Are Hospitals Enough To Beat Cancer in India?
Let me start with some statistics, which will lead to my answering the question:
- India shares more than two-thirds of the total deaths due to non-communicable diseases (NCDs) in the South-East Asian Region
- NCDs account for 60% of all deaths in India
- In 2010, NCDs accounted for more disability-adjusted life years (DALYs) in India than did communicable diseases
The above-mentioned data and many statistics from various studies, including those from the World Health Organization point to one direction - the disease burden in India has clearly changed. While we continue to battle infectious diseases, a massive new category of disease has started to plague a large percentage of the population. The four major types of non-communicable diseases – cardiovascular, chronic respiratory, cancer and diabetes – contribute largely to the morbidity and mortality of our population.
This category of disease, otherwise known as chronic illness is proving to be a challenge for the Indian healthcare system. The west has more resources and has consequently put systems in place to support and handle chronic diseases.
But, we have a gap, which is constantly getting bigger.
Mind the Gap!
Firstly, let me explain the major difference between healthcare concerns for chronic and infectious diseases. The behavior of a chronic disease is very different from that of an infectious one. In an infectious disease, once the agent causing the disease is eliminated, the disease can be cured. However, in the case of a chronic disease, it can never truly be cured. Its nature is such that its risk remains (even after treatment) throughout your life. Hence justifying the use of the word ‘chronic’.
This is most apparent in the case of cancer. Cancer has never known a permanent cure. We therefore hear physicians talking about “beating” cancer rather than curing it. What makes this disease more complicated is that the treatment period is long and the outcome uncertain. Cancer treatments can range anywhere from 6 months to 2 years with patients spending their time in and out of hospitals while grappling with increasing costs and uncertainty. Even if they have a successful treatment outcome the risk of the disease lingers.
But this changing disease scenario poses several difficulties for our current healthcare system. India over the past 5 decades, has worked to combat infectious diseases that primarily rely on hospital based treatments. In the case of chronic diseases, given the uncertainty and duration of treatment, a patient might only spend as much as 20% of their time in hospitals with the remaining care being received at home. Neither our healthcare system nor patient families are prepared for this change. With our past focus primarily being on hospital care, how will we sort this problem? How will we close this gap?
A big example that validates this gap is the large number of calls we receive at the Cancer Helpline - www.cancerhelpline.in. The Cancer Helpline has served over 21,000 patients in the past two years all of whom were grappling with managing the complexity of this disease. The Helpline receives a variety of calls ranging from questions regarding managing treatment side effects at home, preparing meals for patients, understanding cancer insurance, eligibility for government financial schemes etc. If the current healthcare system was equipped to handle these services, we would not receive any calls.
Need for Integrative Healthcare
Right now there is an enormous need for integrative systems of healthcare - organisations and individuals who help fight the disease holistically by helping the patient outside the hospital, while working with the doctor providing treatment inside the hospital.
It is time we consider questions like, can we train a whole new cadre of personnel who can work with doctors to produce better outcomes? In which part of the treatment cycle should we include mental health counselors? Do we have enough social workers and healthcare workers to support the disease burden? How do we train and create cancer coaches?
We now need to acknowledge that our disease burden is beyond the capacity of our existing system. The developed world has already created great examples of integrative healthcare. Macmillan Cancer Support, an organisation based in the United Kingdom, offers support to patients and caregivers. They have a team of health and social care professionals who are exclusively trained to offer appropriate care for cancer patients when they are in the hospital or at home.
India urgently needs a large number of such organisations, which can effectively support cancer patients. According to the World Health Organization, India had 33 lakh people living with cancer in 2014. This number calls for a pressing focus towards integrative healthcare