Assam’s lead in cancer care in the Northeast

The announcement by Chief Minister Himanta Biswa Sarma about the procurement of a proton therapy machine for cancer care by the state government is a major leap for cancer care not just in Assam but for the entire northeast region. The procurement of the Rs 500-crore machine will make the Assam government the first state government in the country to have a proton therapy machine in the public health sector. Currently, proton therapy is available only in a few private hospitals and at the National Cancer Institute in Haryana, which is a unit of the All India Institute of Medical Sciences in Delhi. The availability of such advanced care in the public sector is critical for the region, which is witnessing an alarming rise in cancer cases. Poor access to advanced treatment increases treatment cost, as many cancer patients are compelled to travel outside to seek such care. Proton therapy is a radiation therapy that uses protons, which, at high energy, can destroy cancer cells. According to the Indian Council of Medical Research, proton therapy can also be combined with X-ray radiation therapy, chemotherapy, surgery, and immunotherapy, the central government informed the parliament. The state government made the announcement of the establishment of the proton therapy center at the State Cancer Institute, Guwahati, in the 2025-26 budget speech. The state government floating the tender to turn the announcement into a reality is laudable. Chief Minister Sarma expressed hope that the availability of proton therapy treatment in Assam will open a new horizon in medical tourism in the state, as cancer patients from other states will start coming to Assam to avail themselves of such advanced and precise radiological treatment for cancer. Along with advanced care, it is important to ensure adequate cancer screening to reduce the growing cancer burden. Official data highlights that about 70% of cancer cases in India are diagnosed at advanced stages, the third and fourth stages, which increases treatment cost, as advanced stages require specialized treatment and care. The report calls for strengthening cancer screening at all government and private hospitals and healthcare centers to widen the reach among people. Increasing cancer screening camps as part of the awareness campaign conducted in the region is crucial to bridge the gap in early detection. Establishment of well-equipped clinics for screening and treatment of non-communicable diseases in all districts, as recommended by the parliamentary standing committee on health and family welfare, is yet to see implementation on the ground in the region. Allocation of more funds in the health budgets of the states for strengthening primary care, cancer screening, and NCD clinics can substantially reduce the high burden on advanced care and treatment in the public healthcare sector. Nevertheless, inadequate availability of advanced care in the government hospitals increases out-of-pocket expenditure (OOPE), often making it difficult to complete the entire course of treatment, particularly for low-income households. Increasing awareness of medical insurance is essential to reducing OOPE and insurance claim rejection. Promotion of medical tourism helps in building the awareness of adequate insurance coverage for cancer treatment as medical travelers from advanced states bring in the information, and it helps build the local ecosystem. The increasing number of cancer patients in the third or fourth stage calls for strengthening palliative care along with advanced treatment facilities. Palliative care needs active participation of the society to ease the suffering of critically ill patients. Unfortunately, awareness of palliative care, which requires empathy, sharing responsibility for providing medical care, and supporting such patients to lessen their pain and distress, is low in society. While ASHAs (Accredited Social Health Activists) and community volunteers are trained to identify bedridden patients and others needing palliative care within the community, and they conduct periodic home visits, provide support to patients and families, and help ensure continuity of care by facilitating appropriate referrals, they also have several other duties to perform that come in the required palliative care, particularly for cancer patients. Unofficial estimates highlight that there exist only four palliative care centres for every ten million people in India, due to which a large number of cancer and other critically ill patients remain deprived from pain-relieving palliative care. Mobilizing health volunteers in the society is needed to increase support for the families, particularly low- and middle-income families, so that apart from easing the suffering of patients, they can also share the responsibility of spending time with patients to help family members take a break to perform other important household and office work. The mere establishment of palliative care centres at the hospitals cannot alone bridge the gap if it is not backed by a strong public-supported and volunteer-based palliative care and support system. Nevertheless, strengthening cancer care in the public sector remains crucial to cater to the urgent requirement of providing timely care, such as radiological treatment, to an increasing number of patients. Other states in the Northeast can follow Assam's lead for strengthening cancer care.