Cancer management in Northeast

The high prevalence of cancer in the Northeast region is a grim reality. The latest cancer data has brought to light harsher realities of cancer management in the region. The Indian Council of Medical Research (ICMR) and the National Centre for Disease Informatics and Research (NCDIR) say that the region has a unique cancer profile compared to other areas of the country and incidence, mortality, and cumulative risk of developing cancer have been consistently high in the region. This brings into focus the preparedness of the health system in the region for cancer care as one of the response strategies to the emerging health crisis. A report published jointly by the ICMR and NCDIR paints a gloomy picture of the shortage of quality cancer-related healthcare facilities in the region. The report titled "Monitoring Survey of Cancer Risk Factors and Health System Response in North Eastern Region of India,2022" states that the majority of the cancer patients in the region availed of treatment at a government health facility which is indicative of the availability of treatment in the public sector. However, survey findings that close to a third (29.9%) of cancer patients seeking health care outside of their state, while over a quarter (26%) of the cancer patients self-finance their treatment and only 5.8% are covered by health insurance, point towards the health system in the region being inadequate and not affordable to cater to the requirement of all cancer patients in the region. Other key findings of the survey also shed light on the gaps despite significant progress being made in cancer management in the region. Some of these findings which call for attention by the Central Government and state governments in the region are: cancer screening for all three types of cancers (cervical, breast, oral) was available only in 19.1% of the Primary Health Centres, 20.4% of the Community Health Centres' and 35.7%of the district hospitals and only about a quarter of the district hospitals had daycare facilities for chemotherapy. The survey found that less than 10% of the respondents had received advice regarding lifestyle modification from a health care provider, regarding avoidance of tobacco and alcohol use, maintaining healthy body weight and undergoing screening for common cancers: oral, breast, head and neck. This reflects the critical gap in the awareness drive and an increase in this percentage will go a long way in preventing cancer incidence, ensuring early detection and treatment to reduce morbidity. The report focuses on cancers sharing several common risk factors, and comparable health system needs with other significant noncommunicable diseases (NCDs) such as cardiovascular diseases, diabetes, stroke, chronic obstructive pulmonary disease and chronic kidney disease for prevention, early detection and control. Addressing these major behavioural and metabolic risk factors such as tobacco use, unhealthy diet, inadequate physical activity, alcohol use, raised blood glucose and overweight/obesity can be beneficial for the reduction of both cancer and NCD risks. The survey reveals that nearly half of the respondents (48.6%) were current tobacco users, comprising 61.7% of men and 34.8% of women, over one-third (38.8%) of men were current users of smoked tobacco and close to a quarter (22.8%) of the respondents reported to have consumed alcohol over the past 12 months and 18.3% reported alcohol use within the past month. Ironically, the mean number of days on which either fruits or vegetables were consumed was 0.8 days in a week. There is sufficient evidence that besides lung cancer, smoked tobacco is causally associated with cancer of the mouth, gastrointestinal tract, urinary bladder and pancreas, states the ICMR-NCDIR report. Smokeless tobacco has been linked with a high chance of oral potentially malignant diseases and cancers of the head and neck and oesophagus while the International Agency for Research on Cancer (IARC) has identified the following sites of cancer that are causally associated with alcohol use: cancers of the oral cavity, pharynx, larynx, oesophagus, liver and female breast, it adds. The survey highlights that close to half of the cancers (49.3%) among males in the region are cancers in sites associated with tobacco use which can be prevented through an effective campaign against tobacco use. The ICMR and NCDIR have recommended that policies to promote smoke-free indoor air at the household level, workplace, and public places should be considered for strict enforcement which underlines the importance of taking the campaign against tobacco use beyond the enforcement of prohibition in public places. A comprehensive review of tobacco control policies, programmes and legislations is needed to identify the reasons why these have failed to produce the desired outcomes. While preventive measures form a crucial component of cancer management, strengthening the health systems at all levels to provide affordable treatment to every single cancer patient has become an urgent necessity given the high incidence. This calls for higher allocation of funds for cancer care, research, and training in the northeast region.