Thursday, June 20, 2024

Closing the gap

This is the second year of the ‘close the care gap’ campaign through which the World Health Organization (WHO) seeks to shed a light on the inequities in cancer care as well as on the actions needed to make necessary progress toward their redress. Cancer is a global health issue affecting millions of people worldwide. Along with the rise in non-communicable diseases (NCDs) in India, the country has also seen an increase in the number of cancer cases. However, as the country continues to share a high burden of preventable communicable diseases, it has been suggested that resource allocation to effectively fight NCDs like cancer may pose a challenge. According to a 2022 report in India Medical Journal, the estimated number of incident cases of cancer in India for the year 2022 was found to be 14,61,427. It found that one in nine people are likely to develop cancer in his/her lifetime in India. The study also pointed out that lung and breast cancers were the leading sites of cancer in males and females, respectively. Among childhood (0-14 yr) cancers, lymphoid leukaemia (boys: 29.2% and girls: 24.2%) was the leading site. The incidence of cancer cases is estimated to increase by 12.8% in 2025 as compared to 2020, the study revealed. According to cancer registry data, it is predicted that approximately 8,00,000 new cancer cases will be diagnosed in India each year. It has also been suggested that as we understand the various developments across several types of cancer affecting the human population, it’s crucial to shift our focus toward two specific types of cancer which are on a steady rise among young women: breast cancer and colorectal cancer. Breast cancer is the most common malignancy in women worldwide. In India, it accounts for 13.5% of all cancer cases (both sexes, all ages) and 10.6% of all deaths in India due to cancer. The survival rate of breast cancer patients is poor in India, primarily due to earlier onset age, late-stage presentation of the disease, late commencement of decisive management, and inadequate treatment. As compared to the West, a higher percentage of breast cancer occurs at a younger age in India. There is a similar trend for colorectal cancer. More and more patients are being reported with colorectal, both male and female. The Nagaland Sustainable Development Goals (SDG) Vision 2030 document envisages reducing the burden of non-communicable diseases in the State. Its stated goals include Population Based Screening (PBS) for NCDs for all persons 30 years of age and above for early detection and management of common NCDs such as oral cancer, hypertension and diabetes mellitus and all women over 30 years for cervical and breast cancer; ensure timely referral of suspicious cases to the PHC/CHC/DH for further examination and confirmation by a medical officer, physician, surgeon, gynaecologist or dental surgeon as appropriate. But closing the gap entails easing of access and financial burden. Not very long ago, a Naga doctor had outlined the financial predicament. Out of the nearly 23 lakh population of Nagaland, barely 1-2% could well afford the best and most expensive cancer treatments available in the country or abroad. While 6-7% of Government employees, who have a leeway in managing their finances, can avail treatment at certain hospitals empanelled with the Government and receive reimbursement from the State Government. Then the remaining 89% of the Naga population are without any financial backup. Besides, even patients with health insurance or Government aid face serious challenges because most schemes do not provide the actual amount needed for the treatment which eventually becomes an out-of-the-pocket expense, pushing a significant proportion of people to a never-ending cycle of debt. Again, in the matter of economics, cancer patients after receiving treatment become weak and less-able, eventually leading to loss of jobs and further becoming an economic burden to their family and friends. These are the areas in need of major policy impetus from the Government if closing the gap and easing the burden are to be achieved.