Technology to improve cancer care outcomes in India
The traditional management of cancer through the establishment of large, comprehensive cancer centers is ineffective, especially in a developing country that has poorly-developed primary healthcare facilities.
By Dr. Moni Kuriakose & R. Venkataramanan, Karkinos Healthcare
ETHealthWorld, February 03, 2022: “Close the care gap” is the theme of this year’s world cancer day and this is absolutely fitting for India, since one in ten adults in India face the probability of being afflicted with cancer at least once in their lifetimes. Cancer care is considered a parallel service to the rest of the healthcare, in contrast to other non-communicable diseases such as cardiovascular diseases, where primary care and specialists are actively involved in management. To effectively “close the care gap”, the cancer centers of tomorrow need to be integrated with primary healthcare and multi-specialty medical institutions.
Cancer care is based on planned protocols, so such an integrated approach is eminently feasible. This would deliver care closer to the patient’s home, decentralize and democratize access to quality cancer care, and unclog the existing apex cancer centers, which can shift focus onto managing complex cancers and innovations. The impact of which would be transformational, however needs a different approach.
A distributed, comprehensive cancer care model
Cancer has a stigma, synonymous with suffering and mortality. However, many cancers are now curable if diagnosed at an early stage, and even if diagnosed at late stage effective management can improve quality of life. But this requires a multi-disciplinary approach and adherence to protocols. Even then, outcomes vary between economically similar countries, and even different regions within countries. This begs the question of whether improving the care delivery process can actually improve the outcome of the disease.
Most attempts to improve cancer outcomes have established strategies involving patient-centricity, with a spotlight on early detection and prevention. The traditional management of cancer through the establishment of large, comprehensive cancer centers is ineffective, especially in a developing country that has poorly-developed primary healthcare facilities. This approach burdens apex centers, requires patients to travel long distances and incur additional expense. Building a large number of less-sophisticated care centers also doesn’t work, as they cannot deliver comprehensive cancer care.
The integrated approach to cancer care in India must also bear in mind inequities in healthcare access and the uneven distribution of oncologists across the country. There are less than 1000 formally-trained medical oncologist in India, mostly concentrated in the top nine or ten Tier-1/Metro cities. The ratio of oncologists to cancer patients is a dismal 1:2000, compared to 1:100 in the US.
Technology to democratize cancer care
Digital technology could play a huge role in developing a network that connects expertise at the top of the pyramid to where it is most required: to the community. Such a distributed cancer care network (DCCN) can cover most of the key elements – from diagnostics to care planning, treatment delivery, psychosocial support, palliative and survivorship care – without burdening a single center. This can be done by empowering general physicians, nurses, gynecologists’, dentists and other abundant resources in the system to facilitate the first level of screening and diagnosis, reducing load on apex centers.
Digitally-enabled coordination of cancer care
Cancer treatment requires multidisciplinary care delivery as per a predefined protocol, right from diagnosis to treatment and surveillance. These protocols can be automated and monitored digitally. The first step is educating people about cancer and the importance of early detection. This should be distributed and integrated with existing primary healthcare facilities, which should anchor coordination of care close to the patient’s home. The patients need to be triaged to various cancer treatment centers based on location and clinical needs. This can be achieved by establishing digitally-enabled community cancer centers that promote early detection, surveillance, coordination of care, and offer day care chemotherapy. By setting up multiple such community centers along with primary healthcare services, we can make cancer care affordable and accessible to people living in rural areas.
Once a patient is diagnosed, treatment decisions can be made by a geographically distributed “tumor board” via teleconsultation. Specialists and multi-disciplinary resources become available closer to the patient. Assembling various technology solutions that can facilitate care closer to patients while being monitored remotely by experts, is a technically feasible solution. With currently available technology, we can automate parts of the process by enabling Artificial Intelligence and guidance systems, which can collect data and patients’ medical information. This will reduce human error and upskill the labor force employed at the points of care. The execution of the treatment then can be carried out in various cancer centers based on clinical needs.
This is being successfully implemented in Idukki district in central Kerala, with no existing cancer centers, and Ernakulam with one of the highest numbers of cancer treatment facilities. Enabled by the Karkinos cancer technology platform, six community cancer centers in multispecialty hospitals are connected to two apex cancer centers and an advanced cancer diagnostic center in the city. This network is being expanded to cover the entire state, with 70 community cancer centers proposed state-wide. This potential blueprint can be replicated in any other state or country.
Currently, most cancer discoveries take place in developed nations, leading to a widening of the knowledge gap, and consequently, the need to continuously catch-up with “closing the care gap”. The cancer solutions being developed are either not appropriate for developing nations, or are unaffordable. The cancer management ecosystem ought to be a fertile ground to nurture innovations and start-ups involved in designing frugal solutions. This could result in the development of the overall cancer healthcare ecosystem in India, and help sustain the country’s overall social development agenda. This would not only help to “close the care gap” of today, but contribute to advancement in the field.