Cancer care faces a new challenge in India

About Author: Manikandan Bala, Senior Vice President, TIMEA & Asia Pacific, Direct Sales Strategies & MD India & SA, Elekta Medical Systems India. In a career spanning 32+ years in the healthcare industry, Manikandan has led and managed cross-cultural teams and engaged actively in mentoring next-gen leaders. Manikandan played an instrumental role in driving business growth for companies including GE, Siemens and Johnson & Johnsons. Hei has also been the Co-chair for Medical Devices Forum at Federation of Indian Chambers of Commerce and Industry (FICCI).

We have multiple positive indicators that are driving the nation’s health in the right direction, the national incidence of Non-Communicable Diseases (NCDs) like Cardiovascular diseases, Cancer, Chronic Respiratory Diseases, Diabetes, etc. are estimated to account for around 60% of all deaths in the country. India reported a rise of nearly 324% in cancer cases from 2017 to 2018, according to the 2019 National Health Profile and has also triggered the government to make it a ‘notifiable’ disease in September 2022.

However, we have an opportunity to shape this. With the adoption of cutting-edge systems and technologies, the healthcare industry in India is evolving quickly. India has been successful in countering cancer through the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) program that was initiated in 2011. Though there are areas of improvement like increasing access, availability and affordability of care in Tier 3 and 4 cities, there is a sincere push by the Government and private bodies to meet the demands of the public.

We all understand that decisions are made based on quantitative evidence that is built over some time. Over the last 40 years, the cancer registries that are set up have only been able to collect just 10% of the Indian cancer incidence. Therefore, this is an area that has to be addressed to get a better view of the disease landscape in the country.

Cancer incidence and data collection

Modern computing and information technology have completely transformed the field of conventional medical and healthcare operations. IT subsystems including networking, website, database and software systems completely alter the situation. The medical and healthcare industries have undergone a significant transformation over the past ten years, as a result, there is a gap between India’s supply and demand for medical and allied products. This gap presents an opportunity for the development of medical gadgets.

“Holistic cancer care is based on a multimodal approach – surgery, chemotherapy, immunotherapy, and radiotherapy.”

In this digital age, procedures and diagnostics associated with cancer care are well documented and traceable over the years. Since cancer care is a long-term treatment, electronic documentation of the patient is of specific importance. In line with the Ayushman Bharat Digital Mission, the growth in Electronic Medical records (EMR) adoption is a healthy sign across the country – both in private and government medical facilities. EMR is the foundation for the healthcare industry to thrive and is the much-needed digital tool doctors in the country can rely on. As the penetration of EMR has increased across the country, the support for cancer care has also improved.

Holistic cancer care is based on a multimodal approach – surgery, chemotherapy, immunotherapy, and radiotherapy. The Lancet Oncology Commission Global Task Force on Radiotherapy for Cancer Control (GTFRCC) report from 2015 did a good job of describing the role of radiotherapy in the management of cancer, showing that roughly half of all oncology patients will need radiotherapy at some point during their treatment. There is a direct link between the prevalence of cancer and the number of machines available per million people (CMI).

Challenges faced by patients who need radiotherapy

According to World Health Organisation (WHO) recommendations for developing nations, one Linear Accelerator (Linac) per million people is advised. India has 135 crore people, hence there is a need for 1,350 Linac. At the moment, India has about 545 teletherapy devices (180 tele-cobalt machines and 365 Linac). Consequently, there is an 800 Linac shortage. This shortage means that in public hospitals the waiting period for radiotherapy could go up to 1 year!

“Modern computing and information technology have completely transformed the field of conventional medical and healthcare operations.”

Therefore, one effective way to deal with this challenge is for the Government to take steps directly or in partnerships to upgrade the current medical colleges with minimum radiotherapy infrastructure and manpower to counter the cancer treatment paradigm. This will contribute to the development of an extensive infrastructure of cancer treatment facilities across the nation, making it much simpler for patients to receive cancer treatment at facilities close to their homes and significantly reducing patient travel distance. This will facilitate early diagnosis and the beginning of either chemotherapy or radiation treatment, improving cure rates and lowering disease-specific mortality.

Digital threat to cancer care infrastructure

While the Government and healthcare establishments grapple to deal with the cancer load of the country, there is an unspoken threat that has become stronger on the horizon of digital initiatives that are being taken by the healthcare sector – Cyberwarfare

A US-based report, ‘The hacking report Protenus Breach Barometer’ said healthcare hacking incidents rose 42% in 2020. There have been multiple global incidents around the world – especially in developed markets – where the intensity of cyber attacks on the healthcare infrastructure increased during the pandemic. India has also seen its fair share of cyberattacks by rouge nations and organisations intensify over the years.

Therefore, it’s important to evaluate the security features that are built into the healthcare infrastructure – with a special emphasis on the cancer care and radiotherapy infrastructure of the country. With advanced radiotherapy equipment like Linac systems working on cloud-based systems, the security features that are built in have to be sound to ensure that there are no breaches into the software which could limit patient care.

One such security solution for the next generation of tailored cancer treatments may be provided by professionals with the support of Microsoft Azure – A cloud-based server infrastructure that is constantly updated against any cyber threat, potentially improving patient care. Microsoft Azure has the agility it needs to support patient and research activities through Azure infrastructure, Azure Machine Learning, and Azure Virtual Machines. For any organisation that places a high priority on the security of its IT infrastructure and the privacy of its data in addition to performance and efficiency, it is important to comply with all applicable governmental and industry regulations around healthcare data.

The way forward to preventing cyber-threats

As IT infrastructure evolves around the world, it’s important to partner with academic, IT research and development institutions, healthcare professionals and patients alike to gain insights into their needs and develop solutions that meet their criteria. With the experience of using advanced machine learning and artificial intelligence solutions to develop the most advanced cancer care medical systems in the world, companies should be able to collaborate to share learnings. With Cybersecurity professionals in medical equipment companies working in collaboration with national and international institutions, we can be assured that the future will have better security cover for medical devices and equipment that are available to the world.

*This article was first published in the January 2023 edition of the BioVoice eMagazine. The views expressed by the author are his own.