Better cancer care facilities needed in Assam

Prof. (Dr.) Dharmakanta Kumbhakar

(drkdharmakanta1@gmail.com) 

Assam has witnessed an alarming rise in the number of cancer patients
and a correspondingly 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 and hospital-based cancer registries in India show that in Assam, the most common anatomical sites of cancer in men are the oesophagus, lungs, stomach, hypopharynx, and mouth, while in women, these are the breast, cervix, uterus, 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 rate 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 a 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 existing government full-fledged cancer hospitals in Assam, such as BBCI, the State Cancer Hospital attached to the GMCH, and cancer hospitals established under joint ventures between the Government of Assam and the Tata Trust alone cannot bear the load of such a huge number of cancer patients. 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 an 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 quality of cancer care facilities. Of course, the Cachar Cancer Hospital and Research Centre in Silchar is providing free and heavily subsidised treatment to thousands of poor cancer patients every year. A 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 for cancer in Assam is largely unaffordable for the poor and the middle class due to the high costs of medicines. Most of the poor and middle-class cancer patients of the state die due to a 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 BPL cancer patients get benefits and financial assistance for treatment and care from various state and central government schemes, 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 Assam Cancer Care Foundation (ACCF) has already started to create more cancer care facilities under a joint venture between the Government of Assam and the Tata Trust. Out of the total 17 cancer hospitals to be established at Guwahati, Dibrugarh, Kokrajhar, Barpeta, Darrang, Tezpur, Lakhimpur, Jorhat, Dhubri, Nalbari, Goalpara, Nagaon, Sivasagar, Tinsukia, Golaghat, Silchar, and Diphu under the joint venture, seven well-equipped modern cancer hospitals are already completed and functioning currently, as inaugurated by Prime Minister Narendra Modi and industrialist Ratan Tata on April 28, 2022. The foundation stone for the other seven is already laid by Prime Minister Narendra Modi and industrialist Ratan Tata on April 28, 2022. Once all 17 well-equipped modern cancer hospitals become fully operational, an estimated 50,000 cancer patients will get. 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 daycare 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 the district level.

To ease the high incidence of cancer and the corresponding high fatality rate in Assam, there is an urgent need to develop a comprehensive cancer control programme in the ate. Extensive research is needed that will highlight different aspects (to know the exact causes, genetic or otherwise) for reducing the incidence of cancer. Efforts towards 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, the media, and more to bring about the right awareness and lifestyle guidance. We need to focus on the early detection of cancer patients through a sustained screening programme. There is an urgent need for trained personnel at the primary and secondary healthcare 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 a lack of money. The data on specialised workforces 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 in 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 family members to take 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 aid from different schemes.