Interview

Cancer Continues to a Growing Burden in India

Varian, headquartered in Palo Alto, California is primarily focused on cancer treatments such as radiation and diagnostics for the oncology field. Ashok Kakkar, Senior MD, Varian, has been with Varian for about a decade of his 34- year career in the medical technology vertical speaks to Venkatesh Ganesh about advances in cancer management in India

TEAM IMT He’s worked for GE Healthcare and Siemens, among others, while witnessing the evolution of India’s healthcare industry. Aside from radiotherapy, Kakkar says their portfolio includes advanced diagnostics based on artificial intelligence and machine learning to improve overall effectiveness and efficiency within oncology departments.

In an interview with IndiaMedToday, Kakkar points out that conventional allopathy currently relies on three approaches to cancer treatment, usually prescribed together: Surgery, chemotherapy and radiation. Further, on average, globally, 60 per cent of cancer patients have prescribed radiation. In India, a study by Tata Memorial in Mumbai indicates the number is 18 per cent, which is interpreted as insufficient access to radiation.

With many cancer patients struggling just to survive and also being forced to travel long distances for treatment, what is Varian doing to address such challenges?

We are a private institution and work with customers in both the private and public sectors. We are encouraging big private operators like Tata Trust, Tata Group, Apollo and Reliance, trying to educate them about the country’s need for oncology solutions and the opportunities that await.

We are trying to work with them to establish hospitals in tier II and III locations. A few years ago, we signed a contract with Reliance to set up 20 such hospitals, all in tier II and III parts of Maharashtra, out of which five are already in place, and more are expected.

With Tata Trust, we entered an arrangement in Assam, along with the state government, to create a joint venture called Assam Cancer Care

Foundation, which is 50 per cent funded by the state and 50 per cent by Tata Trust.

We provided them with radiation and other technological solutions. In many cases, we directly engage with states like Madhya Pradesh, West Bengal and Tamil Nadu. Some of these states have purchased solutions directly, while some are now looking at a Public-Private Partnership (PPP) model like what Madhya Pradesh is planning in seven of their teaching hospitals, wherein they’ll have cancer facilities on a PPP model.

Another problem faced in smaller locations is hospitals without oncology facilities. It’s said that patients can avail Ayushman Bharat, but then they don't have it.

In such a scenario, how will Varian’s innovations and advancements redefine cancer care?

Having the ability to network and connect facilities with technology in the absence of sufficient high-end, skilled resources at every location is important. Enabling proper knowledge sharing can greatly improve oversight, quality and consistency in the delivery of healthcare services.

Each cancer patient is different, you can’t use the same yardstick, protocol or treatment for everyone. Artificial intelligence and machine learning solutions have the potential to analyse a patient’s unique medical data and recommend treatment options. The doctor can always decide the best course of action, but this technology can help to improve the process if it is perceived as an integrated solution.

Regarding general advancements in radiation, the linear accelerators previously used could provide 50-60 sittings; but today it’s possible to treat 150 patients per day in India. This is an example of why it’s crucial to design equipment with precision, simplicity and efficiency in mind.

What about the cost?

I think they are available and affordable; they are being deployed by a lot of hospitals. But in India, most private hospitals are at the forefront. Of the hospitals, 80 per cent are in the private sector, and 80 per cent of our business is with private customers, only 20 per cent is government.

Government share should increase, especially for a disease like cancer; things must be done fast, and in areas where it may not be very remunerating. Everybody wants to set up a hospital in big cities, but nobody wants to do it in the interior, that's where the shift is needed.

Prices are reducing and radiation is, in the long term, one of the least expensive ways of treating cancer patients. If you compare India with the US and other developed markets, the treatment cost in India is 1/10th of what is charged elsewhere. But even that is remarkably high because it is not backed up by insurance. Even after Ayushman Bharat, our coverage is perhaps less than 40 per cent of people who are covered through third-party insurance.

The technology is available and affordable, but accessibility remains an issue. Allocating funds is not enough, holistic thinking is required to deploy technology appropriately.

How was the radiotherapy industry affected by covid lockdowns?

I think the significant impact has been delayed diagnosis and treatment. Hospitals shifted their focus to covid, while patients were simultaneously scared to visit hospitals. Some studies have revealed an increase in the growth of cancer because of treatment delays.

Can you elaborate on the current situation with regards to cancer rates?

I don't think we are doing enough from a prevention standpoint at all. For private hospitals, they treat sick patients. They are not in the business of healthcare; they are in the business of sick care. So, if patients get sick, it's business for them.

We should be alarmed because earlier it was around 700,000 people getting cancer, then it went up to a million and now it is 1.5 million reported and it is only going up.

At any point in time, we have 50 lakh, cancer patients. Who is responsible for creating awareness? If a patient gets diagnosed early, they have a better prognosis. If you diagnose cancer at stage III or IV, it is already late, more expensive to treat and the prognosis is poor.

Awareness and education are imperative, creating a crucial role for government and NGOs. They can involve the private sector, all stakeholders, to create awareness. I feel that we need to create hope and not fear.

But it's chicken and egg because if you don't have infrastructure closer to where patients live then they don’t have that possibility of even going in. We can be smarter and try to use technology and not wait for everything to come to us.

Because of the impact of lockdowns on livelihoods, businesses, state government collections and such, state budgets are stretched thin. Is there anything that can be done to address this from a policy angle?

The first thing at the policy level is awareness of the problem. I don't think there is enough understanding that they need to do something different.

Much before this Ayushman Bharat scheme was announced, everybody used to say that even if we create infrastructure, how will people access it when they don't have the means to pay for it? And that led to this. So, there was a fair amount of realisation that something needs to be done to provide universal access.

What is the radiotherapy utilisation in India right now, what’s the near-term potential?

Globally, it's around 60 per cent, in India it's less than 20 per cent. Currently, in India, there are around 650 linear accelerators (radiation therapy machines) but these 650 are in 100 districts and not in all the 720 districts, so we must expand it. until you do something big, and that's where the government needs to act as a catalyst and run a programme, which would take care of this in a big way in the next five to 10 years.

What are the key lessons, especially considering the setbacks of the past two years?

I think the biggest lesson is there is no substitute for planning. Only reacting to a situation is never effective nor efficient as you end up spending more money.

We have tremendous talent and ability in India with some of the best doctors, engineers and scientists plus the wherewithal and the technology, so there can be localised solutions.

Are there studies on the economic impact of cancer in India?

I think there are global studies, I don't think there are any studies like this here, but we are working with agencies to see if we can produce white papers on this.