Better cancer care facilities needed in Assam

Dr. Dharmakanta Kumbhaka(The writer can be reached at drkdharmakanta@yahoo.com)

Assam is witnessing an alarming rise in the number of cancer patients and a corresponding high fatality rate in recent years. According to the 'Profile of Cancer and Related Health Indicators in the North East Region of India -2021' by the Indian Council of Medical Research (ICMR) recently, Kamrup (Metro) district has the third highest incidence of cancer in the country both in men (213.0 per 100,000 population) and women (169.6 per 100,000 population). Lifestyle-related cancers top the chart in Assam. Data from different population- based cancer registries and hospital-based cancer registries in India show that in Assam, the most common anatomical sites of cancers in men are the oesophagus, lungs, stomach, hypopharynx and mouth, while in women these are the breast, cervix uteri, gall bladder, oesophagus and lungs. Cancers of these anatomical sites are mostly linked to lifestyle-related risk factors. Childhood cancer also has a high fatality incidence in Assam.

As per reports, over 32,000 new cancer patients are diagnosed every year in Assam. Over and above, the State also gets cancer patients from other NE states and neighbouring Bangladesh. Despite the heavy burden of cancer in Assam, available expert oncologists and adequate treatment infrastructure – hospitals, diagnostic centres, etc., – for cancer care in the State continue to be scarce. Hence, people are compelled to seek treatment outside the State. The rich ones go outside Assam, but the poor and middle-class patients either sell their property for treatment outside the State or die due to lack of treatment.

Assam has a dearth of well-equipped government cancer hospitals. The existing government cancer hospitals have a huge deficiency in cancer treatment infrastructure. There is no special childhood cancer care centre in the State. There are no satellite cancer care centres in the remote areas. The medical college hospitals of the State cannot provide proper treatment to cancer patients. The BBCI situated in Guwahati and the State Cancer Hospital attached to the GMCH are the only government full-fledged cancer care institutes in Assam. The good news for cancer patients is that the BBCI is now an affiliate of the Tata Memorial Centre for Cancer, Mumbai. It offers cost-effective management and absolute cure for many of the cancers without patients having to go to distant places for treatment. The BBCI will also produce more oncologists and trained manpower, which will boost the better cancer care facilities. However, these two hospitals alone cannot bear the load of such a huge number of cancer patients. Of course, the Cachar Cancer Hospital and Research Centre, Silchar is providing free and heavily subsidized treatment to thousands of poor cancer patients every year. Few private cancer hospitals, like the North East Cancer Hospital and Research Institute, Jorabat, are also providing care to cancer patients in Assam. Moreover, treatment of cancer in Assam is largely unaffordable for the poor and the middle-class due to high cost of medicines. Most of the poor and middle-class cancer patients of the State die due to lack of chemotherapy and a significant number of patients stop visiting hospitals after two or three cycles of chemotherapy due to the unaffordable expenditure. Though the BPL cancer patients get benefits and financial assistance for treatment and care from various State government and Central government schemes, the middle-class cancer patients get nothing.

Considering the very high incidence of cancer in Assam, there is a need for more cancer care facilities, including childhood cancer care centres. The State government has already decided to create more cancer care facilities. The good news is the inauguration of seven well-equipped modern cancer hospitals and the foundation stone laying of another seven in the State by Prime Minister Narendra Modi and industrialist Ratan Tata on April 28, 2022. These hospitals are projects of the Assam Cancer Care Foundation (ACCF), a joint venture of the Government of Assam and the Tata Trust. The ACCF will establish a total of 17 such cancer hospitals in Guwahati, Dibrugarh, Kokrajhar, Barpeta, Darrang, Tezpur, Lakhimpur, Jorhat, Dhubri, Nalbari, Goalpara, Nagaon, Sivasagar, Tinsukia, Golaghat, Silchar and Diphu. An estimated 50,000 cancer patients will get treatment when all 17 hospitals become fully operational. These hospitals will reduce the existing gap between the demand for treatment and the available number of beds and facilities for cancer care in Assam. The cancer care system in Assam by the ACCF has been planned in a three-tier system with the main facility at the State Cancer Institute in Guwahati (Tier I facilities) followed by comprehensive cancer care centres (Tier II facilities) and diagnostic and day care clinics (Tier III facilities). They will run an OPD cancer unit in every civil hospital across the State. Two doctors will be trained and appointed in these OPDs to detect cancer symptoms and give basic treatment. It is expected that the network of cancer hospitals will make Assam one of the best places for cancer care making the treatment affordable and accessible at district level.

To ease the high incidence of cancer and a corresponding high fatality rate in Assam, there is an urgent need to develop a comprehensive cancer control programme in the State. Extensive research is needed that will highlight different aspects (to know the exact causes, genetic or otherwise) for reducing the incidence of cancer. Efforts toward cancer prevention will be immensely helpful in lowering the burden of cancer. Apart from government initiative, it requires the cumulative efforts of hospitals, administrative bodies, medical organisations, NGOs, media and more – to bring about the right awareness and lifestyle guidance. We need to focus on early detection of cancer patients through a sustained screening programme. There is an urgent need for trained personnel at the primary and secondary level health care facilities that could screen the patients and guide them to the relevant facilities.

The government should make efforts to offer the best treatment possible to all cancer patients for free, irrespective of their socioeconomic status. No one should be denied access to treatment due to want of money. The data on specialized workforce should be collected and collated. Cancer treatment facilities for palliative care, radiotherapy, etc., need to be established and strengthened. There should be satellite clinics in the remote areas of Assam for cancer patients who are unable to travel long distances to visit the hospital.

The oncologists of Assam should start going to the villages to provide treatment to cancer patients. They should provide phone consultations and stay in touch with cancer patients who have returned home with prescriptions. Home Care Services as well as facilities to train the family members for taking care of terminally ill cancer patients should be launched. The NGOs should also come forward to help the cancer patients of the state in their treatment, and by providing information and support for getting financial aids from different schemes.