IndiaMedToday Feb 2021

FEBRUARY 2021, VOLUME 5 ISSUE 2 `200 INDIA MED TODAY

CANCER CARE IN POST COVID WORLD

FEBRUARY 2021

INTERVIEW Dr Jagprag Singh Gujral Group CEO, CTSI South Asia

APPROACH Committed to Cancer Care

SPECIAL FEATURE Impact of COVID-19 on Cancer Care

OPINION The Last Song

EDIT NOTE www.indiamedtoday.com

February 2021 EDITORIAL Editor Neelam Kachhap

Together, All Our Actions Matter

BOARD OF ADVISORS Dr Alexander Thomas Dr Girdhar Gyani

Sub-Editor

Dr Prem Kumar Nair

Sanjiv Das

Dr Bhabatosh Biswas

Together, all our actions matter. This year’s theme for World

editorial@

Dr Alok Roy

Cancer Day lays emphasis on what we believe; that in our

indiamedtoday.com ART & PRODUCTION ScreeTract Shylesh

Ramesh Kannan

fight against cancer all things matter and we have to work for

CONSULTING EDITOR

what must be done. Our actions and commitments will lead to

Dr Libert Anil Gomes

powerful progress in reducing the global impact of cancer. As

Dr Salil Choudhary

healthcare providers, social workers, care givers and patients we must understand that our actions - big and small - will make

ADVERTISING Gunjan Chauhan

lasting, positive change to move towards a cancer-free world.

gunjanc@indiamedtoday.com

This World Cancer Day, we at IndiaMedToday have committed

The Media Ant

to bring out a focussed issue to highlight stories of grit and

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determinations from different corners of India. The people and institutions we write about are ushering in a welcome change in the way cancer care is delivered, impacting a huge number of lives for the better.

Our guest editor for this issue is the pathfinder, who has served the cause of cancer care in India for the past two decades and continues to do so even today. Dinesh Madhavan, President, Group Oncology and International, Apollo Hospitals has over two decades of invaluable experience in the healthcare industry. His experience and reputation as the as a “go to” expert on oncology care delivery, his leadership and his role in the evolution and development of a number of cancer centres, made Madhavan a natural choice when looking for a guest editor to lead our Cancer Special issue.

We would like to thank him for his efforts. Despite his busy schedule, Madhavan, worked on this issue to provide a platform for the best in the cancer care universe.

Our Next issue will focus on transplant medicine and we have Dr Sonal Asthana, a towering personality in HPB and Multiorgan transplant Surgery, as guest editor. Look forward to the insights from world renowned transplant surgeons and leaders who will outline the upcoming trends in this field.

Do write back and let us know your feedback.

accurate, we make no guarantees. The views and opinions expressed in the magazine do not necessarily reflect the official policy or position of IndiaMedToday or the publication. Information on IndiaMedToday should not be used as a substitute for professional healthcare advice.

Readers are advised to always seek specialist advice before acting on information contained in this publication. Never disregard professional medicaladvice or delay in seeking it because of something you have read on IndiaMedToday. No part of this publication or any part of the contents thereof may be reproduced, stored in a retrieval system or transmitted in any form without the permission of the publishers in writing.

Printed and published by M Neelam Kachhap, 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam

Editor M Neelam Kachhap

Publishing (OPC) Private Limited, Printed at Paradise Graphics, B-15, Mittal Tower, MG Road, Bangalore-1. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.

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FEBRUARY 2021

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CONTENTS

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15 18

27

DRIVE

APPROACH

SPECIAL FEATURE

The Benevolent Benefactor

Committed to Cancer Care

The World of Cancer Centres

IMPACT

33

Indian Crusader For Global Cancer Care UPFRONT

21 COVER STORY

Cancer Care in Post COVID World 4

February 2021

03 Editorial 05 Letters 06 Guest Editor 07 News roundup 36 Interview 38 Opinion 40 Pulse www.indiamedtoday.com

CHECKIT OUT ONLINE

LETTERS

T

he unprecedented COVID-19 pandemic has impacted more than 1 crore Indians already and heavily stressed the Indian healthcare systems since March 2020. Consistently low budget allocations (about 2 per cent for 2020-2021) that have fallen short of the target spending of 2.5 per cent of GDP (National Health Policy, 2017) have already provided a reality check on the Indian healthcare system and infrastructure. In the light of this aftermath, greater

investment in health is critical for improving infrastructure, making the country safer, and making health expenditure more predictable.

Ishiqa Multani, President, Sagar Group of Hospitals

Declaring Healthcare as a strategic sector like agriculture, which will help the sector get access to credit as much lower interest rates. One of the biggest heart burns for hospitals is that the cost of debt financing is extremely high which creates other operational issues and challenges. If the debt is as low as what is given in the agriculture sector, it will improve the viability and more investments will flow to create infrastructure. Income tax incentives for investment in electronic health records or HIS of various hospitals should be implemented under the National Digital Health Program, at a proposed 250 per cent deduction on the investment made.

It is crucial that the government provides appropriate fiscal

Dr Harish Pillai – CEO Aster India, Aster DM Healthcare

to improving healthcare delivery models and infrastructure, as

The health sector is in dire need of a skilled workforce, among other things. It is imperative to provide healthcare workers with continuous skill enhancement with specialized training for ailments like cancer. There is a need to bring in universal healthcare to bring health uniformity across the country. We suggest incorporating health cess through mobile phones, which will help in directing to pool funds for the use of UHC. Dr BS Ajaikumar, Chairman; CEO, HealthCare Global Enterprises

incentives and creates sustainable public policy to encourage investment in private healthcare infrastructure. Hospitals should be included under the definition of ‘industrial undertaking’ u/s 72A of IT Act. This has been a long standing demand, critical to expedite private investment in healthcare capacity building and to ensure that healthcare is treated at par with other sectors.

Dr Alok Roy, Chair, FICCI Health Services Committee and Chairman, Medica Group of Hospitals In recent months, the Government has showcased its commitment well as taken solid steps to move towards its vision of providing healthcare to all. The sector performed well all through 2020 while battling the pandemic. We are expecting a healthcare-focused budget which is a need of the hour. We expect the government to especially focus on primary healthcare infrastructure that needs huge improvement in terms of improved access to healthcare for low-income households.

Yogesh Mudras, Managing Director, Informa Markets, India

FOLLOW US ON... @indiamedtoday facebook.com/indiamedtoday PLS ADDRESS YOUR LETTERS TO: The Editor, IndiaMedToday and mail to editorial@indiamedtoday.com Pls indicate clearly if you want to publish you views/opinions for this page.

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GUEST EDITOR Global Leader and Pathfinder in Oncology Care Dinesh Madhavan President Group Oncology and International, Apollo Hospitals Enterprises

Circa 1500 bc, the world's oldest documented case of cancer is recorded from ancient Egypt. The details were recorded on papyrus, documenting eight cases of tumours occurring on the breast. It was treated by cauterisation, which destroyed tissue with a hot instrument called "the fire drill."

In 1926, a Nobel Prize was wrongfully awarded for the discovery of the cause of stomach cancer, a worm. The 20th century saw the greatest progression in cancer research. Research identifying carcinogens, radiation therapy, chemotherapy and better means of diagnosis was discovered.

Today, we can cure some types of cancer, and research is ongoing to finding a cure, or a definitive method of prevention. Recent advances have seen the advent of targeted therapy, precision in diagnosis and precision oncology. Prevention, early diagnosis, technological advancements, access to cancer care in remote parts of the world and cancer management teams have made an immense difference between losing to cancer and winning over cancer .

From 1500 BC never was a cancer patient this vulnerable as in the last 12 months from the start of 2020, Patients with cancer are a vulnerable population, and they are prone to many harms during such pandemics, including susceptibility to life-

6

February 2021

threatening infections and interruption of their cancer care. In a recent study, the 30-day all-cause mortality was high in patients with cancer. Similarly, another comprehensive meta-analysis consisting of 7094 patients, concluded that cancer comorbidity is associated with the risk and severe events of COVID-19. A recent pooled analysis of 52 studies, comprising 18,650 patients with both COVID-19 and cancer, showed that the probability of death was 25.6 per cent . The American Cancer Society (ACS) Cancer Action Network conducted a nationwide survey and found that approximately 27 per cent patients currently in active treatment reported a delay in treatment. Furthermore, one-third of all patients were worried about the virus impact on their ability to get care.

The battle seemed endless and the enemy seemed invincible. When the going got tough, the tough get going .

This feature is dedicated to all the cancer warriors, survivors, care givers, specialist and institutions which were resolute and unwavering in their fight against cancer and covid, all coming together for the two pronged battle with immense grit and determination, looking back at the last 12 months one could claim winning over cancer like never before .

I am and I will !

Dinesh Madhavan is a seasoned professional who comes with over two decades of invaluable experience in healthcare industry. He has a trailblazing track record in operations, projects & clinical management, technology introduction, product innovation, strategy, new initiatives for growth, brand building, leadership creation, succession planning, leading healthcare business, international operations and overseas expansion.

Prior to joining Apollo Hospitals, Dinesh Madhavan had been associated with Healthcare Global Enterprises (HCG) for over a decade as Director Healthcare Services; managing the corporate function of brand management, international businesses, operations & management, clinical management, forging partnerships, merger & acquisitions and also leading the oncology business in india and overseas.

With a postgraduate degree in law and business administration, Madhavan is a strategist, astute thinker and team builder. Madhavan is a travel influencer, a devout reader, explorer and an experienced motorcyclist who has motorcycled over 16 countries.

He can be reached dm@apollohospitals.com

at

NEWS ROUNDUP Hyundai Motor India Foundation starts Mobile Chikitsa in Rajasthan

diseases and their prevention will also be

Hyundai Motor India Foundation, the philanthropic arm of Hyundai Motor India commenced their first health initiative Mobile Chikitsa, under their public health programme, ‘Sparsh Sanjeevani, to bolster India’s healthcare services in rural neighbourhoods. The project is a mobile primary healthcare clinic with a doctor on board and equipped with testing facilities for spot diagnostic tests. The medical unit of Mobile Chikitsa was flagged-off for Laxmangarh, a tehsil in Alwar district of Rajasthan in the presence of SS Kim, MD and CEO, Hyundai Motor India and senior CSR officials of HMIF. Mobile Chikitsa will cater to a community of up to 25000 people and if need be can service up to three additional communities. A qualified MBBS doctor onboard will provide free consultation and medicines through the attached pharmacy. The Mobile Chikitsa unit is equipped with testing facilities for spot diagnostic tests covering blood sugar, BP, malaria, dengue etc. They will not provide any routine vaccinations.

Awareness programmes on various

conducted.

Messe Frankfurt India join hands with AMTZ Messe Frankfurt Trade Fairs India

has joined hands with India’s integrated medical devices manufacturing ecosystem – Andhra Pradesh MedTech Zone (AMTZ).

The cooperation aims to provide further impetus

to

indigenous

manufacturing

of medical devices and bring forward innovations and specialised medical tools and technologies that can attract domestic and

global

investors.

The

launch

of

MedTech Innovation Forum aims to create a collaborative platform for medical device manufacturers, innovators and technology experts to exchange advancements and innovations for the development of the Indian medical devices industry.

Slated from October 7 – 8, 2021 in Visakhapatnam, the first edition of this key business event is expected to bring industry leadership together with government and medical consultants to address integral challenges of import dependency, need for technology collaborations as well as medical technology advancements that can be introduced in the industry. The

forum has received support from apex industry bodies – AIMED (Association of Indian Medical Device Industry) and ADMI (Association of Diagnostics Manufacturers of India) ADMI.

Reliance ties up with Israeli firm

Reliance Group has signed a $15 million deal with Israeli company Breath of Health (BOH) to distribute the firm’s swift COVID-19 breath testing system that provides results within seconds.

According to the agreement, the Indian corporate giant will purchase hundreds of systems from the Israeli company in a deal valued at $15 million and will use them to conduct millions of tests a month at a cost of $10 million per month, business portal Calcalist reported earlier. Reliance will also lead research of the system in India and will distribute the platform throughout the country and in the Far East, the agreement said.

Cipla sets up 30 MW solar group captive project in Maharashtra

Cipla has set up a 30 MW solar group captive project in Tuljapur, Maharashtra.

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7

NEWS ROUNDUP Spread across 115 acres, the solar project has been commissioned in partnership with AMP Energy India and is one of the largest solar open access projects in the state set up by a corporate. This is in line with the company’s Environmental, Social and Governance (ESG) initiatives aimed at developing a holistic sustainability road map for the future. By 2025, Cipla plans to achieve carbon and water neutrality, zerowaste to landfill, anti-microbial resistance stewardship and green chemistry. The project will support the company’s green energy requirements for its manufacturing units at Kurkumbh and Patalganga in Maharashtra. It will also help the company avoid carbon dioxide emissions by as much as 35,000 tonnes of carbon dioxide equivalent (tCO2e) annually over its project life of 25 years.

This agreement with BBIL is the result of

to its quality healthcare services to

efforts by GSK, PATH, and WHO to help

patients across the world. Working closely

ensure

vaccine

with the strategic leadership team of the

supply, in the event of a WHO policy

organisation, he would be responsible for

recommendation for broader use and a

fostering and driving a culture of patient/

commitment of sustained funding. This

customer

builds on existing GSK commitments to

patient experience across markets. The

donate up to 10 million RTS,S/AS01E doses

appointment is in alignment with Aster’s

for use in the pilot, and to supply up to

long-term vision to make its quality

15 million doses annually until 2028 if the

healthcare services accessible to patients

product is recommended for wider use by

across the world.

ESIC benefits to be available in 735 districts

the

Employees’ State Insurance Corporation (ESIC) insured persons (IPs) would get access to health services under the ESI scheme in all 735 districts of the country from April 1, an official said. At present, ESIC’s health services are fully available for its IPs in 387 districts and partly in 187 districts, while 161 districts do not have such services at all. The ESIC provides health services to IPs through its health centres and hospitals as well as empanelled hospitals. The ESIC has planned to provide health services to IPs through hospitals and health centres empanelled under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY). An agreement for the purpose was inked a few months ago.

long-term

WHO. It is expected that by 2029, at the latest, BBIL will be the sole supplier of the vaccine, with GSK supplying the adjuvant AS01E to them.

8

February 2021

centricity,

while

improving

CallHealth ties up with NephroPlus

CallHealth, a customer convenience

Aster DM Healthcare appoints David Boucher

platform for healthcare needs and dialysis

services at the doorstep for chronic

Aster DM Healthcare has announced appointment

David

a

joint

network initiative

NephroPlus to

render

launched dialysis

Boucher,

kidney patients. An MoU was signed by CallHealth and NephroPlus, to kickstart

excellence and medical value tourism,

the

to strengthen its patient and customer

which will be expanded to other locations

service offering and enable wider access

later. According to Hari Thalapalli, CEO,

David Boucher

of

centre

a global leader in healthcare service

GSK, PATH, Bharat Biotech in agreement

GSK, PATH and Bharat Biotech (BBIL) announced the signing of a product transfer agreement for the malaria vaccine, RTS,S/AS01E1. The agreement includes the transfer of manufacturing of the RTS,S antigen part of the vaccine and the grant of a license on all rights pertaining to the RTS,S/AS01 malaria vaccine to BBIL. GSK will retain the production of the adjuvant of the vaccine (AS01E) and will supply it to BBIL.

sustainable

initiative

in

Hyderabad

initially,

CallHealth, the service will be accessible across the combined Telugu States within a fortnight and pan-India by April this year.

Tata group in talks with Moderna

Tata Group’s healthcare venture is said to have started initial discussions with Moderna for a partnership to launch its COVID-19 vaccine in India. Tata Medical & Diagnostics could team up with India’s Council of Scientific and Industrial Research to carry out clinical trials of Moderna’s vaccine candidate in India, citing officials familiar with the matter. Moderna did not respond to Reuters request for comment outside business hours, while Tata Medical & Diagnostics did not immediately respond.

Micky Tripathi joins National Coordinator for Health Information Technology Boston-headquartered Arcadia, a leading population health management and healthcare intelligence platform company, congratulates Micky Tripathi, on his new leadership role as the National

Micky Tripathi

Coordinator for Health Information Technology (ONC) with the Department of Health and Human Services (HHS). Most recently, Tripathi served as Arcadia’s Chief Alliance Officer and was responsible for developing strategic partnerships between Arcadia and other innovative companies to further accelerate the use of advanced technology to improve healthcare.

Health insurance scheme for central armed forces launched Union Home Minister Amit Shah rolled out the ‘Ayushman CAPF’ scheme, extending the benefit of the central health insurance programme to the personnel of all armed police forces in the country. Shah ceremoniously distributed the ‘Ayushman CAPF’ health cards among some personnel from the seven Central Armed Police Forces (CAPF). Under this scheme, around 28 lakh personnel of CAPF, Assam Rifles and National Security Guard (NSG) and their families will be covered by ‘Ayushman Bharat: Pradhan Mantri Jan Arogya Yojana’ (AB PM-JAY). An MoU was signed between the National Health Authority (NHA) and the Union Home Ministry in presence of

Shah, Assam Chief Minister Sarbananda Sonowal, Union Minister of State for Home Affairs Nityanand Rai and state Health Minister Himanta Biswa Sarma at the CRPF Group Centre in Guwahati.

Apollo Hospitals raises Rs 1,170 cr

Apollo Hospitals announced raising Rs 1,169.99 crore through allotment of shares to the qualified institutional buyers (QIBs).

The Fund Raising Committee “approved allotment of 46,59,498 equity shares of face value Rs 5 each to eligible qualified institutional buyers at the issue price of 2,511 per equity share, i.e., at a premium of 2,506 per equity share aggregating to Rs 11,699.99 million, pursuant to the issue,” Apollo Hospitals Enterprise said in a filing to the BSE. The issue opened on January 18, 2021 and closed on January 22, 2021, it added. “Pursuant to the allotment of equity shares in the issue, the paid-up equity share capital of the company stands increased from Rs 69,56,25,795 consisting of 13,91,25,159 equity shares to Rs 71,89,23,285 consisting of 14,37,84,657 equity shares,” the filing said.

IRDAI issues insurance policy guidelines on peritoneal dialysis

The Insurance Regulatory Development Authority of India (IRDAI) has recently released the much-awaited policy guidelines to include Peritoneal Dialysis (PD) in the ambit of private insurance coverage. According to the guidelines, patients taking treatment of PD can make reimbursement claims every month through an approved preauthorisation procedure. The provisions of the new guidelines have been in effect from October 1, 2020. The recent development allows kidney patients to avail the benefits of the home-based and cost-effective PD therapy which can enable both patients and nephrologists to put patients on PD rather than the only hemodialysis to aid the kidney failure population in the country. This will also enable both doctors and patients to analyse and choose their choice of dialysis treatment based on the patient’s lifestyle.

The insurance companies’ long-awaited

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9

NEWS ROUNDUP approval of PD’s inclusion in health insurance plans also comes at an opportune time when the public is cautioned to stay indoors owing to the COVID-19 pandemic and avoid hospital-acquired infections in a healthcare setting.

Ravi Deshpande joins ELNA Medical

ELNA Medical has appointed Ravi Deshpande as Chief Business Development Officer, Canada. Deshpande has held a range of management positions at McKesson for over 15 years. Among others, he was Chief Strategy Officer for McKesson Canada and Senior Vice-President at Medicentres; he played a key role in the expansion of the multinational’s Canadian footprint, tripling the pharmacy network through numerous acquisitions. A registered pharmacist, Deshpande has held appointments in the hospital sector in Toronto and the US and served as Assistant Professor of Medicine in North Carolina. He co-founded Phase 4 Health, a pharmaceutical services firm providing patient, prescription, and consultant services to the pharmaceutical industry, acquired by McKesson Canada in 2005.

Ravi Deshpande

10

February 2021

Caplin Point Lab, JAMP Pharma Group in tie up

Drug firm Caplin Point Laboratories has entered into a strategic partnership with Canada’s JAMP Pharma Group for six injectable products. Caplin Steriles (a subsidiary of Caplin Point Laboratories) has partnered with JAMP Pharma Group for six injectable products to be filed shortly in Canada, Caplin Point Laboratories said in a regulatory filing. Caplin Point Laboratories said some of these products have already been filed by Caplin Steriles in the US. CC Paarthipan, Chairman, Caplin Point Laboratories said, “We have targeted Canada as one of our key expansion areas in regulated markets and we are excited to work with JAMP, one of the fastestgrowing companies in Canada.” Paarthipan said the company will add more products to this partnership in due course.

Metropolis Healthcare to acquire Hitech Diagnostic Centre Metropolis Healthcare will acquire 100 per cent equity of Dr Ganesan’s Hitech Diagnostic Centre with a cash consideration

of Rs 511 crore.

The acquisition deal is an arrangement of cash and stock deal. The cash consideration will be funded through internal accruals and debt of up to Rs 300 crore. It will also issue up to 4,95,000 equity on a preferential basis. With this acquisition, Metropolis will be able to expand its B2C business in focus cities of Chennai and Bengaluru, benefitting through optimisation of operational costs in the areas of procurement, supply chain, administration and support resource, laboratory network, and back-office infrastructure along with penetration in different customer segments across key markets of South India. Metropolis Healthcare will be able to get access to 31 laboratories including three National Accreditation Board for Testing & Calibration Laboratories (NABLs) and Indian Council of Medical Research (ICMR) accredited laboratories as well as 68 collection centres of Hitech.

Burns and Plastic Surgery Block at AIIMS Delhi opens

Dr Harsh Vardhan, Union Minister of Health and Family Welfare inaugurated the newly constructed Burns and Plastic Surgery Block of AIIMS, New Delhi and dedicated it to Sushruta, ‘The Father of Plastic Surgery’.

Dr Vardhan shared his vision of the need for a Burns and Plastic Surgery Block. He said, “Burn injury is one of the biggest causes of workforce loss and this is an issue of concern for a rapidly developing economy like India. India has as many as 70 lakh burn injuries annually with a mortality rate as high as 1.4 lakhs per year and an additional 2.4 lakhs patients end up with severe deformities. Due to its large population, most of the burn care facilities are overburdened and the stateof-the-art burn care is negligible. There is a dire need for a healthcare facility which can provide high-quality care for a large fraction of the population. The new Burns & Plastic Surgery Block has been conceived with the vision of providing state-of-theart care in the field of burns management and research.” Dr Vardhan added that this initiative by the government will bridge

the gap between this need and availability.

memoir No Time to Lose. He is the recipient

He explained the objective behind setting

of the Calderone Prize, the Hideyo Noguchi

up Burns and Plastic Surgery Block.

Africa Prize for Medical Research, the

Biocon Biologics appoints Prof Peter Piot Biocon

Biologics

has

inducted

Professor Peter Piot to its Board as an

Prince Mahidol Award for Public Health, the Canada Gairdner Global Health Award and the Robert Koch Gold Medal, and was a 2014 Time Person of the Year “The Ebola Fighters”.

of Global Health.

Dr Kumud Kumar Dhital joins Yashoda Hospitals Hyderabad

Piot was initially trained in infectious

Yashoda

diseases and medical microbiology, with

announced the joining of Dr Kumud Kumar

original contributions in epidemiology,

Dhital, who will now lead the Institute

bacteriology, virology, and public health

of Heart and Lung Transplantation for

policy interventions mostly in low- and

the group. As a programme and surgical

middle-income countries. He was part

director

of the team that isolated the Ebola virus

Heart

in Zaire in 1976. He also led pioneering

Mechanical

research on HIV/AIDS, women’s health

Dr Dhital will be dedicating himself fully

and infectious diseases, mostly in Africa.

to the Yashoda Heart & Lung Transplant

He was the founding Executive Director

program

of UNAIDS and UnderSecretary-General

pulmonary endarterectomy for patients

of the United Nations from 1995 until

with chronic thrombo-embolic pulmonary

2008. He has authored over 600 scientific

hypertension. Dr Dhital is renowned for

publications and 16 books, including his

being the surgical pioneer of the world’s

Independent Director. Piot is the Director of the London School of Hygiene & Tropical Medicine and the Handa Professor

of &

Hospitals

the Lung

Yashoda

Institute

Transplantation

Circulatory

with

Hyderabad

Support

additional

of and

(MCS),

practice

in

first Donation After Circulatory Death (DCD) or Dead Heart Transplantation, from distantly procured donor organ.

MFine raises $16 million Digital Health startup MFine has raised $16 million in a new funding round led by Heritas Capital with participation from Singapore-based family office of Y’S Investment. Existing MFine investors including SBI Investment, SBI Ven Capital, BEENEXT and Alteria Capital have also followed-on in the round.

The oversubscribed round wraps up a strong year for MFine with the company achieving 10x growth amidst exponential adoption of telemedicine and digital health in India in 2020. With this fresh funding, MFine plans to reinforce its leading position in delivering an AI-driven, on-demand healthcare service across India and aims to be one of the largest virtual hospitals in the world with services across primary care, secondary care and chronic care management in collaboration with its trusted partners. MFine will deploy the funds towards tripling its investments in AI, mobile engineering and device integration; expanding its hospital network across the country; scaling the recently launched services which include delivering medicines, preventive health screenings and diagnostic tests. The company will also initiate Series C fundraising in the coming months.

Nightingales and Cloudphysician launch Intensive Care at Home services

Dr Kumud Kumar

Nightingales in association with Cloudphysician has launched first-ofits-kind Intensive Care at Home services to provide intensive care services to critically ill patients in the comfort of their home. The service has currently been introduced in Bengaluru and Mumbai.

The Intensive Care at Home service will be delivered through a comprehensive multidisciplinary team effort led by Cleveland Clinic trained intensivists and an on-site team of experienced clinicians, nurses, and physiotherapists. This offering will benefit a large spectrum of patients in several clinical categories including

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11

NEWS ROUNDUP neurology, oncology, pulmonology, and orthopaedics who continue to remain admitted in hospitals because they need continuity of clinical services which hitherto was not available in the comfort of their own homes.

Bharat Biotech in agreement with Precisa Medicamentos

IIT Guwahati signs MoU with NECHRI Jorabat, Assam

supply its COVID-19vaccine Covaxin to

Indian Institute of Technology (IIT) Guwahati, has signed a Memorandum of Understanding (MoU) with North East Cancer Hospital and Research Institute (NECHRI), Jorabat, Assam, at IIT Guwahati. The collaboration between IIT Guwahati and NECHRI started in 2014.

Both IIT Guwahati and NECHRI have been engaged in identifying novel biomarkers for cancer diagnosis, prognosis, therapy and recurrence. Both the institutes have also been engaged in identifying cancer susceptible population from North East India. This collaboration has already identified novel targets for oral cancer (a leading cancer burden in India) drug discovery. This research has been published in highly reputed International Journal ‘Biomolecules’ in 2019. Based on these results both IIT Guwahati and NECHRI are researching to develop novel drugs for the treatment of oral cancer.

Also, both the institutions are engaged in developing various strategies to help cancer patients from North East region.

The MoU will enable IIT Guwahati and NECHRI to strengthen more collaborations and to help cancer patients from NE region.

Also, studies have been already started to identify different cancer susceptible populations from North East region and to help to prevent this deadly disease among these population.

Signant Health appoints Sanjiv Waghmare Signant Health announced the appointment of Sanjiv Waghmare as Chief Product Officer. Waghmare will be responsible for building upon the success of Signant’s pioneering clinical research science and technology solutions with an emphasis on steering roadmap strategy and optimising core solutions to support the exponential growth of virtual, remote,

12

February 2021

Bharat

Biotech

has

signed

an

agreement with Precisa Medicamentos to Brazil. A team from Precisa Medicamentos visited the Bharat Biotech facility last week to discuss potential export possibilities of the vaccine, the indigenous antidote for the killer virus, the company said in a release. The Brazilian Ambassador to India Andr Aranha Corra doLago expressed keen interest on behalf of his government towards procuring the vaccine and in principle, it was understood between both Sanjiv Waghmare

parties that supplies of Covaxin to be prioritised for the public market through

decentralised, and hybrid clinical trials.

With his depth of understanding in product innovation

and

lifecycle

management,

Waghmare will play an integral role in positioning Signant’s solutions and

a direct procurement by the Brazilian government, it said. Supplies to the private market would be based upon receipt of market authorisation from ANVISA, the Brazilian regulatory authority.

generation advancements in data strategy,

Boehringer Ingelheim appoints Vani Manja as India Country MD

user experience, and configurability of the

company’s core platforms.

that Vani Manja is appointed Country

services a

for

rapidly-

ongoing evolving

success clinical

within research

environment as well as driving next-

Boehringer Ingelheim has announced

Managing Director for India, effective

financial

was

backed Precision Oncology start-up and

January 1, 2021. In this role, she will

the

Director

ACTREC (Advanced Centre for Treatment,

assume responsibility for the company’s

and Chief Executive Officer of HDFC

Research and Education in Cancer) –

businesses in India, Bangladesh, Nepal and

Bank from its inception in 1994 until he

Tata Memorial Centre have signed a

Sri Lanka. Vani will also join the Board of

retired from the position in October 2020,

collaboration agreement for an AI-driven

the company. Manja succeeds Sharad Tyagi,

earning the distinction of having been

clinical interpretation platform, ClinOme.

who retired from Boehringer Ingelheim

the longest-serving head of a private

The collaboration aims at making an

India on December 31, 2020, after over a

bank in India. Puri’s appointment to the

indigenous platform to generate data

decade of successful and dedicated service

Stelis Board comes at an exciting juncture

insights and simplified reports to guide

to the company. During his tenure, Tyagi

for the company as it transitions from

oncologists with personalised treatment

built Boehringer Ingelheim India to be one

its incubation phase to a consolidation

options

of the India’fastest-growing multinational

and growth phase to establish itself as a

ClinOme is a Graphical User Interface (GUI)

pharmaceutical companies.

partner of choice globally to bring world-

based automated tool developed by senior

class treatments at affordable costs to

scientists and clinicians from ACTREC &

patients in both emerging and developed

Tata Memorial Hospital by Dr Amit Dutt, Dr

markets.

Pratik Chandrani and Dr Kumar Prabhash

Aditya Puri joins Strides Group as Advisor

Aditya Puri has joined the Strides

Group as an Advisor and also will be a Director of its associate Company, Stelis

Biopharma

(Stelis).

Recognised

as a stalwart of the Indian banking and

services

iconic

industry,

founder-Managing

Puri

4baseCare ties up with ACTREC-Tata Memorial Centre

4baseCare, an Illumina Accelerator

for

treating

cancer

patients.

for analysis of raw NGS data followed by comprehensive clinical report generation.

It

automates

quality

check,

primary,

secondary and tertiary analysis of raw NGS data followed by report generation that can be easily comprehended by the clinicians. It provides easy to interpret categorisation

of

genomic

alterations

along with approved and experimental therapeutic options for each responsive and resistant genotype-drug combination.

Abu Dhabi-based ADQ to invest Rs 555 cr in Biocon Biologics

Abu Dhabi-based ADQ will invest

Rs 555 crore in its subsidiary Biocon Biologics. The board of Biocon Biologics has approved a primary equity investment

by ADQ, Biocon said in a statement. As per the terms of the proposed agreement, ADQ will invest Rs 555 crore for a 1.8 per cent minority stake in the biosimilar business, valuing Biocon Biologics at a post-money valuation

of

$4.17

billion,

it

added.

The transaction is subject to customary condition precedents and approvals and if it goes through, Biocon’s stake would come down to 89.89 per cent in Biocon Biologics on a fully diluted basis.

Dell Technologies collaborates with MoH&FW, Tata Trusts Aditya Puri

Dell Technologies in collaboration

www.indiamedtoday.com

13

NEWS ROUNDUP

with Ministry of Health and Family Welfare

of additional 162 dedicated Pressure

(MoHFW) and Tata Trusts, has developed

Swing Adsorption (PSA) medical oxygen

a mobile application for the management

generation plants inside the public health

of

Alniche Lifesciences forays into pharma manufacturing

(NCDs)

facilities in the country. The total project

at Government Primary Health Centres

cost includes Rs 137.33 crores towards

(PHCs) across India. The mobile application

supply and commissioning of the plants

was launched by Minister of Health and

and management fee of Central Medical

Family Welfare, Dr Harsh Vardhan on

Supply Store (CMSS) and around Rs.64.25

Universal Health Coverage Day recently.

crores towards Comprehensive Annual

Himachal Pradesh. EffiKasia Lifesciences

The intuitive and easy to use mobile

Maintenance Contract. The procurement

will

app will strengthen the existing NCD

will be done by the Central Medical Supply

nutraceuticals and dermatological. With

IT system’s suite of six applications for

Store (CMSS) – an autonomous body of the

this initiative, Alniche plans to increase

Accredited Social Health Activists (ASHAs),

Ministry of Health and Family Welfare. A

its profit margins and push top-line by

auxiliary nurse midwives (ANMs), doctors,

total of 162 plants with a total capacity

expanding sales operations for exports

programme managers and health officials

of 154.19 MT are to be installed in 32

in semi-regulated markets. Additionally,

in the government.

States/UTs. Government hospitals where

with its manufacturing setup, the company

non-communicable

diseases

PM CARES Fund Trust allocates Rs 201.58 crores for medical oxygen generation plants

these plants are to be installed have been identified in consultation with the States/ UTs concerned. The plants have a warranty for the first three years. For the next seven years, the project includes CAMC (Comprehensive

Annual

Maintenance

New Delhi-based Alniche Lifesciences

has set up a state-of-the-art facility under the name of EffiKasia Lifesciences at Kangra, manufacture

pharmaceuticals,

plans to compete in the institutional tender business thus setting up a new business vertical. EffiKasia is in discussions with various

global

companies

to

acquire

a unique technology platform and by

Citizen

Contract). Routine O&M is to be done

leveraging these technologies, the team of

Emergency

by the hospitals/states. After the CAMC

scientists in its R&D will introduce a whole

Situations (PM CARES) Fund Trust is

period, entire O&M will be borne by the

new range of differentiated formulations

allocating Rs 201.58 crores for installation

hospitals/states.

in the domestic and exports markets.

The

Prime

Assistance

and

14

February 2021

Minister’s Relief

in

DRIVE

The Benevolent Benefactor An astute academician and a compassionate surgeon, Dr VP Gangadharan shares his story of carefree childhood, struggle for knowledge and success as a people’s surgeon

Dr VP Gangadharan was born to a textile engineer MNP Nair and Saraswathi Amma in Coimbatore. The youngest of the four siblings, three brothers and a sister, young Gangadharan was academically gifted. At the age of five, when he went for school admissions, his intellect was equivalent to a 10-yearold as he learnt lessons with his sister who was three years elder to him.

Based on his knowledge, he was offered admission to class four. However, his parents thought it would be in his best interest if he started from class three and thus he embarked on this extraordinary journey of knowledge and learning and completed his schooling when he was 13-years-old. As the youngest boy in class, young Gangadharan tried to fit into the world but mostly found it socially awkward. And yet this did not deter him from enjoying his childhood.

Peshkar Road Gang Dr Gangadharan had a wonderful childhood engraved on the canvas of time. The siblings lived at their grandmother’s house on Peshkar Road, Irinjalakuda. The area had many houses and many kids. Dr Gangadharan remembers the large joint family Vettiyattil house he grew next to, had a unique environment. All the kids in the vicinity used to walk to school and played together. Even though they were of different age groups there was a strong bond of friendship among them and they were fondly called Peshkar gang.

Dr V P Gangadharan

It was a time when discipline came naturally and teachers were vested in the education and future of their pupils.

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15

DRIVE

Art by patient This carefree environment further nurtured Dr Gangadharan’s mind and moulded his personality. The idea of liberty, equality and fraternity was ingrained in his young mind. Even today, Dr Gangadharan lives by these values.

led him to abandon his business dreams.

At this time, his mother reminded him of the maternal uncle who was a great doctor at the time. His namesake uncle had passed away and Dr Gangadharan’s mother wanted him to pursue medicine just like his uncle did.

Dr Gangadharan played all kinds of sports with his friends like cricket, football and badminton. As a sportsman he learnt to appreciate failure, he says.

MBBS Days

Maharaja College Days The academically gifted Dr Gangadharan aced his class at Christ College Irinjalakkuda at the age of 15.

Incidentally, he could not pursue a professional course till he was 17, so he joined a degree course at Maharajas College, Ernakulam. In the 1970s, Maharajas College was the hotbed of social, political and cultural activities.

Here Dr Gangadharan imbibed philosophy and immersed in Malayalam literature. He even scored the highest marks in Malayalam even though he did not enrol for the subject. In 1973, Dr Gangadharan pass BSc with flying colours and still, he was not sure what he wanted to do further.

Medicine and Textile After graduation, Dr Gangadharan went to Coimbatore to join his father’s flourishing textile dye business.

However, his lack of business acumen

16

February 2021

Dr Gangadharan applied for MBBS, and got through to Medical College, Kottayam. He remembers his MBBS days fondly. This is where he met his wife Dr K Chitrathara. During the first year of MBBS Dr Chitrathara was his anatomy class partner. This partnership became friendship and then turned into a lifelong commitment.

Dr Gangadharan says that his days at Medical College, Kottayam taught him important lessons of sincerity and empathy, something that is lacking in the doctors today. He remembers that they had to be on call 24/7, but no one complained. Since the teachers and students stayed on-campus classes were held even late in the evening. The college was like a close-knit community where all festivals were celebrated with the same fervour, and the boundaries of religion and ethnicity did not exist.

Service and ethics were instilled as a doctrine and still guide much of Dr Gangadharan’s work.

When Dr Gangadharan finished his

MBBS, the choice for MD were few. He chooses to work post residency and applied for MD outside Kerala. This was the time when AIIMS, Delhi had started and MD positions opened for students. By this time, Dr Gangadharan was married and Dr Chitrathara was doing her MD Oby-Gync at Safdurjung Hospital, Delhi. It was his background in sciences that helped him get MD radiotherapy at AIIMS, Delhi which he completed in 1984. He came back and did general medicine in 1986 and then went to Cancer Institute, Adayar, Chennai to do DM medical oncology in 1989.

This time in Dr Gagadharan’s life was very difficult. He remembers long work hours, staying in small hospital quarters and challenge of studying with a growing family. He even worked without stipend for free during his DM oncology at Cancer Institute Adayar.

The work was challenging but it prepared him for the life ahead. He learnt a lot from stalwarts like the late Dr V Shantha.

RCC Trivandrum Following training at Chennai Dr Gangadharan joined RCC, Trivandrum in 1989 as Asst. Professor & Head of Medical Oncology. It was here that he established the Medical Oncology Department, the first-of-its-kind in

Kerala. He further trained in Bone Marrow Transplantation programme in USA and UK with NCI and WHO fellowships. He became the first oncologist to do Blood stem cell transplantation in Kerala. He became the first oncologist to treat paediatric cases in the days before specific specialities existed.

He established the Cochin Cancer Society to help the needy cancer patients and to educate the public about cancer and conduct camps for early detection among women.

After leaving RCC in 2003, Dr Gangadharan became the Head of Medical & Pediatric Oncology at VPS Lakeshore Hospital & Research Centre.

He also works with Welcare hospital, Kochi and Caritas Cancer Centre, Kottayam.

Saint with Stethoscope Dr Gangadharan has never refused a patient treatment for want of money.

He is always eager to seek out and help cancer affected people who are marginalised. He says that the patient are his priority and his life’s earnings are the patients and families he has interacted with in his long career. This is the reason for his immense popularity not only in Kerala but around the world.

His stellar reputation draws patients from around the globe. He has received several awards as a testament to his knowledge, practice and philanthropic initiatives.

Dr Gangadharan is married to Dr K Chitrathara, MD, Gynecology and MCh in Urology.

She is the first female urologist in Kerala. Currently, she works as cancer surgeon at Lakeshore hospital and Welcare hospital, Kochi. They have two sons, Gokul and Govind. Gokul is an electronic engineer where as Govind is a doctor.

• First Medical oncologist in Kerala • Established the first Medical oncology department in Kerala, at RCC,Trivandrum • First Blood stem transplantation in Kerala

• First paediatric blood stem cell transplantation in Kerala • Established the first blood stem cell transplantation units in government and private sectors in Kerala

He is known as a valued, trusted and insightful teacher; his colleagues and students remember and appreciate the advice, mentorship and friendship that Dr Gangadharan provided to them.

Dr Gangadharan is the author of many scientific articles and has about 35 national and international publications.

He has authored chapters in three text books. He has delivered about 60 scientific lectures as invited speaker in seminars and scientific meetings.

cell

• First mobile thermomammogram unit in Kerala to screen breast cancer.

• First mobile radiomammogram and ultrasonography unit in kerala Art by patient

A book titled Jeevithamenna Athbudham is a compilation of Dr gangadharan’s life experience with patients. Published in Malayalam by DC books in 2004, it opens up his heart and soul. The book is very well received and has helped many cancer patients face their fate.

www.indiamedtoday.com

17

APPROACH

Committed to Cancer Care Tata Medical Center, Kolkata is a setting example of how the institute has been able to cater to a large number of cancer patients from the Eastern and North-Eastern part of the country with cutting-edge health technologies Team IMT

“I have applied most of what I have learnt at CMC Vellore to TMC in Kolkata'' Dr Mammen Chandy

18

February 2021

Since 2011, Tata Medical Centre (TMC) in Kolkata, has been catering to the patients of the Eastern and NorthEastern part of the country. Limited cancer care facilities made patients travel far off to Tata Memorial Hospital in Mumbai or CMC Vellore besides other corporate hospitals in other parts of the country. According to a Lancet study, the cancer situation is grim in certain North Eastern states which record higher incidences of cancer. As reported in the Lancet paper (Cancer mortality in India: a nationally representative survey Lancet 2012; 379: 1807–16) the North Eastern States of India has the highest risk of cancer-related death 11.2 per cent (95 per cent CI) when compared to Tamilnadu, Orrisa, Bihar 3-2 per cent). “The quality of cancer care was very poor in eastern India but we have changed that. People with cancer, who have gone to Mumbai for treatment and then come to us, have not gone back to Mumbai centre,” says Dr Mammen Chandy, Director, TMC. TMC Kolkata is governed by a charitable trust – Tata Medical Center Trust, established in the year 2005. The centre sees about 20,000 new patients every year. Backed with modern technologies and upgraded facilities, it is a win-win situation both for the patients and the centre. The hospital was designed by Cannon Design, a

renowned architectural firm from North America and is located on 13 acres of land at New Town in Kolkata, West Bengal. The hospital campus is one of the three institutions planned for management of cancer, the other two being Premashraya (an accommodation facility for outstation patients and their relatives) and the Tata Translational Cancer Research Center (TTCRC).

Says Dr Mammen Chandy, Director, TMC, “The centre has excellent diagnostic laboratories for histopathology, cytogenetics and molecular diagnosis apart from routine microbiology, biochemistry and haematology. All labs are NABL accredited. The centre also

offers imaging with CT, MR, Mammo, PET, and a Cath lab, it has state-of-theart OR’s with the Da Vinci Robot, 4 linear accelerators, haematopoietic stem cell transplantation and has completed 500 transplants.”

The centre caters to 75 per cent of patients in the general category and 25 per cent in the private category.

The private unit charges twice what it costs to provide a service in the general category. Last year, TMC provided about Rs 18 crores of financial assistance to patients through the Tata Trusts, crowdfunding and individual donors.

The hospital has a capacity of 437 beds and serves all sections of the society

with 75 per cent of the infrastructure earmarked for subsidised treatment for the underprivileged sections.

Having spent 42 years in CMC Vellore, the exposure has been invaluable. Dr Chandy says, “I have applied most of what I have learnt at CMC Vellore to TMC in Kolkata. Most importantly many of the intrinsic values of not having a private practice, treating all employees with respect, working together as a team and making the patient the centre of all that we do have been the guiding principle at TMC.” TMC has many collaborations both domestic and international and these

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19

APPROACH have helped the centre move ahead with individual departments in working tie-ups with cancer centres all over the world. The paediatric team at TMC works with the group in St Jude’s Tennessee USA, the collaboration with Duke in North Carolina has been in areas like nursing and radiotherapy, the RT department works with Christie Hospital, The Royal Marsden and the Leeds Cancer Center.

The hospital has also been engaged with startups in the field of cancer care. Citing examples of the tie-ups, Dr Chandy says, “The BALCO Cancer Hospital in Chhattisgarh is an example of the way TMC works to help build other institutions in the region. We have been involved in the design, construction, equipment choices, SOP etc from inception to commissioning and we are still collaborating with them.

The hospital has undertaken various research projects during the past years.

TTCRC have received Rs 75 crores from TCS and over Rs 10 crores from DBT is conducting a national multicentre trial on the treatment of childhood

leukaemia where more than 2000 children have been treated at different centres with reduced mortality and improved outcomes. TTCRC works with the University of Manchester and other leading centres for childhood cancer in Europe. TTCRC will focus on translational research, bringing problems from the bedside to the laboratory and solutions back to the bedside.

TMC is part of a DBT-funded Systems medicine cluster for research on oral and cervical cancer. The DBT has just approved funding for TMC to develop a CAR T cell programme.

The Quality Assurance & Control Department at TMC works in tandem with best practices, optimising process outcomes and ensuring patient satisfaction and safety of the environment of care and occupants.

One of the prime objectives of the department is to obtain national and international accreditation for different departments and processes at TMC. The blood bank of the facility is accredited with the National Accreditation Board for Hospitals and Healthcare

OPD at TMC Kolkata

20

February 2021

Providers

(NABH).

The

Laboratory

services are accredited from National Accreditation Board for Testing and Calibration Laboratories (NABL) and the hospital processes are being designed for

accreditation

by

the

National

Accreditation Board for Hospitals and Healthcare the

Joint

Providers

(NABH)

Commission

and

International

(JCI). The blueprints of the facility have already been reviewed by Joint Commission

International

Consulting

(JCIC) and were in coordination with international facility safety standards.

The hospital undertakes phase I/II/ II clinical trials as well as laboratory and technical studies on a wide range of and

subjects.

Collaborative

developmental

research

activities

with

some of the best academic hospitals are planned often. A memorandum of understanding (MoU) has already been signed with Duke University in the US for collaboration in a wide range of activities, including clinical research as well as health information technology.

COVERSTORY

Cancer Care in Post COVID World Fundamental research, innovations and the concept of create-in India can be a game-changer in cancer care

Dr Vishal Rao Associate Dean, Centre for Academics and Research, HCG Cancer Hospital Bengaluru www.indiamedtoday.com

21

COVERSTORY

W

hen we talk of the future of cancer, we essentially think of the next decade which holds the responsibility of bridging the gap between biological advances and technological advances.

To bridge this glaring divide between the two progressions, we will need to define targets and timelines under four broad

heads: advances in molecular biology, cancer research, cancer moonshot initiative for India and cancer technologies aimed at prevention, detection and cure.

Cancer in Perspective Currently, in India, cancer is one of the leading causes of mortality, and the overall survival rate is poor as most cases are presented at an advanced stage. Worse, the best of recent advances have made a trifle impact on outcome outcomes in the vast majority of cancers. Even the global statistics of 24 top cancers are not heartening on this count, as the curative ordeals have been far from the game-changer they were expected to be. By 2030, a significant rise is expected in the number of cancer cases, given the double blow at play. On one hand, tobacco and alcohol abuse is rampant, on the other, the use of preservatives, pesticides, chemicals, and adulterants in our food is playing havoc with our minds and bodies.

Conscious Capitalism Our current focus in cancer care should hence be on designing a comprehensive plan that addresses a 'Prevention to Palliation' approach while stressing on prevention. After prevention, the next best strategy is early detection. These two need to be at the top of the pyramid in our fight against cancer. More importantly, we need to adopt a societal approach to address this cancer epidemic which could graduate into a pandemic in the coming years if left unchecked. If we look around us, we increasingly find society itself developing a cancerous mindset, thanks to the reigning vulture capitalistic approach. We simply want more and more of everything, virtually driven to despair by the “buy one, get three free” frenzy in every purchase, whether tobacco, alcohol or adulterated food.

The only way we can add value and meaning to life and arrest this mayhem is by

22

February 2021

replacing the vulture capitalist approach by conscious capitalism. And towards this effect, the WHO, federal and state governments would need to invest more in cancer prevention strategies, else healthcare costs are only going to rise exponentially. The 19th century was for dynasties, 20th for the federal government, but the 21st century will belong to states and cities to take decisive actions on healthcare.

Statistical outliers in cancer and science of healing I wish to allude to a patient of mine, a 67-year-old lady who came to me with an aggressive cancer of the mouth, a sarcomatous carcinoma of the maxilla. Post an eight-hour surgery, when she came back in a month for radiation and chemo, the tumour had recurred both in the lungs and local area. The patient was now in a wheelchair, unable to walk on her own. Despite the seeming futility of further treatment given the poor prognosis, I briefed the patient about metronomic chemotherapy – a low-dose chemo variant founded on the simple premise that if you cannot demolish a building at one go, try to remove one block at a time. I gave her the needful tablets and requested to keep me updated through regular follow-ups. One and a half years later, the family came to report that she was back to normal life. A PET scan showed no tumour this time around. This case was nothing short of a game-changer given its extraordinary significance in shaping the direction of future cancer therapies.

Small is Equally Big Typically, in aggressive cancers, on a chart showing stage-wise survival rates at diagnosis, where X-axis denotes survival time intervals and Y-axis shows tumour growth in per cent, the tumour never exactly touches the Y-axis, thanks to the statistical outliers, people who beat the statistic, despite being pitted against the bulk of cases which go from bad to worse. However, given the customary focus on big data, we lose sight of the small data, which is a priceless pointer to where we went right in an ocean of wrong. To me, this tiny, minuscule minority is integral to scientific advancement as it will lead the alterations and tweaks in major protocols where we have been failing recurrently.

Ground shot and Moon shot In 2016, Joe Biden set up the Blue Ribbon Panel with the NIH support that kicked off the cancer moon shot, a brilliant, billion-dollar initiative targeted at the core areas of cancer equipped with five weapons: enabling technologies, immunotherapy, precision medicine, personalised medicine, and Big Data. I believe India should spearhead its cancer moonshot initiative. We should be at the forefront of oncology research making our discoveries. In the case of the lady mentioned above, precision medicine and personalised medicine worked wonders with the difference that my focus here was both on big and small data. This is the highly patient-centric moon shot that we need to unleash in India.

In the context of these five areas, I am reminded of Moses Judah Folkman, best known as the father of angiogenesis, and perhaps the one who has significantly contributed to advances in tumour angiogenesis. He wondered long back whether we will reach a point in history when we can peacefully coexist with our tumours. In other words, one won’t have to kill the other in an elusive zero-sum game if cancer could be made akin to diabetes or hypertension. This is the moon shot we need to work towards, of making cancer a truly chronic disease. Precisely why, while we aim for the moon shot, we also need to look at the ground shot to make cancer treatment easily accessible at the grassroots level.

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23

COVERSTORY

Gene side and Bedside Medicine Biomarkers are characteristics of tumours that can be measured objectively as indicators of a pathological process or therapeutic response. In the course of my research, I have proposed the immune TNM staging in oral oncology. T stands for T-cells, N for neutrophils, and M for macrophages that together help predict the progression of a disease. Till now, the whole focus of cancer staging systems has been on tumour node metastasis, given that tumour starts at a particular area, spreads to the lymph nodes and later to other organs.

The new staging systems must necessarily study the immune system. Why? Because even cancer of the same stage does not necessarily behave the same way in all human bodies. Stage I cancer in one person may approach cure, while in another body, it may necessitate a protracted treatment, and in a third body, it may spread beyond cure. This is the reflection of the denominator in the immune system, not merely the nominator. A probe into genomics, proteomics, and metabolomics will lead to gene side medicine complimenting bedside medicine.

Microbiology of the Cancer Biology Simply put, Genomics helps us know who we are. It is the horoscope of the gene which makes some startling revelations about the truth of the human body. We house 23000 active genes, while the genes in one grain of rice amount to 55,000.

So, if we think we are highly evolved, we seriously need to take an introspective break. In this context, epigenomes assume critical significance as they help answer the key question: Who controls our genes – who turns the switch on and off? More important than the switch is the controller of the switch. The controller can be our minds, the food we consume, or the air we breathe – which is another reminder of why we need to take care of our environments, curb our addictions, balance our diets, and be wary about the pesticides and adulterants that may be killing our good microbes, much against the assumed metaphor of war- ‘the only good bug is a dead bug’.

24

February 2021

Studies show that while our human genome is relatively fixed, we are truly defined by the other contagious genome, which is the microbiome. We have 100 trillion microbial cells housing 20 million microbial genes present since birth.

At HCG, we are working on finding whether there is an oncobiome? Are there any bad microbes that cause cancer? One of my recent projects in oral cancers revealed the possibility of a few bad microbes playing a causative role in creating the oncobiome with parallel depletion in good ones. So, the field of microbiology has now shifted from observing these microorganisms under the microscope to studying their genetic trails. You cannot see viruses under the microscope, but their DNA materials can well be traced. Most microbes are good bugs, but we need to track the minority of bad bugs too, as they could represent the true reflections to our immune system.

Size, Seed and Soil While studying a tumour, we are invariably size-fixated. Bigger the size, advanced the stage, and larger the capacity to invade is the current dictum. At HCG, we are exploring the depths of non-invasive methods for diagnosis and one such way is the circulating tumour cell clusters known as liquid biopsy. Our probe seeks to answer the question: Can we come to a stage where we can pick up and predict various cancers from the circulating tumour cells or even earlier? Can we track the cancer cells in the circulation itself while it plans its spread? Our ongoing research has shown that while a person of stage one cancer had aggressive circulating tumour cell clusters in his blood, a stage four person’s circulation showed none. So, the very perspective of looking at a stage based on size may be flawed as there are biological signatures and factors beyond mere size alone, which have been laid less emphasis on. The fundamental relearning that has to happen in oncology is through revalidating some of our prior assumptions through research. The concept of seed and soil has been central to the assumptions - from the early 50s, we have believed that seed is more important than the soil. It is the seed that will cause the tumour to proliferate. But over the years, we have understood that the soil is equally important – that seed cannot germinate without the right soil. Today,

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25

COVERSTORY we have gone one notch above to find that the seed carries with it its own soil, and could be more important than the seed. If the soil is fertile and ready, it could attract the seed to itself. Once the circulating tumour cells originate, the soil will call for it. It will create a climate to attract the seed like a magnet. That is what we have known through the microenvironment, and at HCG, we have developed the Tumour Immune Micro Environment (TiME) score.

Create in India based on Fundamental Research It has been conventionally believed that genomics alterations lead to changes in proteomics and metabolomics. But what if there was another route? Rather than looking at a constitutional defect, why not look for an extrinsic action of various carcinogens that we are exposed to? We have recently published a paper where I have hypothesised that cancer can be predicted through the understanding of physics, chemistry, quantum physics and mathematics which will fuel a quantum leap in our understanding of cancers.

Digital diagnostics, IoT and the cloud, ultra-fast scans, wearables, blockchain, digital therapy, big data, nano health, AI health, hackathons, system learning and robotics, these 12 technologies will form the foundation and future of oncological targets to make cancer treatment accessible and cancer more affable, in the sense of coping with it like a chronic ailment rather than succumbing to its identity as a killer disease. Unfortunately, India’s GDP spending on research is negligible. We are largely content with replicating and revalidating the West rather than innovating and originating. That’s why we need to look beyond ‘Make in India’ to ‘Create in India’ based on improved crosstalk between fundamental research and innovations, on the lines of the approach taken by BIRAC-Dept of Science and Technology, Govt of India. This would call for substantial investment both from private and public bodies, a grand collaboration to bring academia and industry rooted in lateral thinking across diverse areas of expertise.

26

February 2021

SPECIAL FEATURE

The World of Cancer Centres Key to successful cancer centres and how to develop them

Dinesh Madhavan President, Group Oncology & International, AHEL

Cancer Care projects have evolved over the years when the projects have been commissioned by selfless crusaders, not for profit institutions supported by the government, central and state government bodies who have envisioned these projects as access to affordable cancer care projects to the last two decades; where we have seen greater access to comprehensive cancer centres, public-private partnerships, stand-alone comprehensive cancer centres, the hospital in hospital model, day-care chemotherapy centres, cancer diagnostic centres, and advanced cancer centres. Thanks to private enterprise which has greatly filled the gap that could not be addressed by public enterprise.

Cancer is not only one of the biggest challenges that the medical fraternity faces but also one that is rapidly evolving. Especially with the advent of biologically targeted treatments and personalized cancer treatments based on genomic sequencing. It is clear that an interdisciplinary approach to integrating research, treatment and care will help address those challenges with improved outcomes, increased patient wellbeing and more effective prevention and treatments in the future.

Through these significant investments, hospitals aim to provide the best cancer care. However, infrastructure alone cannot guarantee best in class care.

Here are several steps that hospitals can follow to develop a successful cancer centre.

1. Articulate a vision. The management team should start building a cancer centre by developing and articulating a vision for cancer care. The promoters and leadership need to agree on a vision

for the centre that includes the size of the centre, clinical program, its mission, standards, and its goals in patient care.

2. Develop a strategic plan. Once leaders of the hospital and service line support a common vision, they need to develop a strategic plan with the disease burden in the geography, mapping of the cancer care providers and policies on cancer .

3. Design - The design of cancer centres must not only address the clinical requirements but also consider ways in which patient wellbeing can be optimized through the design and layout of the space in order to maximize positive outcomes.

Operationally, cancer centres must be flexible enough to adapt to new approaches to care and treatment and new technologies. They must also be able to integrate the treatment of patients with the research value of a live cancer care environment by providing an interdisciplinary setting.

4. Cancer Management Teams - To begin staffing a cancer centre, hospitals need to recruit a multidisciplinary team of clinicians. One of the keys to a successful cancer centre is focussed cancer management teams that specialize in a specific type of cancer only. It is an impossible task to expect cancer specialist to keep up with the rapid pace of new developments in every cancer and also master that domain.

5. Advance technology - Advances in technology has played a very important role in accurately diagnosing cancers and also for precise treatment that has shown to improve outcomes.

Some of the advances in acceptance of technology that have made a difference are robotic surgery, robotic radio

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27

SPECIAL FEATURE

surgery, digital PET CT, digital pathology, intraoperative MRI, proton therapy, tomosynthesis, adaptive radiotherapy and molecular lab.

6. Support Group and Foundation – Cancer winners and survivors are of great support and guide for newly diagnosed cancer patients, they repose faith on how cancer can be overcome and you could live a life free of cancer or a qualitative life with cancer .Support groups in hospitals or communities have proven to be beneficial in ensuring guidance, addressing concerns and also taking care of many an emotional aspect. In addition to the support groups a cancer foundation that could help the economically challenged to access qualitative cancer care is crucial to ensure better access to cancer care and no one is deprived of treatment for financial reasons .

28

February 2021

7. Offer clinical trials. After establishing a robust clinical programme with specialised teams and advanced technology, hospitals should consider offering clinical trials as a way to increase treatment options for patients.

This gives them the opportunity to try new medications and therapies that may result in better outcomes.

8. Focus on the patient experience. As an additional step, hospitals that aim to be recognised for strong cancer services need to focus on the patient experience when delivering care. A patient's experience is shaped by everything and everyone in the care environment.

9. Expansion and Improvement – Cancer care is fast evolving and thus the need to embrace newer models of treatment and the technology that are introduced, it is thus important that every cancer project is structured in 2-3 phases

and a continuous improvement plan in services and technology upgrade is planned. Planning for this from expertise, tech advancements and funding is important.

10. Raise awareness on various cancers – It is important that awareness is raised on various cancers, its prevention, screening treatment options, living with cancers and life after cancer .

11. Advocacy - Cancer centres should take the lead and actively participate to ensure that policies on cancer and its management is reviewed with government bodies, changes or improvements are made that will help in identification, prevention, screening, diagnosing, notification, national policy, incidence and integrating with the national cancer grid.

The move towards specialist cancer centres to support the work carried out in treating and caring for patients in hospital oncology departments is

creating scope for specialist expertise in the design of cancer care environments.

A ‘hub and spoke’ model for patient care with comprehensive cancer centres at its core, feeding into major urban cancer units and regional hospitals, enables appropriate treatment and care to be delivered at varying stages in the patient’s treatment journey, supporting both optimisation of resources and patient wellbeing.

The typical project completion period for a cancer centre is around three years, with the design period taking up to 12 months and a further twov years required for construction, fit out and commissioning.

There is an increasing design emphasis on how cancer centre environments affect patients’ anxiety levels and wellbeing, which, ultimately, influence outcomes.

The challenge is aligning clinical pathways with spatial design, rather

than allowing spatial planning to be determined on a silo departmental basis.

Practical operational considerations, such as building services engineering, weight loading and access, must be factored into this approach, but the treatment pathways must be the starting point. Furthermore, the facility’s research objectives must be built into the patient journey to ensure that diagnostics, research and treatment are seamlessly integrated. Making research visible to patients reassures them that their treatment is up to date and of the highest quality, encouraging higher rates of participation in clinical trials.

Ultimately, the purpose of designing specialist cancer care units is to support patient wellbeing and improve outcomes. This can only be done with an approach that puts consultation at the centre of achieving a bespoke design that meets the needs of specific professionals and patients.

South East Asia’s first Proton Therapy Centre

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SPECIAL FEATURE

Impact of COVID-19 on Cancer Care How cancer universe was affected by the pandemic

Dr (Col) R Ranga Rao Chairman, Paras Cancer Centre, Paras Hospitals, Gurugram

The coronavirus pandemic and the subsequent lockdowns have impacted not only cancer care but also cancer research, in India and the world alike.

The initial period of uncertainty brought new challenges for cancer patients, disruption of the delivery of cancer treatment and the continuity of cancer research. Many elective cancer surgeries were cancelled to redirect resources and healthcare staff to manage the coronavirus pandemic, as well as for the fear of corona infection.

Simultaneously, after a short gap, the addition of telemedicine, artificial intelligence and digital healthcare services happened in a revolutionary manner across the world, to maintain the continuous healthcare services to all concerned patients as well as to help the patients and people to be advised promptly about the corona infection.

This helped the patients to curtail the spread of the virus, and advise about their medications from the comfort of their houses.

For cancer patients, the challenging and unintended times began for those who didn’t know that they are going through cancer. Various studies have suggested that the pandemic led to a roughly 80 per cent drop in routine screening appointments that could catch new cancers in March and April.

Since the cancer screening can’t happen virtually, the cases of breast, colon and cervical cancer also increased. Most of the screenings for above-mentioned cancer require an in-person procedure like a colonoscopy (for colon cancer), mammogram (for breast cancer) or a

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pap smear (for cervical cancer). There has been a tremendous decline in the number of tests to screen for cervical, breast and colon cancer by 85 per cent or more after the first COVID cases were diagnosed in India. Delays in cancer screenings and treatment are expected to lead to more than 10,000 additional deaths from breast and colorectal cancer over the next decade.

The pandemic has taken a toll The COVID-19 pandemic has no doubt left a negative impact on cancer care.

It has been found that nearly 50-80 per cent of people in treatment for cancers have experienced some delay in care due to the pandemic. However, as we are getting back to the normal many healthcare centres are once again encouraging patients to come in for routine care. Many have implemented safety protocols (like limitations on visitors, getting rid of waiting rooms and mandatory COVID-19 testing for certain patients and staff) that make it safe for most patients to come in for screening tests. Doctors are also asking outstation cancer patients, who are in the advanced stage, to get their chemotherapy done from their nearest hospital just in case travelling is an issue.

COVID-19 was harsh on cancer patients COVID-19 has a dangerous consequence of having an overaggressive immune response known as a 'cytokine storm,'

which can damage lung and other tissues. Patients with cancer are treated with immune-stimulating therapies such as immune checkpoint inhibitors, chimeric antigen receptor (CAR) T-cell therapies and bi-specific T-cell engagers (BiTEs) are at the risk for complications if the immune response produced by these therapies results in an attack on normal, healthy tissue. Patients treated with CAR T-cell therapies and BiTEs, in particular, can develop a side effect known as cytokine release syndrome, which is similar to the cytokine storm in patients with COVID-19. Researchers have theorised that COVID-19 could aggravate cytokine release syndrome in patients treated with certain immunotherapies, but studies have not shown that this is happening.

During COVID, old patients couldn’t come for a check-up which resulted in the delay in diagnosis and treatment.

New cancer patients could not get into the hospital for getting their check-up done as many government centres were

either shut or converted into COVID ward.

Impact on cancer research To limit the spread of COVID-19, many laboratories have developed new policies so that a limited number of lab workers can enter. This also resulted in putting many studies on hold.

Many projects supported by private philanthropy groups faced funding issues. Drastically decreased donations to cancer-focussed philanthropic organizations have also been witnessed.

A report suggests that the American Cancer Society expects a $200 million decrease in donations this year and has not been able to accept applications for research grants for the fall grant cycle. This is not all. Some cancer centres also put a hold on enrolment on clinical trials entirely during the height of the pandemic. A survey of clinical investigators in March found that nearly

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SPECIAL FEATURE 60 per cent of respondents had halted screening and/or enrolment in certain trials, and that half of their institutions had ceased collection of blood and other tissue for research purposes.

Despite these challenges, investigators have come up with a variety of ways to adapt to challenging circumstances so that trials could continue. These include, leveraging telehealth, e-signatures for trial documentation and shipping oral medications and allowing tests to be done even outside the lab.

Lessons learnt from COVID Cancer patients and caregivers, by necessity, have to become adept at living in limbo. Will cancer come back? Will, there be another epidemic or pandemic or something that can change? We don’t know. · Be prepared, not panicky It’s good to educate yourself, but you want to find the right resources and avoid stories that feed into the panic. The more informed you are, the

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more you’ll feel in control of what’s happening. · Stay connected with others — and yourself No matter what happens, one must always remain in touch with their loved ones and own too. It’s easy to become isolated and lonely. But that makes your weak both mentally and physically.

We can’t control what’s happening right now, but we can control how we respond to it. Things may seem haywire but every day there’s something to be thankful for. Find what makes you happy and focus on that, whether it’s family or friends or the sound of birds chirping outside. · Healthier protocol is the need Not only people, even hospitals and healthcare centres have become more aware of healthier protocols. Wearing a mask and good sanitization has also become the norm. People have understood the severity of infectious diseases and started following healthy practices.

IMPACT

Indian Crusader For Global Cancer Care In conversation with the first Indian Oncologist directly elected as, President of the Union for International Cancer Control (UICC, Geneva), Dr Anil D’Cruz

By M Neelam Kachhap

The Union International for cancer control (UICC) is the largest and most influential cancer organization globally that works closely with WHO and other global cancer and economic bodies and has a membership of 1200 organizations from over 172 countries. Dr Anil D’Cruz, Director,

Oncology

Services,

Apollo

Cancer Centres, Mumbai, is the first Indian Oncologist to lead this global body.

As a well-recognized global leader, clinician, researcher and teacher in Head and Neck Oncology, Dr D’Cruz brings with him over 30 years of experience in the field of cancer care. Dr D’Cruz has held leadership positions and is on the board of numerous professional organizations, universities, research organisations and cancer institutions across the country and abroad. His landmark contribution on the management was neck nodes in oral cancer was awarded the prestigious plenary at the American Society of Clinical Oncology in 2015. Here he talks about his role at UICC and his vision for Dr Anil D’Cruz

UICC in the coming year.

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IMPACT Could you tell us about the global burden of cancer and how it has changed after the COVID-19 pandemic?

The global and country specific burden of cancer is monitored and data released in the public domain by the IARC (International agency for research on cancer-WHO) as globocan data and is available as a free download on the internet. IARC releases updated figures every couple of years, the last being in mid-December. The new estimated global cancer burden had risen to 19.3 million cases and 10 million cancer deaths. IARC estimates that globally one in five people will develop cancer during their lifetime and one in eight men and one in eleven women will die of this deadly disease.

Breast cancer, accounting for one in four cases is the commonest cancer in women globally while lung and prostate cancers are the commonest in males and together constitute a third of all male cancers.

Latest Indian data from National Cancer

Registry Programme projected the number of cancer cases in India to be 1.3 million for the year 2020, with breast, lung, mouth, cervix and tongue being the five leading sites. Distressingly two thirds of cancer in our country present at a locally advanced stage.

Since the COVID pandemic is barely an year old, it is not expected to have an appreciable change on the burden of cancer in such a short period, however there are indications that given the impairment of regular health services, stoppage of screening programs as well as shut down of transportation in many countries, there would be an expected stage shift towards cancer being detected late globally.

What is UICC’s role in the fight against cancer?

Union International for cancer control (UICC) is the largest and oldest international cancer-fighting NGO, founded in Geneva in 1933, with over 1200 member organisations across 172 countries. Its mission is to unite and support the cancer community,

to reduce the global burden of cancer, promote greater equity and ensure that cancer control remains a priority on the global health and developmental agenda. UICC partners with over 50 organisations, associations, companies and foundations that are committed to the fight against cancer. It enjoys consultative status with the united nations economic and social council (ECOSOC) and has an official relationship with WHO, IARC, International atomic energy agency and united nation's office on drugs and crime (UNODC).

The activities of UICC are in three main domains namely advocacy (tobacco control, cervical cancer elimination), convening (world cancer congress and world cancer summit) and capacity building (Fellowship grants, CEO training programmes, master courses)

You are the first Indian to be elected President of the UICC, this is a great impetus to India’s efforts in the fight against cancer, how do you see this new role?

It is an honour to be the first Indian to be elected as the president of this great organisation. It gives me a chance to work on the mission of UICC both nationally as well as on the international stage. Many organisations within our country have been doing excellent work in the area of cancer control and I see myself strengthening their activities as well as facilitating their interaction with global organisations. Also, I would make efforts to influence leaders and policymakers to strengthen our fight against cancer.

What is your vision for your presidency at UICC? The pandemic has impacted and shifted the focus from cancer control. However to me, cancer must remain a top priority on the global health agenda and for countries at the national level. We at UICC will continue to lead to ensure that our advocacy messages and those of the cancer community are heard worldwide. We will work closely with our membership and further strengthen

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our collaboration with our strategic network organisations namely IARC, IAEA, city cancer challenge foundation, NCD Alliance, McCabe Center of Law and Cancer as well as our partners in the private sector. My dream is to engage more global health leaders from academia from across major institutions. Supporting the WHO global strategy to eliminate cervical Cancer is another of my priorities. Also, we will support countries to ensure that they set up a robust national cancer control plans. Countering the growing challenges of the E-cigarettes and the continuous sustained fight against the use of tobacco will be other areas of priority for me in the next two years.

Convening leaders in cancer, which is one of our fortes, will be another core priority area as we adapt to the pandemic. We have already affected a shift from traditional face to face meeting to setting up virtual fellowships, workshops and webinars. Hopefully, we look at transitioning to a hybrid model of meetings in the near future.

sure the voice of cancer is heard loud and clear with the theme "I am and I will". In addition, we will hold the world cancer leaders summit at October 2021 at Boston with the theme ‘Driving innovation to advance cancer control equitably'. We are designing new ways to engage members virtually in a quest to bring all voices together.

country or region. For me I believe the best way to overcome these issues is the diagonal approach to healthcare.

This includes strengthening both the primary healthcare of a region (will help in prevention, screening and early detection) as well as strengthening centre of excellence and manpower (improving outcomes).

Our efforts in cancer care are concentrated in pockets around the world, how do we increase the impact of the effort to reach even the marginalized in remote locations?

What would be the best ways to attract the attention of global leaders towards cancer care efforts?

Equity in healthcare is a concern world over, including in some of the most developed countries. Addressing this issue is difficult as the reasons are multi-factorial and in addition to do with socioeconomic causes which are linked to the development of the

As mentioned earlier, convening the world leaders and having them exchange ideas at the highest level would help attract their attention to the growing incidence of cancer as well as what needs to be done to help in its control. Also, encouraging and helping them to develop cancer control plans in their own countries would help prioritize cancer care efforts.

What are the challenges you perceive in connecting global voices in cancer advocacy?

How do we bring all voices together?

The biggest challenge as I see today, is the uncertainties and restrictions brought about by the pandemic.

Rightfully, the focus did shift to issues related to COVID 19.

The financial impact of the pandemic has also affected many organisations within our community. In a survey of our members, 120 of whom responded, 3 per cent will cease operation as a result of the pandemic; 40 per cent have seen drops in income between 25 - 75 per cent; and 20 per cent have seen drop up-to 25 per cent. We do not know how long this impact will last and what 2021 has in store for us.

However, our cancer community has been very resilient and are bouncing back towards pre-covid status. We plan to bring our cancer community together strongly starting with the world cancer day on February 4 when we will make

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INTERVIEW

Providing Precision Cancer Care Dr Jagprag Singh Gujral, Group CEO, CTSI South Asia talks about the company's strategy for the Indian market

By Sanjiv Das

Cancer Treatment Services International (CTSI) CTSI is a privately-held provider of comprehensive clinical and administrative solutions for the treatment of cancer and other complex diseases. CTSI was co-founded in 2006 by a group of physicians and industry experts with decades of experience in the development, operation and networking of private and academic medical practices. CTSI owns and operates an expanding network of comprehensive cancer treatment facilities primarily focussed on India and South Asia. CTSI’s flagship international centre, American Oncology Institute (AOI), commenced operations in 2013. American Oncology Institute is a 300,000 square foot cancer-focussed multispecialty hospital in Hyderabad, India. The hospital serves as a state-ofthe-art treatment destination for cancer patients, featuring radiation oncology, medical oncology, surgical oncology, full-service diagnostics and other supportive care services.

CTSI is the parent company of AOI, could you tell us about the company and how is it structured to integrate cancer care?

Dr Jagprag Singh Gujral, Group CEO, CTSI South Asia

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CTSI was started by a group of clinicians and entrepreneurs from the University of Pittsburgh Medical Center (UPMC) who came together to bridge the gap in cancer speciality care between the Western developed hospitals and the speciality hospitals in emerging

markets. The key objective was to develop a comprehensive cancer care setup across the emerging markets with a vision to build an evidence-based practice to meet the highest standards for trust, transparency, and technology while taking care of patient needs.

What is the current strength of CTSI (AOI) in South Asia and how do you see this number rising?

CTSI (AOI), a focussed cancer care chain, has grown from a network of three hospitals to 15 hospitals over the last 26 months. With presence ranging from the North East to Jammu to Sri Lanka, the cancer care chain caters to a population base of 300 million and has maintained its leadership in differentiation due to its quality clinical protocols, superior technology, evidence-based practice to identify and prevent cancer at the earliest stage possible, benchmarked clinical outcomes and superior service standards.

There is a huge geographical presence which we have been able to establish in the last few years in the region keeping in mind the demand-supply gap.

Apart from Sri Lanka, we plan to set up facilities in Bangladesh, Nepal and Myanmar which are currently under consideration.

With affordability, access and bestin-class care at the forefront, AOI is leading the fight against cancer in South Asia. AOI’s growth trajectory, industryleading financial performance and differentiated approach to healthcare delivery have driven this recognition.

CTSI has been registering a compound annual growth rate of around 65 per cent over the last few years. Considering that we are a very young company and have $100 million in revenue with a robust growth pipeline, I see us sustaining this growth rate. We have launched on an average of five cancer hospitals annually and would continue the trajectory.

Our hospitals in Imphal, Guntur and Nagpur are stand-alone cancer hospitals.

What challenges did you face while catering to patients during COVID-19 pandemic?

How did you overcome it?

Covid has been especially challenging for cancer patients due to their added vulnerability as a result of cancer. It was important to not only ensure continued treatment of cancer but also create an environment of comfort for the same.

Keeping patient safety, AOI has adopted a comprehensive set of measures for infection-control, personnel-screening and hygiene to ensure that all patients and staff remain safe from the prevailing virus across our 15 facilities. The oncology clinical protocols followed at AOI are benchmarked with the National Comprehensive Cancer Network (NCCN) Guidelines of the US. During the pandemic, AOI treated more than 25,000 cancer patients over the last nine months in a safe and covid restricted environment in its hospitals.

What are the main differentiators of AOI and what strategies help you keep ahead of the competition?

The differentiated competencies developed by AOI address unmet industry needs including meeting patient expectations and addressing grievances. The constant feedback mechanism and a customer-centric approach in a patient's journey is key to a differentiated services model that AOI adopts.

The use of a central treatment planning and clinical dosimetry team allows for a standardised and datadriven approach to identify necessary treatment pathways across its network.

Superior clinical outcomes with minimal tissue damage are achieved through precise dosimetry and the central team supports both India-based American Oncology Institute clinics and partner institutions affiliated with the University of Pittsburgh Medical Centre (UPMC) in the US. AOI also provides patients with expert care by leveraging an international board of tumour

experts affiliated with UPMC. All centres participate in weekly oncology discussions and selected patient case reviews.

What is the business model of AOI? Oncology is a dynamic science with advancements being achieved almost daily. The strategy of CTSI - American Oncology Institute constitutes a holistic care model to support the needs of the patients.

AOI’s hospitals are designed to offer a spectrum of treatment services including medical oncology, surgical oncology, radiation oncology, haematologyoncology, and high-end oncology diagnostics (like PETCT, SPECT, CT, realtime tumour tracking). Moreover, the company offers advanced diagnostic services such as histopathology, molecular pathology, cytogenetics, and next-generation sequencing. The robust IT infrastructure ensures seamless data processing across the treatment cycle.

CTSI is an established benchmark for most of the technology adaptationsProduct Technology, Information Technology (IT), and Clinical Technology.

It is well established that these three are synergistic to each other and ultimately- how well you translate the technology for the end consumer or doctor or patient is the value that can be derived from these adaptations.

Which new technologies did you implement recently in your hospitals to provide precision cancer therapy?

We are a 100 per cent subsidiary of the largest oncology product company - Varian. All 15 hospitals that fall under this group have access to the latest radiation equipment and protocols.

Another significant thing is the utilisation of available technology for patients. The technologies are all based on NCCN protocols and information technology networks, with the help of which we deliver benefits of advanced technology to the patients.

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OPINION

The Last Song What happens when the physician becomes the patient and when death comes calling? Reflections of a surgical oncologist

Dr Ajit Pai Apollo Cancer Center and Apollo Proton Cancer Center, Chennai

The year is 1812. A tale is told of a physician who is guided by death in his ministrations. The doctor becomes famous for his ability to sense who could be healed and for whom there is no hope. Eventually, his endeavour to cheat the grim reaper, to help a sick woman ends with the candle of his life snuffed out by death. This tale finds resonance in today’s grim times. Physicians are succumbing to the COVID-19 virus in droves. Fathers and mothers, sons and daughters are disappearing from this earth as they go about providing succour and hope. The threat of passage, imminent, real and present, which threatens the covenant between the patient, the doctor and the maker has never been more evident.

As we individually and as a collective strive to reclaim life for the dying, we find death shadows us, claiming one as his next victim; perhaps agnostic to the individual who has to depart.

The initial days of the pandemic were dark and filled with fear and uncertainty, as frontline workers like me were exposed to a poorly understood foe. We trudged on nevertheless claiming life for our patients, risking our all. Several colleagues were infected with COVID-19 during those nascent days. One gentleman, in particular, severe illness.

An anaesthetist by profession, he likely contracted the disease while in the line of duty. Hospitalised for several days, he describes his time in the hospital as filled with guilt, despair and waiting for the inevitable. Guilt for infecting his family members and then being isolated from them, despair knowing there were no effective treatments at that point in time and waiting for the inevitability of possible deterioration and death. He survived and is a much more empathetic physician now he says, having tread the same path as our patients and his blood

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being bound to that of the patients he and we as a collective treat.

Death it would appear makes us all equal. The fate of the human race perhaps stands on the knife-edge of our response to the perceived risk of mortality and the cloak of immortality thereof.

As a surgeon treating gastrointestinal cancers, I am surrounded by death and yet I’m defiant. I struggle every day, all day, using every ounce of knowledge, skill, training, intuition; all in pursuit of the holy grail that is fundamental to oncology- to cheat death against all odds and let life breathe a little easier and a lot longer. Though, we yearn to look life in the eye and turn back from youth, to face death with a smile and open arms as a measure of our legacy for ages to come, I suspect here in the deep, steady hands waver and hold us back. In peacetime, it is said, every man or woman is a hero; but it is in war, a great test of our times that we find what we are made of.

How then does one prepare for the spectre of death, that shadows our every step in these dark days? Will the grim reaper find us cowering in our beds and our safe houses or will it find us like Horatius at the bridge, mouthing "To every man upon this earth, death cometh soon or late, and how can man die better, than facing fearful odds, for the ashes of his fathers, and the temples of his Gods?”

I for one have left words for my loved ones to read and rejoice, a soft bower of roses to cushion my fall; a song which should echo far into the distant days, yet to come. It is reflective of the altered reality which marks our days.

Perhaps this is our song as a mass of men and women, a paean to the knights we espouse to be.

When I Die

By Ajit Pai

When I do the inevitable and fall into the dust, Let me go without the sirens and the codes, The machines and the potions, Let there be no sad songs nor wailing, No mourning and no crying, No flowers and no incense, No cortège and no procession, No grim faces and no pallor of gloom.

Let the drums beat and the music roll,

Jazz and country and rock and roll,

Let the drink flow and the cellar run dry,

Till there’s not a sober fool,

Nor a hungry heart in the house,

Let the earth ring with the noise

And eyes stain with the colours of a life lived in profusion,

And let the words be from the heart,

Raw and real and unscripted,

Slake not the wounds of the living with the words of the dead,

Burnished and wise though they be

Let the mighty oak live on In memory rich and green, pulsating with life, The dark corridors of the dead haunt me no more, Four score years among the living haunt me more, And I must reach that place beyond the sea of sorrows Before I am frozen into this life,

And take me down from your walls and your museums,

Your temples and your shrines,

That is for the faded, not for me to you and you to me,

I am the first ray of light And the blazing hues of the setting sun, The first showers of spring and deep snows of the ending year, And I cannot be captured nor kept alive Anywhere but in you, as you laugh and rejoice, Singing my words and dancing to my tunes, In the green valleys of our youth

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PULSE

The Vaccine Queue Who must get it next?

Dr Anu Grover Dy General Manager - Medical Affairs, Ipca laboratories

Dr Manish Grover Pharm R & D Expert, Ex Global Director

Meenu G Sharma Principal Consultant, Businessassociar

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The day of 16 January 2021 was a muchawaited day when the vaccination drive against deadly pandemic COVID-19 began in India. While the approval of two vaccines, under emergency use clauses, has brought lots of hope, there were reports in media raising concerns about their efficacy and safety. There has also been a bit of confusion on one vaccine being released in ‘clinical trial mode’ which was not clear in its meaning and intent, so created some sort of initial vaccine hesitancy.

At the current juncture, while we still do not know everything about the COVID-19 virus and its cures, we already have two vaccines approved for emergency use by the regulatory bodies in our country. It is definitely commendable progress in a very short time. We must realise that this is humanity’s war against a deadly virus.

In war, one does not have the luxury of

time. Therefore, these vaccines have been approved with abridged trials, meaning they have adequate data to say that they are safe for human use and that they have sufficient positive response in a majority of the population that these were tested on. This is a very good starting point for all of us.

Most people have basically two questions in their mind: First, whether to opt for vaccination or not and the second connected question for those who answer the above question with a yes, is which of the two available vaccines one should opt for? The situation reminds one of the popular Shakespearean dilemma, “To be (vaccinated) or not to be.”

For the government, with two vaccines in hand to possibly combat the virus, the next thought is how to select the sections of population who get it first and how to prioritise its usage for the

whole nation.

Since supply in the initial phases is going to be limited, various countries are handling prioritization and distributions using different approaches: • The UK sets out tiers of prioritization, and strategizes to start with getting the vaccine to the very old and to those working in care homes before moving down the age brackets. Prioritizing the most vulnerable members of society is a common/conventional approach.

Joint Committee on Vaccination and Immunisation (JCVI) advised that the first priority should be the prevention of mortality, and to do this they have opted for immediate protection of very vulnerable, elderly people, rather than general prevention of mortality by using the vaccine to reduce the reproduction rate (R-number) of the virus and slow down transmission.

• Germany’s strategize to vaccinate at-risk groups first, along with nurses and doctors. An estimated 40 per cent of the population gets first dibs on a vaccine under the German plan.

• China has put citizens with overseas travel plans among the groups prioritized for emergency-use vaccines.

Aside from preventing its citizens from bringing the virus back home, it also reduces the risk of Chinese nationals becoming carriers of the virus overseas.

• The Advisory Committee on Immunization Practices (ACIP) in the US has recommended that healthcare personnel along with long term care residents be offered COVID-19 vaccination first (Phase 1a) followed by persons aged ≥75 years and non–health care frontline essential workers (Phase 1b) and then to persons aged 65–74 years, persons aged 16–64 years with high-risk medical conditions (Phase 1c) • A recently published model from Khalifa University supports this. Authors suggest that priority should be accorded to groups with the highest number of daily in-person interactions. This amplifies the vaccine’s effectiveness by reducing infections (and mortality) both among the vaccinated group and those

they come into contact with. According to their model, proper prioritization can reduce total fatalities by up to 70%. How to weigh other risk groups? Obesity is a comorbidity for serious complications from COVID-19. Do overweight people get to jump the queue?

Are these models the best way to minimize fatalities due to COVID? Let us focus on India. With a population exceeding 1.3 billion, we do carry a very high risk of the rapid spread of the virus. So far, infection rates per million of population is reported to be one of the lowest in our country when compared with the developed world.

Nevertheless, we do need a logical strategy to prioritize the vaccination of residents of this country. This must include the answer to at least two questions; first being how to prioritize population and second how to cover the whole population of this vast country.

For the first part of the strategy, we need to first understand who is at a higher risk. We know that the virus spreads by people to people contact.

Hence, the best approach would be to stratify the population on the basis of people-to-people interaction frequency.

• High interactions – People who travel using public transport or have interactions with large number of unknown people, like hospitals, shopkeepers, restaurants etc.

• Moderate interactions – people who go to work, but travel in their own vehicles and meet a set number of known people on a daily basis.

• Minimal interactions – People who have a sedentary life. This population mostly stays at home and has minimal interaction with other people.

It is group 1, who will have the highest probability of catching the virus and by corollary the highest probability of spreading it too. Hence, this set of population needs to be targeted on priority.

In addition to this risk group, it is also important that we minimize probability of getting the virus from

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PULSE outside India and sending virus out of India. Hence, everyone travelling in and out of the country – irrespective of their interaction frequency, must compulsorily be vaccinated.

Covering a population exceeding 1.3 billion is going to be a big task. In the first phase which is currently underway, 30 million healthcare workers are being vaccinated, being at the highest risk.

However, with the current pace, experts estimate it could take about 3 years to vaccinate 300 million high-risk people targeted in the next phase of rollout. The government infrastructure alone may not be adequate to quickly vaccinate the large population of our country and we would need private setups to support the effort. Once vaccines are granted full approval for mass use, the government should de-control vaccination and use a more flexible model. For example, a set percentage of available supply, say 30-40 per cent, could be allocated to be applied through the private sector along

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with sufficient safeguards to prevent black-marketing and also ensure safe usage. This will speed up vaccination of larger population size in a much shorter period of time, without compromising access for the highest-risk subgroups.

And now to the question, “to be (vaccinated) or not to be”. It’s too early to know if the vaccines will provide long-term protection.

Additional research, which is time consuming, is needed to answer this question.

However, available data indicates that vaccines are designed for the body’s immune system to safely recognize and block the virus that causes COVID-19.

Of course, the final choice will be up to the individual. We must remember that we have two weapons in the form promising vaccines that will help us fight the disease. Those who will take it will not only help reduce the burden of disease, but will also help us in charting further strategy to fight the scourge for the long term.

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