14 February,2021 07:39 AM IST | Mumbai | Anju Maskeri
The hospital officially opened its doors on January 30 this year. Activities over the past two weeks have centred around launching the OPD (outpatient department) and OT (operating theatre). Pics/Pradeep Dhivar
Last year, when the municipal corporation was busy converting vacant buildings into COVID-19 care centres, a small group of doctors from Mumbai were invested in the creation of a facility that would target the other deadly C-word: cancer. As surgeons working for private hospitals, they would routinely come across patients in need of affordable care, but following protocols meant less autonomy. "The patients' costs and doctors' charges are decided by the hospital. Even if we reduce doctor fees, it doesn't make a difference to the patient's overall budget. How much you end up paying for the treatment is also linked to the selection of bed on a per day basis. Same with OT charges and medicine costs," says oncologist Dr Chetan Anchan, whose expertise lies in the management of bone and soft tissue tumors. It was admittedly all the more heartbreaking for him as his cases largely involve children. "Bone cancer is very common between the age of five and 20 years. I've seen cases where patients' families have chosen to forego treatment and gone back home, because they couldn't afford it, which is why we wanted a hospital that belonged to us - where we are in control of the costs."
Specialty Surgical Oncology (SSO) is that place. Located in Ghatkopar, the hospital is the brainchild of six oncologists, who, with their solid experience in highly focused areas of cancer surgery, have joined forces to provide the best of their collective expertise to patients. The hospital is touted to be a one-stop centre for all treatments of cancer. Had it not been for the Coronavirus outbreak, Dr Anchan says they would have been up and running by September last year. Despite the delay, the hospital officially opened its doors on January 30 this year. Activities over the past two weeks have centred around launching the OPD (outpatient department) and OT (operating theatre) and finalising the remaining recruitments for various positions.
In addition to Dr Anchan, the core team includes Dr Sanket Mehta (cytoreductive surgery and HIPEC, surgical procedures performed for advanced ovarian malignancies), Dr Jay R Anam (breast oncosurgery), Dr Amit Chakraborty (head, neck and thyroid), Dr Praveen Kammar (laparoscopic and robotic surgeries) and Dr Nilesh Chordia (gastro-intestinal and gynaecologic cancers). It was important that they find the right location to set this up. "Accessibility was a crucial factor. We faced challenges at every level, right from arranging finances to getting the paperwork in place. Fortunately, the BMC was supportive," says Dr Anam, who, after completing his MCh Surgical Oncology Training from Tata Memorial Centre, went on to do a Fellowship in Breast Oncology from Centre Oscar Lambret, France. According to him, Mumbai has either premium tertiary care centres for cancer (owned by corporates) or those run by the BMC. "Then, there's Tata Memorial Centre, which is already overburdened with patients. All of us in the team have worked there.
There is no in-between option for the patient where quality care can be offered." They have also collaborated with a medical social worker who will look into the various government funds that can be made available to underprivileged patients.
"Holding a yellow or orange ration card in India doesn't mean you're underprivileged in our country. I've seen patients come in an Audi, but still holding a yellow card. We'll do a proper assessment to identify the deserving ones," says Dr Chakraborty.
India had an estimated 1.16 million new cancer cases in 2018, according to a report by the WHO, which said that one in 10 Indians will develop cancer during their lifetime and one in 15 will die of the disease. Cancer in India also entails a socioeconomic challenge. "Years of treatment are enough to drive a quarter of their households into poverty, making cancer the disease most likely to impoverish," a World Bank report reads. Dr Chakraborty says cancer treatment, however, has undergone huge advancements in the last couple of decades, especially in India. "The treatment has become so specific, complex and complicated that it's impossible for one person to be an expert in all the organs." It's the reason why they decided that each of them would focus on a particular speciality. The International Classification of Diseases (revision 11) lists more than 600 types of cancer, most of which require unique diagnostic approaches. "Cancer is not a single disease. It's a generic name for a vast group of different diseases with diverse behaviour. The only fact connecting them is their ability to grow uncontrollably and spread in the body, posing a threat to the life of the patient. Even in patients suffering from the same cancer, the treatment plan can be very different. A lot of variables have to be taken into account for planning cancer treatment, including the site, type, size, grade and stage of disease, age of patient, location of the disease, general condition of the patient, other comorbidities," explains Dr Anchan. The spectrum of cancer treatment spreads across surgery, radiotherapy, chemotherapy and palliative care. This can be either alone or in a combination.
Currently, there are only 62 dedicated cancer care hospitals in the country, including both regional and national facilities, according to the National Cancer Grid.
Dr Pradeep Mahajan, Regenerative Medicine Researcher, says although Mumbai is sufficiently equipped to deal with cancer, it is not enough when you compare it with the population that it is expected to tackle. "When you talk of cancer, you only think of Tata Memorial Hospital, although there are good cancer hospitals in Chennai, Bengaluru, Delhi and Gujarat. But, the level of awareness about these places are low. What's needed is to build more satellite care centres in regional pockets across the country in order to reduce the burden on Mumbai." Last year, Tata Trust announced their plan to build four new cancer hospitals and equip secondary level hospitals and community health centres with facilities to carry out chemotherapy, radiotherapy and minor surgeries. It will build a 340-bed hospital at the cost of R350 crore inside the Banaras Hindu University campus.
Currently, India has 300 general providing care to cancer patients. Dr Prashant Mullerpatan, onco surgeon at Apollo Spectra Hospital, says one of the reasons the city lacks dedicated cancer centres is because it may not be a financially viable option. "The management might not be able to recover the costs of setting up a 200-or 300- bed only-for-cancer-patients hospital in Mumbai, given how expensive it is. But, super speciality hospitals like Kokilaben Hospital, SL Raheja, Fortis Hospital, Hinduja Hospital and Nanavati Hospital are offering all the facilities."
Having said that, the general consensus is that cancer requires a sharper focus as compared to other diseases. "Yes, there are scientific guidelines on the management of the disease, but the treatment has to be tailored for a patient. Which means it's different for every patient," adds Dr Mullerpatan. Dr Anchan concurs. "Treating cancer is a complex affair. It's enough to shake anybody's foundations. These patients need a different sort of care and mixing their treatment with other types, can affect the quality of service."
Advances in diagnostics and therapeutics, however, have shown hope. "We have entered a new era where therapies are now being based on molecular and cellular aspects with a target-specific approach. For example, immunotherapy based on natural killer and dendritic cells is capable of inducing, sustaining, and regulating T cell responses, which then targets cancer cells. The advantage is that these cells belong to our immune system, and can be "educated" to specifically target cancer cells. Thus, the side effects associated with conventional therapies, wherein even normal cells may be attacked, can be avoided through immunotherapy," says Dr Mahajan. Dr Chakraborty concurs.
"Previously, cancer meant you're "cancelled". That's no longer the case. Early diagnosis can guarantee early cure."
62
Number of dedicated cancer care hospitals in the country as per the National Cancer Grid
