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Onco-philosophy: Changing the Paradigm of Cancer care in India

June, 2017

Dr. B.S. Ajaikumar, Chairman & CEO, HCG, on how the approach of trying to “cure cancer” is now being replaced by “effective cancer control”

A cancer diagnosis, for every type of cancer, elicits a range of feelings and emotions from anxiety and fear to helplessness and depression in patients and their families. The disease has a profound effect on a person’s state of mind. Most patients go through various stages of denial, shock and finally acceptance. Every patient comes with a burden of anxiety that is very personal. So, for me, every single individual matters deeply and in a different way.

Cancer is more than just a disease. Its management and treatment protocols can only be decided after closely examining each case in order to achieve the best possible treatment outcome. I believe that cancer care involves managing the disease like any other chronic disease such as diabetes or heart disease, while also recognizing that emotions and feelings are an important part of a cancer patient’s journey. It is crucial that we listen, observe and find ways to instil hope throughout the course of the treatment. This is what I refer to as my ‘onco-philosophy’. Using this onco-philosophy as a treatment and management approach to cancer has enabled us to better understand and deal with the disease.

Decades ago, a cancer diagnosis was like a death sentence. Today, however, we have come a long way in our approach to treating and managing the disease. The approach of trying to “cure cancer” is now being replaced by “effective cancer control”, which aims to improve or maintain quality of life as long as possible and by all means for patients diagnosed with cancer. Fortunately, rapid advancements in science and technology are taking us many steps closer to this goal.

The progress we have made is evident in every area of cancer care, from screening and diagnosis to treatments such as chemotherapy, surgery, immunotherapy, biological therapy, and radiation. We have begun to better understand the biology of the disease, enabling us to develop technologies that deliver precision oncotherapy to diseased tissues while sparing healthy tissues. Our onco-care goal is to deliver targeted, personalised and precision medicine. Moreover, we now have better ways to manage nausea, pain and other side effects, allowing patients to live better and more fulfilling lives.

I believe early diagnosis can facilitate good cure rates and reduce the cost of treatment. The way I see it, early cancer diagnosis necessitates the use of high-end diagnostics coupled with an increasing awareness about cancer, effective surveillance and screening programs for high risk communities, and outreach programs in rural areas with telemedicine to aid diagnosis and identification. We now detect 60% of cancers in the early stages compared to 20-30% a few decades ago, largely owing to increased awareness, education and advances in diagnostic imaging.

Cancer is a complex condition, where you find multiple diseases within a disease. However, sometimes we have to accept that the best way to view it is as a chronic entity. To me what takes precedence is finding ways to help the patient lead a healthy, fulfilled life during this period of time. “CURE” therefore has a different meaning for cancer patients: for some it may be to prolong life to see their son getting married, or see him graduate, and fulfilling their wish would help them achieve a sense of accomplishment.

I am reminded of a patient who visited me five years ago. She had an advanced cancer with a life expectancy of 5 months and was prescribed morphine as palliative care. When she walked into my office, she had lost all hope. Together with my team of specialists at HCG, we worked with her and she went on to live for another 5 years! This is just one of the many examples of patients who come to us after undergoing treatment elsewhere. We have established ourselves as a centre for advanced disease with a multi-disciplinary clinic, which believes in psycho-oncology, and the power of positive thinking and family acceptance. This has enabled us to successfully control and manage late stage cancers using a host of treatment options that approach every patient case from a personal point of view. We also believe it is very important to detect cancer at an early stage and that patients follow up immediately on the course of treatment.

I would also like to focus more on how high quality of cancer care can be given to all individuals and how to create a bridge for them to meet their financial needs. When we talk about cancer care, there are various forms of cancer care. We always have to work so that affordable cancer care goes hand-in-hand with quality cancer care. You cannot say, “Let me give you low cost care, but not focus on quality”. There have been various reports where low quality care has led to the increase in mortality. 

We all face this in our daily practice, where a patient needs appropriate treatment which can be in the form of high-end surgery, high-end radiation or medical oncology in terms of expensive or innovative drugs. However, we are unable to give it to them because of the cost that the patient is not able to bear that time.

For example, a patient may need a biological therapy for breast cancer. It may cost them Rs. 5 lakhs for the whole course of 6 months, and the patient may not be in a position to pay Rs. 1 lakh every month. The issue of cost becomes challenging especially In India, where, for various reasons, majority of the patients do not have insurance. However, when we look at the actual cost structure for the high-quality care we provide, India is the cheapest healthcare provider in the world.

Here lies the conundrum. India is multiple countries within a country. While there is a large section – approximately 250-300 million – who fall in the upper-middle class community and can afford treatment, a large majority is in various other jobs like farming, where access to sudden funds becomes a problem. In this regard, majority of the farming community and the middle class communities try to make high quality care accessible by borrowing money, and a lot of them end up borrowing from the moneylenders. This has caused high interest rates and in turn, it has a major impact on their finances for years to come.

The Government has come up with schemes for people below the poverty line. However, if you look at the schemes, they cover only a certain amount of money for a certain type of treatment. In most instances, it will not cover optimum care. It only covers them for a minimum amount of care.

Unfortunately, most of the time, cancer care demands optimum care. It is in these situations that innovation has become critical. While we innovate in terms of technology and treatment, financial innovation is also important. There have been moves by organizations to breach this gap.

Major cancer care providers like HCG have tried various forms, in the past, including an EMI method. Even though it is a novel way of doing, it is not a sustainable model. We now have an exclusive tie-up with groups like Arogya Finance, which came forward to help patients with interest-free loans for the first year. There is, of course, a certain percentage they charge, which is acceptable. Institutions that provide these services benefit from the certainty that funds will come for the right treatment and they can recommend the right treatment to patients. Patients benefit from immediate payment, and have at least a year to pay back the interest. Even if it goes beyond a year, the interest rate is around 6% for the second-year plan, and 8% for the three-year plan.

This becomes an acceptable form of finance, particularly since there is no guarantee given by the patient or no mortgage done on properties. It is based on certain psychometric testing, where the organization conducts it on the patient or the family to make sure that they are reliable for the repayment. The payment will be done within 24-48 hours. This ensures there is no interruption or delay in starting the treatment.

I think these are the various models, which can be carved out as we move forward for the Indian scenario. Obviously, one of the best ways is to encourage insurance companies to come forward and provide low cost health insurance coverage even for a few lakhs to these patients. These kind of schemes have become very viable, particularly for the elderly. As we know, beyond a certain age of 58 or 60, most of the insurances companies do not cover for cancer even though there have been a lot of initiatives from stakeholders to include it. In this regard, programs like the partnership between HCG and Arogya Finance will be a novel model to bridge this gap that exists, and helps deliver proper care at the proper time.

It is a giant step towards the idea of conquering cancer. By integrating onco-philosophy with every aspect of cancer care, we can finally move towards an environment where the highest levels of excellence are met with no compromise in the quality of cancer care delivered. The many advances we have made in cancer detection, treatment, and financial aid have given us the tools to keep the disease at bay for a longer period of time. 

The opinions expressed in this article are the author’s own.