“Choosing Wisely” for Cancer Care in India

Cancer services in India have evolved and expanded significantly in recent years, with a surge in the availability of biomedical oncological treatment facilities for certain cohorts of the Indian population in urban areas. Despite significant and sustained economic development in many areas of India, major issues persist in the delivery of cancer care, even in the context of relatively prosperous urban populations. This article explores the dilemmas evident in Indian cancer care as perceived by a group of Indian oncology clinicians. Specifically, the interviews focused on their perspectives on the key challenges facing cancer patients, particularly in relation to help-seeking and access to care. The main concerns that emerged in the interviews were: (a) practical constraint (i.e. access and treatment); (b) cultural values (i.e. communication, stigma and the clinic); and (c) structural conditions (i.e. inequalities related to place, gender and class). We unpack these as important elements of cancer care in contemporary India, and present Farmer's notion of structural violence, among other concepts, as potentially useful for understanding some facets of this social problem. We conclude that without a greater understanding of social and cultural issues shaping cancer care in India, little progress will be made in coping with a disease that is set to become a major burden within an increasingly prosperous and ageing population.

Income tax deductions aimed at alleviating the financial strain of catastrophic health expenses, prove inadequate in supporting cancer care in India. First, the stringent eligibility criteria for accessing this tax deduction restrict its availability to a narrow segment of the population. Typically, it is granted only to those who receive treatment at government-sanctioned medical facilities. Consequently, this deduction excludes a substantial number of patients, intensifying their financial woes. Moreover, the maximum deduction amount, despite sporadic revisions, falls short in the face of skyrocketing cancer treatment costs. The current structure of the income tax deduction does little to alleviate this burden, as the deduction often pales in comparison to the actual costs incurred. Rather than dissolution of this provision in the new tax regime, we propose a reform and reevaluation of the income tax deduction framework to ensure it genuinely fulfills its role in alleviating the financial strain of cancer care in India.

Dr. V. Shanta (1927-2021) made priceless contributions that significantly changed advanced cancer care in India. Trained at Madras Medical College and further trained in oncology internationally, she transformed the Cancer Institute in Chennai from a 12-bed facility into a leading cancer care institute of global repute. Dr. Shanta championed early cancer detection and sought to dismantle the stigma surrounding the disease, particularly in rural communities. Under her leadership, the institute introduced pioneering technologies and established India's first pediatric oncology institute. She was instrumental in creating comprehensive cancer registries that informed national health policies. Her dedication to holistic, patient-oriented care and her commitment to equitable healthcare earned her numerous accolades, including India's highest civilian awards such as the Padma Vibhushan and Padma Bhushan and Asia's premier prize the Ramon Magsaysay Award. Her work remains a cornerstone of oncology in India, continuing to inspire future generations of medical professionals.

Cancer remains a formidable public health challenge, with the financial burden of treatment placing many families under severe economic distress, particularly in low-to middle-income countries like India.Recognizing this, the Indian Union Budget for 2024-2025 introduced customs duty exemptions and GST reduction (from 12% to 5%) on three high-impact cancer drugs: trastuzumab deruxtecan (TDxd), osimertinib, and durvalumab.This policy change marks a critical step toward making life-saving therapies more accessible and affordable, potentially significantly improving patient outcomes.

Addressing the challenges of head and neck cancer care in India – A compelling need of the hour

<title>Abstract</title> PURPOSE Over 75% of Indian households affected by cancer face catastrophic health costs. Support from non-governmental organisations (NGOs) and corporate philanthropy, through initiatives such as Corporate Social Responsibility (CSR), which involves corporate funding for social development, helps address health disparities. This study explored factors influencing CSR spending on cancer projects and associated barriers and facilitators. METHODS In-depth semi-structured interviews were conducted with 15 NGO and 3 CSR stakeholders. Data were thematically analyzed using an inductive approach until saturation was reached. RESULTS Participants indicated that CSR funding for cancer initiatives was affected by four factors: 1) misalignment between corporate priorities and NGO cancer care needs, 2) neglect of NGOs’ operational and capacity-building costs, 3) businesses’ preference for initiatives in their close vicinity, and 4) outcomes of the diseases. NGOs seeking CSR funding for cancer care faced barriers, including limited attention to sustainability and long-term impact; limited organisational capacity to meet communication, reporting, and administrative demands of CSR grants; and the competitive disadvantage of small or grassroot NGOs versus larger, well-established organisations. Despite these challenges, participants identified facilitators and opportunities to enhance CSR’s impact, such as adopting innovative partnership models between corporates and NGOs, extending CSR support to non-medical care costs like lodging, educational outreach and nutritional assistance, and fostering collaborations where established NGOs share CSR funds or expertise to support smaller organisations in joint cancer care projects and a tendency for companies to contribute when leaders or staff had personal or family experiences with cancer. CONCLUSION This is the first qualitative study to highlight the determinants, barriers, and facilitators of CSR spending on cancer care in India. While India’s mandatory CSR legislation has increased investment in social development, its full potential in cancer care remains untapped.

Living with cancer is a challenge to the individuals and their families. This is a personal perspective of a person living with a diagnosis of cancer for over a decade and as psychiatrist supporting others in a similar situation and their caregivers. The challenges are medical, psychological, social, and spiritual. In the care of persons living with a diagnosis of cancer, there is a need to mobilize all of the resources toward relief and recovery. In the Indian context, to make sense of the uncertainties, spirituality in various forms is harnessed by the patients and their families. Epics and religious stories are routinely used to make sense of the pain, distress, and uncertainties of living with cancer. It is for the caregiving professionals to understand this rich resource in India, and develop ways of maximizing the value of spirituality in the care programs. Systematic study, documentation, and adaptation of the spiritual resources of different religions and communities in the cancer care could be an important Indian contribution to cancer care in the world. Such a development could be similar to the universal acceptance of the value of yoga in the recent years.

Cancer Care in India: An Interview with Past IDEA Recipient Dr. Navneet Singh

754eP The role of businesses in supporting cancer care in India: Priorities, barriers and facilitators

Revolutionizing cancer care in India: pioneering low-cost, next-generation CAR-T cell therapies to position India as a global leader in precision oncology

EXECUTIVE SUMMARY Oral cancer is the term described as cancers occurring in the mouthparts that include lips, cheeks, sinuses, tongue, hard and soft palate, or the base of the mouth extending up to the oropharynx. Globally, oral cancer ranks 17th among all types of cancer in terms of both incidence and mortality. India has the largest number of oral cancer cases in the world, and this constitutes more than one-third of the total global burden. In India, oral cancer ranks as the second most common cancer, and is the number one cancer among males. In India, around 130,000 new cases and &gt;75,000 deaths were reported only in the year 2020, with an expected doubling of incidence by 2040. This burden of oral cancer is further complicated by the late-stage diagnosis and low survival rates. In India, the majority of oral cancer cases are reported in the advanced stages, and hence, the chances of cure are very low. This report provides an insight into oral cancer as a public health problem in India, along with etiology and strategies to diagnose, treat, and prevent it while providing recommendations to improve upon the availability and delivery of treatment for oral cancer. The predominant risk factor for developing oral cancer is tobacco consumption. The continual use of tobacco in both smoking and smokeless forms is a major contributor to tumor development in the oral cavity. Other risk factors such as alcohol, diet and nutrition, oral thrush, dental problems, chronic irritation from sharp teeth or ill-fitting dentures, and human papillomavirus (HPV) infection also contribute to the burden. Further, social, cultural, and psychological factors too play an important role in developing oral cancer. Oral potentially malignant disorders (OPMDs) are a diverse group of conditions that are the precursors of oral cancer. It is important to recognize that a patient diagnosed with an OPMD has an increased risk of developing oral cancer compared to a person with a healthy mucosa. Lesions such as Erythroplakia, Erythroleukoplakia, Leukoplakia, Proliferative verrucous leukoplakia, Submucous fibrosis, Palatal lesions associated with reverse smoking, oral lichenoid lesions, oral lichen planus, smokeless tobacco keratosis, and more are the common OPMDs seen in the country. Oral cancer screenings, which are conducted to identify any clinical premalignant phase (accessible to visual inspection), are usually done on a mass scale and shows a decreased burden of advanced oral cancer incident cases and deaths as compared to no screening. Among the screening strategies, it is suggested that high-risk screening is cost-effective compared to mass screening at periodic intervals. Oral cancer screening methods vary across healthcare settings, each with its advantages and limitations. While visual inspection remains a fundamental tool, adjunctive technologies are sometimes used in dental clinics; community outreach programs and telemedicine extend accessibility to screening. The Ministry of Health and Family Welfare, Government of India, has prepared a universal and objective operational framework for cancer screening and management that aims to promote, coordinate, and conduct research to better understand, detect, diagnose, and treat cancer. The framework makes it mandatory to perform screening of oral, cervix, and breast cancer for males and females above the age of 30. Concerning oral cancer treatment, several modalities are available; however, the cure depends on the cancer stage when diagnosed and the delay in starting treatment. Primary surgery is the preferred modality of treatment for a vast majority of operable oral cancers. Radiotherapy is an alternate for early-stage oral cancers with comparable control rates to surgery. Typically, the primary treatment for oral cancer is surgery. The primary goal of surgical resection is to ensure complete removal of the tumor tissue. However, the potential negative impacts on appearance and functionality due to the extent of the disease and the necessary surgical removal stress the importance of using less invasive surgical methods. The National Cancer Grid Management Guidelines for early-stage cancer recommends surgical local excision with a minimum of 1 cm gross margin, accompanied by appropriate neck dissection and suitable reconstruction. For advanced stages, surgery is preferred, along with adjuvant radiotherapy or chemotherapy. Oral cancer in its entirety imposes a significant fiscal burden on a national, institutional, family, and individual level. Funding of cancer care in India is a complex mixture of state and government accountabilities, with the government shouldering most of the responsibility. Oral cancer as such, has not been given a separate budget in India, but it is covered under various facilities of the government, schemes, and programs for cancer. This report entails the Task Force Committee recommendation for screening, diagnosis, prevention, and management of oral cancer, along with research, policy, and advocacy recommendations to address this immense public health problem in the country.