncosurgery, Narayana Super Specialty Hospital, Gurugram added, “This year’s theme focuses on inequality in the distribution of cancer care. Inequity is not just the unequal distribution of resources, but unfair and avoidable differences in cancer care. These barriers can be cultural, educational, financial, socioeconomic, geographic, and gender or age-related discrimination.
As we look on today, let us know more about these inequalities that are widening the gap in cancer care in India.
Lack of availability of health workers and services.
Lack of access to health workers and services continues to be one of the biggest obstacles affecting cancer in the country. Highlighting the same, Dr. Shabber Zaveri, Surgical Oncology Consultant, Manipal Hospital, Old Airport Road, said, “In India, the number of healthcare providers available to treat cancer it is inadequate considering the large number of cancer patients. We have only about 4,000 oncologists for our entire population of 1.3 billion. Most cancer care centers are overcrowded and patients wait a long time for their treatment.”
According to Dr. Zaveri, this problem is much more acute in rural areas. “About 70 percent of cancer patients live in rural areas with little or no cancer care centers. About 95 percent of cancer care centers are located in urban areas. Travel to the urban area, accommodation and financial difficulties are the main logistical challenges faced by the rural population. In addition, cancer treatments require multiple visits for weeks at a time, making trip more challenging.”
The expert further emphasized the scarcity of the latest diagnostic techniques and treatments in India. “There is a noticeable limitation compared to developed countries. Sophisticated treatments like radiotherapythe use of monoclonal antibodies and immunotherapies are not affordable for many patients”.
Socioeconomic Factors Affecting Cancer Care
In addition, socioeconomic factors such as education and financial constraints deprive many of adequate and timely cancer care in India, the experts noted. “India spends less than 2 percent of GDP on health care. Out-of-pocket spending continues to be the main form of payment for more than three-quarters of cancer spending in our country. Although there are government centers, they are overcrowded and patients have to wait days or months before starting treatment, causing a significant delay in treatment,” said Dr. Sharma.
He added: “Although a good number of private hospitals provide excellent quality cancer care, these centers are out of reach for many due to financial reasons. People living in rural areas or small towns have to travel long distances to access basic cancer care, which subsequently delays their timely treatment, making the situation even worse. Similarly, lack of education results in a lack of awareness leading to a delay in cancer screening.”
To recognize these socioeconomic inequalities, JB Sharma, MD, HOD and Senior Medical Oncology Consultant at Action Cancer Hospital highlighted the importance of listening and acknowledging the impact of these factors on cancer survivors in order to think of better ways to deal with them. “Everyone should have a fair chance to live a healthy life, to have better access to health care, especially cancer services, regardless of their educational level, financial status, where they were born, where they live, where they work.”
COVID-19 and cancer care
According to a study by the Institute for Health Metrics and Evaluation (IHME), the current covid disease pandemic it has certainly slowed the progress of cancer care. These delays and decreases in cancer diagnosis and treatment protocols have a great impact on the lives of cancer patients. TO Lancet The study indicated that all cancer services were significantly reduced between 2020-21 in India.
“During these 2 years of pandemicwhat we have observed is that many newly diagnosed cancer patients in 2020 avoided hospital visits and therefore treatment, or switched to alternative treatment modalities, due to delay in treatment they advanced to an advanced stage and missed the opportunity to healing,” Dr. Kanika Sharma, Radiation Oncologist, Dharamshila Narayana Superspeciality Hospital said.
He asked cancer patients not to abandon treatment at all costs and to get vaccinated as a priority unless otherwise indicated. Citing research from American Journal of Epidemiology, he said, “More people will die from cancer than Covid in the next few years. Therefore, the clear indications are to obtain timely treatment with adequate safety measures for all cancer patients.”
Importance of palliative care
Experts point out that palliative care, a special approach to caring for anyone with a serious illness like cancer, can help cancer patients a lot. However, there is a lack of palliative care facilities in the country, making it another factor affecting cancer care.
Explaining the term, Dr. Sharma said, “When cancer patients cannot be cured of their cancer, we try to control their symptoms to improve their quality of life. Is named palliative care. This aims to reduce suffering by achieving control of pain and other symptoms. It’s an important aspect of cancer management that isn’t often talked about.”
Dr JB Sharma agreed, adding: “This does not necessarily mean late stage disease. Survivors, at any stage of the disease, should be given enough support to lead a quality life with minimal suffering. Even just talking about diagnosis, treatment, prognosis and expenses can be part of palliative care.”
Despite its importance in cancer care, India still lags far behind in providing palliative care to patients. “Many more professionals need to be trained in this aspect. With the increasing aging of the population and the increase in cancer cases, a greater number of hospices they need to be established,” said Dr. Zaveri.
How can the gap in cancer care be closed?
The experts highlighted the importance of increased investment and a strengthened health system by the government and policymakers. “Efforts must be made to improve access to cancer care for the entire population in a uniform manner, regardless of geographic and socioeconomic barriers. Simultaneously, we must work to raise awareness among the general public to improve understanding of cancer so that myths, misconceptions, and stigma are minimized. This will ultimately trickle down into cancer prevention, early detection and timely treatment,” Dr. Sharma said.
Dr. Zaveri noted that most cancer patients are not covered by insurance in India, forcing them to pay out of their own savings. “The government makes available schemes like the Ayushmann Bharat scheme and the universal health insurance program to help people with poor economic backgrounds who require cancer care. More such schemes should be encouraged even in the public sector. It is very important to make people aware of these schemes so that they can get enough support and coverage for cancer care,” he said. indianexpress.com.
For Dr. JB Sharma, unity is the key to closing this growing gap in cancer care in the country, as combined efforts can make a world of difference. In addition to providing financial aid and spreading awareness, he also grasped the need for better services and facilities. “There is a need to target preventive and early detection services. A less expensive and more effective health network is the key! Advanced equipment for treatment and necessary medicines must be made available to everyone at fair costs throughout the country,” he concluded.