Indians must have options to get treated and cured: AIIMS director
In an interview with Sanchita Sharma, director of All India Institute of Medical Sciences, Dr Randeep Guleria spoke about the available cancer treatment options in India and the need for a state-of-the-art institute for the killer disease. Excerpts:
Why did AIIMS choose to build a standalone institute on cancer treatment and research?
Somewhere around 2003, the burden of illness shifted from communicable diseases to non-communicable diseases (NCDs), and now we are seeing a huge surge in cases of cancer, diabetes, hypertension, coronary artery disease and other lifestyle ailments.
Many of these diseases don’t need in-patient or specialised care. Diabetes and hypertension, for example, don’t need a linear (accelerator) or a proton (therapy), or chemotherapy. And there is enough infrastructure for diabetes and heart disease.
But if you look for cancer hospitals, especially in the government sector, there are not enough. In Delhi, AIIMS has a cancer unit, but other major government hospitals such as Safdarjung, Ram Manohar Lohia, Maulana Azad Medical College and University College of Medical Sciences don’t have it. Other states are even more underserved. How many offer radiotherapy, high-end chemotherapy, PET (positron emission tomography) scans...? There is a huge unmet need.
Also, the intensive treatment for cancer is very long, with follow-ups. It’s a multimodality treatment, which involves surgeons, medical oncologists, radiotherapists, physicians and palliative care management. It’s a team. Even for diagnosis, you have a tumour board, where doctors decide as a group whether a patient will benefit from XYZ treatment. That’s why we need a centre like this.
How will this centre be different from the 22 other AIIMS?
It’s a state-of-the-art centre. The core lab is the first of its kind in a government set-up, some private hospitals have a mini version of it. National Cancer Institute (NCI) will decrease waiting time for cancer surgeries. We don’t have enough OTs (at AIIMS, Delhi). Patients have to wait for months. It’s not right. The high number of OTs at NCI gives us the freedom to do a large number of surgeries. Besides, the modular OTs cut down on operating time.
The wait for treatment, including daycare, will come down. The daycare here (in Delhi) is overflowing, and the conditions are not hygienic to give chemotherapy to patients who are immune-suppressed.
Now, at NCI, we can provide better quality care, reduce waiting time and get more surgeries done, which ultimately will lead to more patient satisfaction while improving training.
Has cancer treatment improved?
Cancer treatment has made rapid advances. We are moving more and more towards molecular diagnosis. Many cancers that were fatal are now being considered chronic diseases. People in India must have an option to get treated and cured. The challenge in the country is not just treating cancer but also preventing it and making people aware.
How will NCI improve treatment outcomes?
It’s not just about treating people. It’s also looking at India-specific cancers and doing research to see how we can bring down the burden. Tata Trusts is supporting a national cancer grid, but my challenge in this is to make it cost effective. See, Tata is a private concern that charges high fees.
Our vision is to develop a national cancer grid in the public sector with the National Cancer Institute as the hub, connected to centres across the country, even at the district level and small, tier-3 cities, where you will have a good centre and doctors trained to give chemotherapy and radiotherapy following national protocols, and patient will treated at subsidised rates.
The cost of treatment will go up as you have newer and newer molecules. In lung cancer diagnosis, for example, we now look for mutation. If the mutation is positive, we give targeted therapy. It’s an oral tablet, not chemotherapy, so the patient just has to take one tablet a day.
Isn’t targeted therapy very expensive?
In one group it has come down. But when it started, one month’s course was Rs 30,000. Now, it’s around Rs 6,000-Rs 7,000 a month. But this is just one drug, there are other drugs also. If we get a new molecule which is better and patented, it will be very expensive. The cost for one oral tablet can go up to Rs 1-2 lakh.
Where will you get trained cancer experts from?
We have a programme to train our own people and looking at modalities to attract people from outside. If we build a centre and develop innovative ideas that attract not only national but international people, and we give them a little bit of freedom, it may work.
The time is right. Globally, countries are becoming restrictive in letting outsiders come in, like the US and the UK, and people want to come back to India. This is probably a good time to reach out to them.
Are young doctors interested in specialising in cancer treatment?
Yes, they are. We have a DM programme and we have a lot of interest in that. It’s a tough field, but many see it as a challenge. It’s a tough career, but it is very satisfying.
How do you keep up with rapidly changing technology?
We are trying to keep pace with the changing technology, but it is always going to be a challenge. Medical technology is changing so rapidly that sometimes things change in a year’s time. We start the process of tendering and by the time we are ready to place the order, the department says no, as a new model has come. Very often, we change it or negotiate with the company to give us a newer model.
NCI was announced in 2014. How did you finally push it through?
The biggest challenge is getting three things to work in parallel — construction, equipment and human resources. You have to plan for everything simultaneously so it all comes together at the same time.