Cancer In India

Jaslok Hospital and Research Centre.

A decade ago, infection was the most prominent cause of morbidity and mortality in India. With the recent positive change in the economic status and technological advances in our country, there has been an appreciable upgrade in the literacy level. Consequently, health awareness has risen even in the most peripheral regions of India.

Due to its vast size and large population, health care delivery is of variable quality, but is available throughout the country via the central government, state governments and the private sector.

There has been a prominent shift of focus of attention from infection to cancer over the last decade. In today’s India, cancer is an increasingly important health problem. The incidence is steadily rising due to improvement in lifestyle but because of increased cancer awareness, cancer is being diagnosed much earlier. Today we have infrastructure addressing all aspects of cancer control, including prevention, early detection, diagnosis and treatment. Again both government and private hospitals cater to cancer-related needs. Nevertheless, cancer treatment is still conducted in tertiary referral centers, usually located in the metropolitan cities where chemotherapy, radiotherapy and surgery are all readily available under the same roof.

India has a population of more than 1000 million which leads to more than 800,000 new cases of cancer being detected per year. According to the National Cancer Registry Program, lung cancer is the commonest cancer in men. Lung is a leading site of cancer in women as well, although cancer of the cervix and breast are the commonest cancers in women.

Thawing of peripheral blood stem cell.

Cancer in India is unique from the perspective that it usually presents in a clinically advanced stage in a very high percentages of cases - about 75-80%. There are also some unique aspects of cancer epidemiology in India. For example, tongue cancer in males from Bhopal, and gall-bladder cancer in Delhi have among the highest incidence rates in the world.

Survival rates in most cancers are today comparable with the western world, but vary from center to center within India. Five year survival rates are 40-60% for breast cancer in females and 40-50% for cervical cancer.

Bone marrow transplantation today has become an easily available form of potentially curative treatment. It is being offered by four leading centers in India namely Jaslok Hospital and Research Center, Tata Memorial Hospital, Mumbai, CMC Vellore, AIIMS Delhi and the Apollo Hospital in Chennai. A bone marrow donor registry program has been recently initiated. India has also entered the world of targeted therapy, which is in the limelight in the treatment of cancer worldwide. We have a national surveillance program for the early detection and prevention of cervical and breast cancer and educational programs for breast self examination, and the dangers of tobacco, which are promoted at a national level.

Peripheral blood stem cell collection.

Cancer diagnosis and treatment is expensive all over the world. The same applies for India. For western countries, the cost of cancer treatment is met by medical insurance companies which is not the case for the bulk of Indians. While some of our patients have private medical insurance and state-run mediclaim policies, the bulk of the cost of treatment is borne by the patient himself. There are, however, a number of societies providing financial help for patients seeking cancer treatment, including cancer support groups.

Fortunately today, due to the privatization of pharmaceutical companies, many chemotherapy molecules, including many targetted drugs are being indigenously produced. Both trademarked as well as indigenously manufactured drugs are readily available, the latter being much less expensive.

JASLOK HOSPITAL AND RESEARCH CENTRE: OUR ROLE IN CANCER TREATMENT

Our hospital, Jaslok Hospital and Research Center, a public charitable trust hospital, was established in July 1973. Today, it is a 377-bedded hospital which includes 230 paying, 51 free and 96 subsidized beds. It is a tertiary referral center and a multidisciplinary, multi-faculty hospital and is recognized by the Medical Council of India for the training of post-graduates for the diplomas of the National Boards in internal medicine, pediatrics, neurology, medical oncology, general surgery, nephrology, radiation therapy and interventional cardiology.

Peripheral blood stem cell infusion.

The Medical Oncology Department and Bone Marrow Transplant Unit at our hospital is headed by Dr. S.H. Advani and was first established in 1985. Today it includes 8 medical oncologists, 12 cancer surgeons, chemotherapy nurses, research fellows, a research nurse and a data manager. We have an out-patient department, chemotherapy daycare (six beds) and in-patients distributed throughout the hospital. A bone marrow transplant unit (two beds) performs two transplants a month. We are supported by a blood bank which includes a cell separator and cryopreservation facility. Our infrastructure is complete, with state-of-the-art hematology, histopathology, microbiology, cytogenetics and molecular medicine labs and also an electron microscopy department. We have our own radiotherapy department, which has a linear accelerator and a cobalt radiotherapy unit. We have a “superspeciality” post-graduate training program for trainees in our department registered for the qualification of Diplomat of the National Board in Medical Oncology.

Chemotherapy nurses are well trained in the administration of chemotherapy and also run an intravenous indwelling catheter care clinic. We have an Imaging department, which includes MRI, CT scan and PET scan, all of which contribute greatly to the management of patients. There is a strong interest in research projects and currently our unit is actively involved in multiple phase II and phase III international multicentric clinical trials. In the future we plan to study familial and hereditary patterns of cancer.

We also have several cancer support groups—including social workers, V-care and Make-A-Wish Foundation—that make an important contribution to the overall care of our patients.

On an average we see 50 adult and five pediatric patients in the out-patient department in a day, of which four or five are new. At any one time there are approximately 150 in-patients. In our bone marrow transplant unit we have so far performed 12 allogenic and 38 autologous bone marrow transplants in a variety of diseases. Our unit caters to patients coming from various parts of the country and also from even more distant neighboring countries, including Pakistan, Bangladesh, Nepal, Kenya, Nigeria and other south Asian countries.

We have a fully equipped data management system with an experienced staff, six computers dedicated to oncology clinical trials. Our data manager participated in a training program at the INCTR office in Belgium. We have good access to the Internet as well as our own website: http://www.jaslokhospital.net.

Contributed by Suresh Advani, Department of Medical Oncology, Jaslok Hospital, Mumbai, India.