Delivering cancer care in India: doing things differently and getting it right
1,2 Soumitra Shankar Datta and Eduardo Cazap3
1 Senior Consultant, Dept of Palliative Care and Psycho-oncology,Tata Medical Center, Kolkata, India 700160
2 Honorary Researcher, Institute of Clinical Trials & Methodology, University College London, United Kingdom
3 Editor-in-Chief, ecancer, 13 King Square Avenue, Bristol, BS2 8HU, UK and President, Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
Corresponding Author: Soumitra Shankar Datta Email: ssdatta2000@yahoo.com
This special issue aims to highlight some of the challenges of cancer care delivery in low- and middle-income countries (LMICs) and the way these could be overcome. We have six papers in this special issue on a wide range of topics such as 1) diagnostic performance and survival outcome of Sentinel Lymph Node Biopsy (SLNB) procedure in 1500 breast cancer patients from a tertiary cancer care centre 2) information sharing preferences of professionals looking after children with cancer 3) Outcome of clinico-radiologically advanced cancer (cT4b) of buccal mucosa 4) Pre-operative risk factors associated with a post-operative psychiatric diagnosis in oral cancer patients, 5) A public policy analysis with key stakeholders' insights to understand India's compliance with the WHO Framework Convention on Tobacco Control 6) Teaching breast cancer surgery in India: Challenges and opportunities.
Even frugal innovations can make a big impact on cancer outcomes. The paper on sentinel lymph node biopsy by Agarwal et al reports data on 1500 women with early breast cancer adopting a technique of combining blue dye and ICG methods. The authors feel this is the way forward for LMICs as it is a cheaper alternative to radioactive dye and more accessible to clinicians in LMICs. The technique when used appropriately would avoid unnecessary axillary dissections in many patients and possibly lead to improved quality of life. This is a perfect example of frugal innovation that may have far-reaching consequences. Not all that is done has to be expensive. We hope it will help readers to learn and adapt their practices in cancer care.
Survival in childhood cancers has improved in the past few decades [1] and it is not unusual to come across parents wanting detailed information on the outcome of childhood cancers. The special issue has a paper that reports on the communication preferences of professionals in paediatric oncology. The paper has used a qualitative research methodology. The authors suggest a model for communication that is suitable for LMICs to provide a stable foundation of care for children with cancer.
In another paper, Jain et al discuss the benefits and outcomes of upfront surgical treatments of cT4b buccal mucosa squamous cell carcinoma. The authors discuss this in the context of choosing a path of curative treatment for this group of patients, in contrast to being deemed inoperable had they adhered to some of the other treatment guidelines. Let's hope this starts off a debate on the treatment of such cancers. There is another paper on post-operative psychiatric morbidities and their management strategies in oral cancers. Head and Neck cancers, although one of the commonest cancers in India [2], require intensive treatments and need to be managed holistically.
The special issue has an interesting article by Ghose et. al. on public policy analysis using a novel methodology of juxtaposing the findings of qualitative interviews of key stakeholders alongside analysis of secondary data available in the public domain. This paper also addresses the strengths and gaps of the tobacco control policy in India.
The last article by Agrawal et al discusses the challenges and opportunities of teaching breast cancer surgery in India and the authors cover the way students could be trained during their undergraduate, post graduate and super specialist training.
India currently has a high cancer burden [3]. As editors, we hope that this special issue will contribute to the planning of future cancer services in India. Providing holistic care that is sensitive to the physical and emotional needs of the patient is crucial. We need preventive programs, early identification of patients as well as cost-effective cancer care that is evidence-based and accessible to the patient.
References
[1] Lam CG, Howard SC, Bouffet E, Pritchard-Jones K (2019) Science and health for all children with cancer Science 363 (6432) 1182–6
[2] World Health Organization: International Agency for Research on Cancer. Cancer Today: Data Visualization Tools for Exploring the Global Cancer Burden in 2020 [Internet]. [cited 2022 Apr 10]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf
[3] Mallath MK, Taylor DG, Badwe RA, Rath GK, Shanta V, Pramesh CS, et al. (2014) The growing burden of cancer in India: epidemiology and social context Lancet Oncol. 15 (6) e205–12
