Currently, chemotherapy, targeted therapy (mostly biologics), hormonal therapy, surgical, radiation, and palliative care (supportive care) are the different types of cancer treatmentsavailable in India. Chemotherapy and surgery are the most prevalent treatment options in India, but targeted therapy is believed to be the future of the oncology market (here and globally). This is because targeted therapy, which consists mostly of biologics, have low toxicity and low radiation — this achieves better results with very minimum or no side effect. Targeted therapy sees increasingacceptance,but its significantly higher cost vs. traditional therapies such as chemotherapy and surgery make it unaffordable in many emerging markets such as India.
Radiation therapy is less entrenched into Indian oncology treatment due to the capital-intensive nature of radiation devices. Amongst the indicated treatment options, chemotherapy accounts for the maximum market value (could be over 50% of the total oncology market).
Due to the complexity of the disease, normally a multimodality treatment is followed for solid tumours using any two or all of the therapies including –surgery, chemotherapy, as well as radiation.The type of treatment is designed based on the type of cancer, the stage it is in, and the patient’s response to treatment. In case of hemato-lymphoid malignancies (or blood cancer), chemotherapy is largely used with a limited use of radiations, based on the stage of cancer. Due to the multimodality treatment practices, the treatment cost multiplies.
The cost of cancer treatment varies significantly from types/stages of cancer and also on a case-to-case basis. For example, treatment of blood cancer (Acute myeloid leukaemia (AML) or Acute lymphoblastic leukaemia (ALL)) would costRs 500,000-600,000in Tata Memorial Hospital. In case of low-grade lymphoma, the treatment would cost about Rs 40,000. “If bone-marrow transplantation is suggested, the treatment cost jumps to around Rs 1mn”, says Dr SeemaGulia, medical oncologist, Tata Memorial Hospital. She further adds, “In advanced breast cancer, in which targeted therapy is needed, the cost could be as high as Rs1.0-1.1mn, but an early stage breast cancer treatment will cost about Rs 50,000-60,000 with multi-year hormonal therapy treatment.” All these treatment costs are about 20-25% higher in a private cancer centre.
As per available industry facts, adjusted for income at constant currency, the money spent on cancer care is equivalent to 0.12% of per capita gross national income in South America, 0.05% in India and 0.11% in China. In the UK, Japan and the USA, the corresponding numbers expenses are 0.51%, 0.6%, and 1.02%, respectively.
Unfortunately, a large chunk of Indian cancer patients belong to either the below-poverty-line category or the lower-end of the middle class — due to this, many people do not receive appropriate cancer treatment. Dr SeemaGulia believes that about 70% of the cancer care reporting for diagnostic and treatment services is in the advanced stages of the disease, which leads to high mortality rates amongst patients in India.
In the early 1970s, there were hardly 3-4 cancer treatment centres — Tata Memorial Hospital, (Mumbai), CMC (Vellore), and All India Institute of Medical Sciences (AIIMS), which pioneered cancer treatment in India. With the increasing incidence of cancer in the country, the Government of India gradually created multiple Regional Cancer Centres (RCCs) under the National Cancer Control Programme,which started in 1975 under the Ministry of Health and Family Welfare (India).
These institutes function under the joint control and funding of the Government of India and the respective state governments. As of now, there are about 30 RCCs in the country, but only 6-7 of them employ adequately trained medical oncologists.
However, private companies such as HealthCare Global Enterprises, International Oncology Services,and Apollo Hospitals have set up multiple cancer centres with advanced cancer-care equipment.Their intent is to capture the huge growth potential in cancer treatment delivery. Spotting significant investment and business opportunity in the early detection and prevention space, many private hospitals have also developed dedicated cancer departments in their hospitals.
According to the health ministry, India has about 300 cancer centres, of which 40% are not adequately equipped with advanced cancer-care equipment. India will need at least 600 additional cancer-care centres by 2020. More than the limited number of cancer-care centres, it is the uneven distribution of such centres through the country that keeps a large chunk of Indian cancer patients away from treatment. Also, a very small percentage of these hospitals provide all three areas of oncology —surgical, medical and radiation.
In addition to deficient cancer centres, there is huge shortage of specialized surgical and medical oncologists in India. Industry data suggests there are only about 1,000 trained oncologists for 1.8mn cancer patients in the country — so the ratio of oncologists to cancer patients is about 1:1,800. To put this in perspective, the US has an estimated 12,500 oncologists to treat about 1.4 million patients diagnosed with cancer — a ratio of about 1:100.
The reason cancer has reached almost epidemic proportions in a developing marketlike India and the reason why we as a country are unable to controlthe disease is mainly lack of awareness. Ignoranceof preventive cancer care coupled with improper dietary habit and deteriorating lifestyle are the key culprits.
Rising affluence levels in the country and consequent changes in lifestyles are also leading to higher cancer rates. According to Mr Kiran Kalavadia, the head of Cipla’s oncology division, Cipla, women are getting married later, having fewer children, are avoiding breast feeding, and some are smoking and drinking alcohol — all these lifestyle changes have increased the incidence of breast cancer.
In advanced countries, early detection and prevention by creating awareness has proven to be the best strategy in controlling cancer. Focused research on various cancers and advancement in healthcare delivery have already started reducing the cancer mortality rate and eased the life of patients with cancer in advanced countries. In fact in the last decade (between 2000-2010) the decline in death rate in the US has been particularly sharp.
In order to curtail cancer incidence, the Indian government has started taking the following steps — creatingawareness, upgrading diagnostic and laboratory and treatment facilities at the district level, and strengthening regional cancer centres. Indian drug manufacturers’ are also pitching in — they have made available generic cancer medicines domestically at affordable rates and this has become a ray of hope for poor and middle class patients. Players such as Dr. Reddy’s, Biocon, and Ciplaconduct various awareness campaigns and research initiatives for early detection and prevention of the diseases.
The increasing focus of government agencies and private players such as Cipla towards setting uppalliative care and dedicated centreshas made the life of cancer patients easier. Entrepreneurs and hospital administrators in the private sector have identified the huge gap between demand and supply of cancer care treatment — therefore, they have started spreading their reach into mid-sized towns, thus benefitting the rural public. With efforts fromboth public and private players,the survival rates and quality of life of cancer patients in India will be definitely better.
However, even though the life expectancy and disease-free survival rate in India is improving, India will continue to have accessibility and affordability problems—basically, even in the near term, there is still a huge gap between demand and supply of treatment.
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