New Delhi: Being aware of the fact that India has had a high cancer load over the decades, the Indian Journal of Medical Research (IJMR) has suggested that the hub-and-spoke model is one of the major factors that could control cancer in the country.
The latest issue of the IJMR emphasised strengthening the healthcare infrastructure and human resources to deliver cancer care - the hub-and-spoke model. "We need to implement the hub-and-spoke model of cancer care delivery in the next decade within the public sector to enable access to affordable, quality cancer care for patients close to their homes," it said.
According to IJMR, modern cancer management requires collaboration between various medical and paramedical professionals working together to plan the best possible plan for a given patient.
It said that achieving high levels of multidisciplinary collaboration is not a trivial task. Expertise is scarce and not well distributed geographically. Hubs are tertiary care cancer centres that have all the infrastructure and human expertise in various disciplines to manage almost the entire range of cancer cases, including complex ones, it said.
"Given India’s current and projected population size and cancer incidence, it may require about 30-50 hubs, geographically so distributed that individuals need not travel long distances to receive care. Spokes are smaller centres that have the facilities and human resources to treat common cancers and are appropriately linked to a nearby hub. Approximately 3-5 hubs are required for every spoke. India has several large, relatively sophisticated central and state health institutions, which can be readily deployed as cancer care hubs with some support for infrastructure and considerable support for the upgradation of human resources,” the journal said.
The IJMR has suggested that India’s robust indigenous pharmaceutical industry that produces cancer and other drugs at some of the lowest costs in the world is a relief to cancer patients. The medical journal, however, cautioned that as India's population ages and increases, the incidence and burden of cancer will also increase, as these have in the past few decades.
"Despite the lower incidence of cancer in India compared with many high-income countries, because of its large population, the number of cancer cases is high," the journal said.
Asserting that cancer is a very serious issue which is also the second most common cause of death in India just after heart disease, renowned oncologist Dr Shankar Deb Roy said that India needs to give much more importance to the prevention and early detection of cancer.
"Cervical cancer, which is second most common among females, is preventable and can be cured if we can detect it early," said Dr Deb Roy told ETV Bharat.
This hub & spoke method is being introduced by a few institutions which will have a great role in early detection and treatment of cancer, he said.
It is estimated that currently, there are about 1.3 million new cancer cases and approximately 0.85 million deaths due to cancer every year, and these are estimated to increase to about 2.1 million and 1.3 million, respectively, by 2040.
"These numbers also suggest that approximately 60 per cent of individuals, who are currently diagnosed with cancer in India will die of it, a proportion that is about 20-25 percentage points higher than that seen in developed countries,” the journal said.
"Lack of population-based systematic screening for common cancers, presentation in advanced stage and deficiency of geographically and socially well-distributed and adequate healthcare infrastructure are the main reasons for the relatively high case-fatality ratio," it added.
The medical journal further noted that there is a large network of private-sector healthcare facilities ranging from low-cost to modern corporate facilities, many of which deliver good quality healthcare. "The framework of public health infrastructure at the primary and secondary levels is well established, although it needs to be strengthened in many locations. From the cancer standpoint, a few solutions need to be implemented in the coming decades as India continues its journey towards becoming a fully developed nation," it added.
The journal in its paper also highlighted promoting prevention and early detection of cancers. "This would need to be coupled with smart and implementable screening programmes, using evidence-based strategies such as visual inspection of the cervix with acetic acid and clinical breast examination which have been proven to reduce mortality. Integrating prevention and early detection into national health strategies is essential for a proactive approach to cancer control,” it said.
Strengthening palliative care, the promise of precision oncology and integrating digital health and artificial intelligence (AI)-based solutions in cancer care are the other three factors that the government needs to emphasise to control cancer cases in India, the journal said.
Dr Tamorish Kole, past president of the Asian Society for Emergency Medicine said the data of the IJMR is pointing towards a serious cancer burden in India.
"Lung cancer is the most common cancer among males, while breast cancer is prevalent among females. Additionally, childhood cancers, such as lymphoid leukemia, also make significant contributions to cancer cases. The projected burden is also expected to rise to 2.1 million (new cases) by 2040," he said.
In a recent study by Apollo Hospitals (Health of the Nation 2024), India has been given the grim title of the "cancer capital of the world."
"The high incidence of cancer in India is influenced by a combination of lifestyle, environmental, and socioeconomic factors. Rampant tobacco use, air pollution, unhealthy dietary habits, and socioeconomic disparities contribute to this serious health challenge," Dr Kole said.
He further said the hub-and-spoke model of cancer care has the potential to significantly improve healthcare in India, particularly in rural areas. "As India’s oncology network grows, the hub-and-spoke model can optimise resource utilisation and transform cancer care by making it more accessible, cost-effective, and patient-centric," Dr Kole said.
