What was once thought to be a disease afflicting the developed countries is spreading fast to other parts of the globe too. Cancer strikes one in every eight Indians, says the Indian Cancer Society. A 2008 World Health Organization (WHO) report says more than 24 lakh Indians have this disease. Mumbai’s Tata Memorial Hospital, one of India’s renowned centres for cancer treatment, sees 40,000 patients every year, up from about 20,000 two decades ago, as per official data. According to a WHO India report, by 2020, the developing world would have 70 per cent of the projected 20 million C-stricken patients globally.
There are, however, far fewer oncologists in India than required, especially for surgical and medical (involving therapy such as chemotherapy) treatment. A task force report for the XI Plan said, “At present, the country is training 20-25 medical oncologists every year; this figure needs to go up to 100 per year. This is required in order to deal with the existing cancer load of approximately 17 lakh patients needing chemotherapy, which is projected to increase by 40 per cent over the next five years.”
Says Dr Rajendra Badwe, director, Tata Memorial Hospital, “There’s a larger shortage of surgical oncologists. It’s a tremendous scarcity. India produces about 15 surgical oncologists every year, whereas the need is at least three times more. Radiation oncologists, too, are in short supply.”
According to Anupama Hooda-Nehra, chief – medical oncology and haematology, Max Healthcare Institute, Delhi, among the three sub-specialities, there are more radiation oncologists. The stress now should be on training more medical and surgical oncologists, she says.
The good news is that the number of trained oncologists in the three tracks is expected to go up as the Medical Council of India will soon allow greater student intake.
It’s not about one super-specialist versus another. All the three categories of oncologists often work in tandem, as a patient may require surgery followed by chemotherapy, and then radiation. “All three are pillars of a good cancer treatment centre,” says Dr Hooda-Nehra.
A good oncologist also needs to help a patient deal with the emotional upheaval once the C-word is pronounced. At times, a patient may want to show you 20 reports from other systems of medicine, such as ayurveda and what have you. So, inter-personal skills are as crucial as medical or surgical expertise. Dr Badwe says students should take up oncology if they “are tuned to work for people”. The work requires “huge effort” and “immense dedication”, he says.
“Cancer requires multi-modality treatment. It includes recognising the side effects (of therapy), managing the psychology of the patient, giving him moral support,” says Dr Hood-Nehra. Despite the odds you and the patient are pitted against and knowing his likely fate, you have to remain positive without making false promises. “We can change the picture (by increasing longevity),” says Dr Hooda-Nehra.
As the patient load grows, there’s a need for super-specialisation. “Today everybody cannot do everything,” says Dr Badwe. “You need to do super-duper-specialisation. Earlier, I handled all kinds of cancers. Now I focus only on breast cancer. There’s huge amount of work in that.”
What's it about?
Oncology is the study of cancer, a disease characterised by abnormal cell growth in the body. Its sub-specialities include surgical oncology, medical oncology and radiation oncology. A medical oncologist provides systemic therapy such as chemotherapy, hormonal therapy, targeted therapies, and bone marrow transplantation. A radiation oncologist treats patients with radiation
An average workday of a medical oncologist:
8.30 am: Reach hospital. Attend tumour board meeting (with surgical and radiation oncologists, gynaecologist, pathologist, etc)
9.30 am: Go for in-patient dept round
10.30 am onwards: See patients in the OPD
3 pm: Lunch
5 pm: Evening round in wards
6.30 pm: Leave for the day
In the government sector, a fresh surgical/medical oncologist earns Rs 30,000 a month and a radiation oncologist Rs 25,000 a month. At the upper end of the hierarchy, the respective take-home salaries are: Rs 90,000, and Rs 70,000 to Rs 80,000 a month. Packages vary in the private sector; a fresh oncologist may make Rs 60,000 to (in a good institution) Rs 2 lakh a month. Further hikes depend on experience and level of expertise
Fully equipped and trained to ensure a patient’s comfort — physical and psychological
. Be sensitive, compassionate
. Good inter-personal skills
. Be a good listener
. Be self-motivated and able to put in huge effort
How do I get there?
Study science with physics, chemistry and biology at the plus-two level. Then go for an MBBS degree, after which you do a three-year a) MS, followed by a three-year MCh programme, b) MD (medicine/ paediatrics), topped up with a DM (medical oncology) qualification or c) MD in radiotherapy. If you can’t do MS or MD, opt for a DNB
Institutes & urls
. Tata Memorial Hospital, Mumbai
. All India Institute of Medical Sciences, Delhi,
. Rajiv Gandhi Cancer Institute and Research Centre, Delhi
. Gujarat Cancer & Research Institute, Ahmedabad
. Kidwai Memorial Institute of Oncology, Bangalore
Pros & Cons
It’s a respected profession
Patients repose a lot of faith in you
Training takes time
There’s great satisfaction in treating patients and increasing their life span
A fair number of your patients die
You need keep updating yourself; go for CME (continuing medical education) courses
Work with potentially hazardous machinery and chemicals
We get 40,000 cases a year
The head of a top cancer hospital talks about the demand and supply of specialists
Why should a student consider specialising in oncology?
There are two primary reasons. One, there’s a need for oncologists. The incidence of cancer is rising and the incidence of curable cancers is rising, too. Ten years ago, there were 15 breast cancer cases per one lakh women in metropolitan India. Today, it’s about 30 per lakh. And a 100-per cent increase is expected in the next 10 years. However, compared to the US and UK, the absolute numbers will still be lower in India.
The second reason is the short supply of oncologists (in all three branches – medical, surgical and radiation). There’s a larger shortage particularly of surgical oncologists. It’s a tremendous scarcity. India produces about 15 surgical oncologists every year whereas there’s need for at least three times more.
The Medical Council of India is soon going to double or triple the student intake but the students will come out about five years later.
At our centre, we receive, on average, a minimum of 250 applications for two seats (to be increased to 10 in June) in surgical oncology every year. In radiation oncology, for which we offer five-six seats, the number of applications would be close to a hundred. It’s the same in medical oncology. But seats will be increased this year. The demand is, one, because of the need in this field and second, due to the popularity of the institute.
What's been the rise in the patient inflow at your hospital in the past 20 years?
We get about 40,000 patients per year now. About 20 years ago, it was 20,000 a year.
Which are the most common cancers, in order of prevalence, in India?
Tobacco-related cancers (of the lungs, oral cavity, voice box, oesophagus, and so on) account for about 50 per cent of all cancers among men in India. In both men and women, breast, uterine, and tobacco-related cancers constitute about 65 per cent of all cancer cases. Given the numbers, anti-tobacco drive and regular screening are very much needed. Cases of cervical cancers have declined (due to family planning, barrier contraceptives and better hygiene among men) while those of breast cancer have gone up because of family planning, fewer children per woman, having the first child late, and obesity.
What skills and traits are the most crucial pre-requisites for an aspiring oncologist?
Huge effort and immense dedication and least material needs. It’s not that the doctor should be poor. One should have a finite appetite. As a doctor, my objective should be zero disease and not diseased individuals.
Who should get into oncology?
If you are tuned to work for people, then take it up.
Dr Rajendra Badwe, director, Tata Memorial Hospital Interviewed by Rahat Bano