India needs a bold approach to bridge the access, affordability gap in cancer care

In India, one in nine individuals is projected to be diagnosed with cancer in their lifetime; the cancer incidence is predicted to climb further due to rising pollution, urbanisation, and poor diets and lifestyles

India has made notable progress in recent years in its fight against cancer, with breakthroughs in research and increasing public awareness. Yet, cancer incidence in the country is rising at an alarming rate and is expected to surpass global averages—from 1.39 million in 2020 to 1.57 million by 2025, becoming a major national concern. While inadequate healthcare infrastructure is a significant concern, it is only the tip of the iceberg when it comes to the fight against this illness. The escalating cancer crisis is fueled by deep-rooted socio-economic disparities and limited health tech access, resulting in alarmingly low screening rates and inadequate preventive measures—challenges that hit developing nations hardest. 

In India, one in nine individuals is projected to be diagnosed with cancer in their lifetime. In 2022 alone, 1.4 million people were diagnosed, making India the third-highest globally in terms of cancer burden, behind the United States of America and China. This burden is predicted to climb further due to rising pollution, urbanisation, and poor diets and lifestyles. 

Health system inequities

In Asia and other developing countries, cancer is often diagnosed at later stages (stage 3 or 4), while in North America and Europe, it’s typically detected earlier (stage 1 or 2). These disparities are largely due to the absence of effective cancer care networks, particularly in smaller countries where population sizes may not justify the establishment of comprehensive cancer infrastructure, including tertiary cancer centres. 

Existing and planned cancer care facilities are insufficient to address India’s growing cancer burden. For example, India has only one radiotherapy machine per 1.5 million people, while the World Health Organization recommends at least one machine per 2,50,000 people. A study finds that nearly 70% of Indian population lives in rural India but nearly 95% of cancer care facilities are in urban India.

Cancer research too, is heavily skewed across similar lines with most clinical trials taking place in the likes of the U.S. or France. Although advanced gene editing techniques like CRISPR or IIT Bombay’s CAR-T cell therapy, hold promise for revolutionising treatment, these innovations alone will not be enough to tackle the rising cancer burden across the world and at home. 

While institutes such as IIT Madras are making strides in cancer research with their recent patent to use Indian spices to treat cancer, there is still a need for more Indian patients to sign up for cancer clinical trials to move forward on the road to recovery. 

In India, the average medical expenditure during hospital stay per cancer hospitalisation across public and private hospitals, stands at ₹61,216, a heavy price to pay for most of the population. Cancer treatment is one of the most financially demanding healthcare challenges, contributing to what is often referred to as ‘financial toxicity’. 

Reducing modifiable risk factors

To address the root cause of cancer, India’s control efforts should focus on reducing modifiable risk factors like tobacco, alcohol, menstrual hygiene in rural India and obesity. There should also be a stronger emphasis on increasing access to care and improving outcomes for those already diagnosed.

Currently, most efforts are directed towards expanding and upgrading treatment facilities. However, there is limited focus on developing country-specific evidence for key areas such as prevention, early diagnosis, access to care, survival rates, and palliative care. Strengthening primary care services is the need of the hour to shift the needle to early diagnosis. Emphasizing quality and value in these areas is crucial for long-term success.

A strategic effort

India still has a long way to go, but it is committed to progress. Government health expenditure stood at 1.9% of India’s GDP in 2023-24, and is expected to increase to 2.5 per cent of the GDP by 2025. This, combined with policies allowing for faster drug approvals, and notable home-grown innovations like IIT Bombay and Tata Memorial Centre, Mumbai’s CAR- T Cell therapy, there is momentum towards developing a stronger healthcare system and a cancer-free future. 

In the Northeast, where cancer rates are triple the national average, the ‘Megh CAN Care’ programme, in partnership with the Meghalaya government and Apollo Hospitals, aims to provide free cancer screening for one million people. This public-private model could become a blueprint for other States.

The need for a global clarion call

National efforts alone are not enough to brave this challenge. Countries must collaborate as a global cooperative to address this challenge effectively. One critical initiative in this collective effort is the establishment of a common cancer observatory, comprising various nations. I have enumerated this in detail, in an essay for The Lancet, written in collaboration with colleagues from Harvard University and The University of Toronto. This observatory proposed by us would define a core, harmonised dataset on cancer, aligned with indicators that cater to underdeveloped nations. It would include a comprehensive system for the regular collection and analysis of data related to cancer control resources—such as human resources, infrastructure, and health services.

By participating in this global observatory, India will have access to critical, standardised data that can directly inform national policy decisions. This data-backed approach can help optimise funding allocation, ensuring that resources are directed to the most pressing needs. Moreover, this enables more effective, region-specific cancer control initiatives working in tandem with local healthcare infrastructure and challenges.

Our proposal further suggests that this observatory be supplemented by a taskforce, to improve regional networks to provide timely access to effective health services, especially for countries with small populations and for small island states. Vedanta’s BALCO Medical Centre (BMC) is one such 170-bed cancer care centre, and we need many more across the country. BMC was created by Vedanta Medical Research Foundation (VMRF), dedicated to making world-class cancer care accessible and affordable across Chhattisgarh. 

India stands at a critical juncture in the fight against cancer, where innovation and inclusivity must converge to address one of the country’s most pressing health challenges. By 2030, nearly three-quarters of all cancer deaths will occur in developing nations, including India, underscoring the urgent need for a more combative approach. This means not only investing in advanced treatments but also focusing on prevention, early detection, and health equity across urban and rural landscapes. To truly impact lives, we must tackle the socio-economic divides that prevent millions from accessing timely, affordable cancer care. India’s approach must be bold and comprehensive—a model for health systems that prioritise every life, because our progress will be measured not only by medical achievements but ultimately, by the lives saved and the barriers broken.

(Dr. Bhawna Sirohi is cancer specialist, BALCO Medical Centre. Bhawna.Sirohi@vedanta.co.in)

Published - November 27, 2024 05:00 pm IST