Today, cancer care has evolved by leaps and bounds but we have not gotten rid of the negative cancer terminology like palliative care, terminal disease, or Stage IV. Why can't we treat cancer like any other chronic disease? A diabetes patient is never told he is a victim of diabetes, or he is being given palliative care.
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
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.
Associated with HealthCare Global
B S Ajai Kumar is an Indian oncologist and entrepreneur. He is the founder and executive chairman of HealthCare Global Enterprises Ltd, a South Asian provider of cancer care.
Kumar got his MBBS from St. John's Medical College, Bangalore. He completed his residency at University of Virginia Hospital. Then, he obtained a MD at MD Anderson Hospital in Houston, Texas.
During the course of his career he visited India frequently. In 1989 he founded Bharath Hospital and Institute of Oncology in Mysore, built with grants given by the government of the United States through a non profit trust. He began practising value based medicine, which consists of giving the same treatment at a much lower cost than in the United States and Europe. Then he started the Bangalore Institute of Oncology.
He practised for two decades in USA (he was charged by the Board of Medical Examiners of the State of Iowa with professional incompetence and practice harmful or detrimental to the public; he surrendered his Iowa license to resolve the matters in 2006); in 2003 he decided to return with his family to India, and in 2005 he formed HealthCare Global Enterprises (HCG). introducing new technology for cancer treatment. In 2021 HCG had around 21 comprehensive cancer care centres.
He also partnered with Kamini A. Rao to establish fertility centers in India in 2013.
Kumar is also the President of Association of Healthcare Providers Bangalore and Chapter and Advisor of the Federation of Healthcare Associations. He has given several talks at Harvard Business School and other universities and participates in different health initiatives.
Board of Directors
Health Care Global Enterprises has been defining the future of cancer care in India by designing, building and managing cancer centres with a steadfast vision: To transform cancer care environment by bringing core clinical services in one centric place. The intent of this single place is to help patients achieve longer, better lives and to improve cancer care, one centre at a time.
At HCG, we view each centre as a model of excellence – a place where physicians can achieve professional fulfillment and breakthrough in patient care. We are committed to creating an environment that fosters the professional achievements of each person who crosses the thresh hold of a centre. And by sharing these achievements across the network, the achievements of each centre, each physician and each hospital are further heightened. Patients are the beneficiaries of these achievements – every accomplishment brings us one step closer to our ultimate goal of better lives for cancer patients and their families. Health Care Global Enterprises is currently a leader in cancer care managing a network of 20 cancer centres that span India. Each centre is provided with a business system, management expertise and capital resources to bring patient focused, state of art cancer care to new regions across the world.
Bharat Cancer Hospital Mysore
Being a registered non-profit organisation, it provides treatments at a nominal cost. For the high-quality service provided by us, our hospital was honoured with the “Rajyothsava Award” by the Government of Karnataka during 2003-04.
MD Anderson is widely considered to be one of the foremost cancer hospitals in the world. The MD Anderson Center provides care to over 174,000 people annually and employs more than 22,000 people.
Frost & Sullivan
Frost & Sullivan is an American business consulting firm. It offers market research and analysis, growth strategy consulting, and corporate training. It has about 45 offices in the Americas, Africa, Asia and Europe; the principal office is in Santa Clara, California.
Frost & Sullivan was started by Dan L. Sullivan and Lore A. Frost in New York City in 1961. In the 1970s it started a corporate training division, began sponsoring conferences and industry meetings, and opened an office in London.
In 1982, it was publicly traded, and had annual revenues of $9.1 million. By 1987 revenue had grown to around $17.5 million, with $290,000 in net earnings. Theodore Cross acquired 53% of the stock in the mid-1980s. In January 1988 the company was taken private by merger with a subsidiary of FAS Acquisition Co., a company formed by Cross and Warburg Pincus Capital. It was sold to David Frigstad in 1993.
A sales office in New York was damaged in the September 11 attacks. During the ensuing recession the company laid off 10% of its 700 staff.
Frost & Sullivan issues industry awards based on research using a proprietary methodology, which is sometimes based on a single article produced by the receiver of the award. Organizations that receive a Frost & Sullivan award must pay a fee to communicate the outcome to the public.