Thought Leadership

It is indeed tragic that most Indians across generations are groomed from their formative years to subscribe to a flawed interpretation of the Karma theory and the caste system built on a fatalistic premise, which assumes without second thought that whatever happens (or does not happen) is the outcome of our good or bad karma
Dr. B. S. Ajaikumar

There are key advancements in cancer treatment, but how to address care disparities

  • Date: 2024-03-28 07:52:59
  • Author: Dr. BS Ajaikumar
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There are key advancements in cancer treatment, but how to address care disparities

One of the most probable causes of cancer is inflammation, as it often leads to conditions where the immune system becomes impaired and even turns counterproductive. The recent breakthroughs in targeted therapies have vastly enhanced the prognosis of inflammation-induced diseases and disorders. If treated properly in time, cancer can be brought down to the level of a chronic disease, which is why precision medicine has become the most pivotal breakthrough discovery of our times.

Precision Medicine, Targeted Therapy & Robotic Surgery

 

What does precision medicine mean in layman terms? Simply put, precision medicine replaces the legacy way of treating every cancer patient using standard protocols and guided by randomised trials. It personalises the treatment to ensure that the curative process is in line with the specifics of the patient. 
 
If two patients have been detected with the same disease in the same organ of origin and share the same pathological condition, why does treatment invariably induce different responses in the two? What is the root cause — is it  the genomic heterogenicity; is it subtle difference in pathology; or even if the pathology is the same, is it a hot tumour or cold tumour; what are the PD-L1 expressions and molecular diagnostic expressions?— and so on and so forth. The actionable genes guide us to the right therapy. 
Precision medicine goes into the depth of the above questions and personalises the treatment through the right therapy for each patient such that both gain from lasting outcomes. A multi-disciplinary approach to cancer care is fast becoming the norm to provide the right treatment the first time. For instance, lung cancer therapy has advanced by leaps and bounds and even people with advanced disease are seeing better outcomes with targeted therapy and immunotherapy. Laser technology has transformed early-stage laryngeal cancer treatments and robotics has been a game changer for advanced-stage cancer treatments.   
Precision medicine is a work in progress of moving targets which is why we will accomplish a series of fascinating advancements on this highway of disruptive innovation, leading to research-backed discovery of new drugs.  In the coming time, healthcare will increasingly benefit from a broad spectrum of technologies including robotic surgery,  laser therapies, extended reality,  molecular targeted imaging, digital pathology, and cellular immuno-oncology therapy.
Disparities In Healthcare
 
As regards disparities in healthcare, a despairing rich-poor and urban-rural divide is still one of the most daunting challenges facing India, although in recent times, access to quality healthcare in India’s two-tier and three-tier towns is steadily improving. Some cancer specialty hospitals, especially the ones that operate with a hub and spoke model, progressively incorporates newer, peripheral geographical territories. Many remote centres like Ongole and Ranchi are now equipped with linear accelerators, as also access to the best of breed genomic and molecular diagnostic insights and specialist advice of the metro hubs.
 
Having said that, India’s towns and villages yet face a paucity of competent doctors, nurses, administrative staff, and healthcare activists. Notwithstanding the fact that there are government schemes to cater to the poorer sections of the society and they are doing a good job overall, they are not able to bridge the gap when it comes to high-quality advanced treatments like immunotherapy and robotic surgeries, as the reimbursement rates fall short of covering the price tags.
 
The mainstream healthcare conversations in our country are fixated on the cost, at the cost of ignoring critical aspects like quality of treatment and outcomes. The cost of ‘low cost’ is detrimental to the sector as it directly impacts the quality of outcomes. 
 
The government must set up an advisory body comprising domain experts, technocrats, and government executives for developing prudent and sustainable solutions to address the healthcare disparities. It can also create an endowment fund for earmarked healthcare spends by monetising weakened assets, vacant real estate, and loss-making ventures. This fund can go a long way in funding critical healthcare initiatives and innovations.
 
Ideally, the government should play the role of a monitoring agency to evaluate the performance of private hospitals, thereby penalising wrongdoers and incentivising performers. 
 
Rich or poor, urban or rural, all patients have equal right to quality treatment. Even though private hospitals are doing their best to bridge the gaps, the ultimate need for India is an universal healthcare cover with no caps, ceilings and limits, which alone will help weed out the existing disparities and institutionalise equality in healthcare. I earnestly hope universal healthcare becomes a reality very soon and transforms healthcare in the truest sense of the word.
 
—The author, Dr. B. S. Ajaikumar, is one of India's top oncologists, and the Executive Chairman of HealthCare Global Enterprises Ltd. The views expressed are personal.