May 2019

Awareness is key to cancer cure by Dr Arnie Purushotham

The three most commonly occurring cancers in India are those of the breast, uterine cervix and oral cavity. Survival rates for all three cancers are good, if detected and treated at an early stage. As of now, 70 per cent of the cancers are detected at a late stage. Also, a majority of cancers in India are preventable. Therefore, it is vital that prevention and screening programmes are given immediate attention. Spreading awareness on adequate preventive measures and cancer screening will enable early stage detection and ensure better survival rates.

The current challenge with the cancer care ecosystem in India is the lack of awareness about the signs and symptoms of even the most common cancers (breast, uterine cervix and oral cavity). There is confusion in the minds of the general public on the real causes. Women are believed to be highly susceptible to delaying treatment due to their overall ability to endure and the fear of embarrassment around health issues in general. Apart from the insufficient understanding of the disease, there is also a strong association of cancer with fear — fear of its onset, unpredictability of treatment, high expenses, and even death. This leads to a delay in diagnosis, with most of the patients entering the formal healthcare system at later stages, further leading to poor outcomes. It is necessary to address this fear associated with the disease, along with the societal myths and prejudices associated with a diagnosis of cancer, that even some of the healthcare professionals carry forward. Additionally, there is little to no knowledge of the financial assistance available for cancer treatment in our country.

The need of the hour is to build a cancer care model that addresses the concerns above.

In a major programme to impact India’s health outcome, the Tata Trusts are engaged in partnering with state governments and other entities to establish cancer care facilities across the country. This is being done by developing an ecosystem for cancer care through a distributed model of cancer care with a vision to create patient centric cancer institutions across India. The model has three levels of cancer treatment facilities, from basic primary healthcare cen¬tres in rural and semi-urban areas to tertiary care institutes of excellence in urban areas.

1.The level one facilities will be apex centres providing tertiary cancer care services. Present in the major cities, these centres will deal with patients with common as well as complex cancer cases that need advanced treatment and care.

2.The level two facilities will be greenfield cancer hospitals that will cater to the majority of cancer cases and will be built adjacent to government medical colleges. These centres will address the issues that patients have in accessing the tertiary centres in the urban areas.

3.The level three facilities will leverage the district hospitals and provide day care, diagnostic and treatment services. These centres will reduce the time taken for confirmatory diagnosis, day care treatment, and follow up. This will address the problem of patients dropping out due to long travel time for treatment and follow up.

All these levels of cancer facilities will offer community-based screening, diagnostic and treatment services as well as follow-up and palliative care for patients. The idea of this distributed model of care is to make cancer care more accessible and affordable. The most important element of this distributed model of cancer care is the programme on health promotion, cancer prevention, screening and early detection.

To raise awareness, campaigns need to be designed such that they reach the right stakeholders and bust myths around the disease. Targeting for cancer screening should be based on age and gender as defined by the Government of India guidelines for non-communicable disease screening. The overall campaign must be directed towards the general public with a special focus on women as often they can be the promoters of better health seeking behaviour in the family. For breast and cervical cancer, messages targeting women that educate them to look for early symptoms will enable them to protect themselves as well as their families. These messages need to be reinforced by the general physicians, gynecologists, auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs) as well. Additionally, inclusion of policymakers, the police force and other government organisations like the education department are required. Messaging for these groups that convey that cancer is more than a health crisis and can be addressed only with collective social and political motivation will play a critical role.

The focus needs to be on showcasing the most important risk factors of cancer and promoting choices around healthy lifestyle. In addition, knowledge about early signs and symptoms need to be ingrained in the general population, so that they can access the general physicians and other healthcare professionals at an early stage. There is also a need to destroy the myths around cancer like ‘cancer is contagious and fatal’ and promoting facts that ‘cancer screening/ diagnosis is simple and painless’, ‘cancer is curable if detected early’ and ‘cancer care is affordable if detected early’. The tone of the messaging should be such that it creates positivity around the issues and generates hope for the people around cure and the fact that patients after treatment can lead a healthy lifestyle for decades.

Apart from using mass media vehicles like television, radio, short films, outdoor ads, digital media, interpersonal communication with the community by accredited social health activist (ASHA) and anganwadi workers during home visits and by auxiliary nurse midwives (ANMs) during visits to primary healthcare centres should be explored. Community engagements through folk/street theatre, public meetings, public meetings should also be done as part of this multi-pronged approach.

While treatment is the need of the day and investment in infrastructure is needed for the same, there is a critical need for a strong focus and push towards cancer prevention and early detection programmes to make an impact on cancer survival.

The author is Medical Director, Cancer Care Programme, Tata Trusts; and this article was first published in BW Healthcare World.