Even as cancer is fast turning into an epidemic in India, with about two million registered patients, the country is facing an acute shortage of oncologists, surgical oncologists and radio-therapists. The mismatch between the number of those with cancer and specialised doctors in this field has hit the expansion plans of corporate hospitals trying to foray into smaller towns, as well as cancer centres in the pipeline.
Official data show there are only about 1,000 trained oncologists in the country and the ratio of oncologists to cancer patients is about 1:2,000. By comparison, the US has an estimated 12,500 oncologists to treat about 1.4 million patients diagnosed with cancer - a ratio of about 1:100. While the situation is similar in other developed countries, data show that preparedness in other South Asian Association for Regional Cooperation (Saarc) countries, too, is as inadequate as in India.
According to the International Agency for Research on Cancer (IARC), a World Health Organization entity, India had 1.8 million people living with cancer (within five years of diagnosis) in 2012. During that year, about a million new cases were recorded, while about 683,000 deaths due to cancer were registered.
A large number of cases aren't detected, under-diagnosed or deaths due to cancer aren't registered, making the situation more alarming, say doctors.
On the shortage of oncologists, a senior management official at a leading Delhi-based hospital told Business Standard it was a challenge to appoint cancer specialists while expanding business in places like Bathinda (Punjab). "I am looking for good cancer specialists for our new hospital chains, but doctors, especially oncologists, who are in huge demand, do not want to relocate to Tier-II or -III cities due to lack of infrastructure and facilities," he said.
In India, there are about 440,000 doctors in other specialties. For instance, there are about 40,000 cardiologists against a patient population of 45 million - a doctor-patient ratio of 1:1,125. The situation is worse in the case of nephrology: While about 10 per cent of the overall population is suffering from kidney diseases, there are merely 1,500 nephrologists in the country - a doctor-patient ratio of about 1:8,000.
In the case of cancer, there is a need for dedicated centres with multiple specialties. Eminent doctor and Medanta Medicity founder Naresh Trehan says the dearth of specialists in this space also stems from the fact that the segment is highly critical and complex and requires multiple specialties - for lungs, liver, prostrate, breast, kidney, bladder, brain, etc.
Though doctors have traditionally been trained in sub-specialties of oncology, Indian medical institutes and the Medical Council of India started recognising these courses only recently.
"It is important that patients with such complex diseases are in good hands. The problem is not just about shortage of cancer specialists; there is a need for proper training and research," says Dhairyasheel Savant, a surgical oncologist and the Indian Association of Surgical Oncology secretary.
Trehan agrees. "Cancer has taken centre stage and is in an upsurge because more people are being detected with the disease. But there is a serious dearth of high-quality and trained oncologists."
IARC estimates show, the mortality rate globally is the highest in cases of lung cancer, while the incidence of breast cancer is seeing the most rapid rise.
Savant says while the patient load is more in smaller towns, there is a dearth of oncologists and infrastructure in these regions. "Increasingly, corporate hospitals are focusing on oncology and cardiology, as the disease burden is huge and growing fast. But in cities other than metros, it is a challenge to run cancer centres because of the lack of doctors," he adds.
India has 27 dedicated cancer hospitals and an additional 300 general or multi-specialty ones providing care to cancer patients. Research reports suggest for those aged between 25 and 69 years, cancer is the fourth-leading cause of death in India (after cardiovascular diseases, respiratory diseases and tuberculosis). Experts say the concentration of cancer patients is more in the northeastern states, Uttar Pradesh, Bihar and West Bengal.
According to doctors, tobacco consumption, low socio-economic status, low availability of dedicated cancer specialists, and poor medical care are some of the reasons for the increasing number of cancer cases in these areas. Though Guwahati (Assam) has a cancer centre, those in the know say it handles only a fraction of the state's total cancer load.
Most oncology centres are located in western and southern parts of India.
India has an official national cancer control programme that largely focuses on primary, secondary and tertiary cancer-prevention strategies. Experts say there is a need for immediate government intervention, as the death toll in this segment is on the rise, with chances of the disease rising fivefold by 2025. The Indian Council of Medical Research has urged the government to make cancer a notifiable disease.
"There is a need for the government, the private sector and non-governmental organisations to work in a cohesive manner and to create quality doctors," says Trehan.
Savant adds the government should promote research and clinical trials in this field so that doctors can be skilled to treat new and advanced cases.
THE MISSING CURER
* 1.8 million: People living with cancer in India (within five years of diagnosis)
* 683,000: Deaths due to cancer in 2012
* Over 1 million: Number of new cases getting added every year
* 1,000: Total number of trained oncologists in the country (doctor-patient ratio of 1:2,000)
* 40,000: Total number of cardiologists in India (doctor-patient ratio of 1:1,125)
* 1,500: Total number of nephrologists in the country (doctor-patient ratio of 1:8,000)
* 27: Dedicated cancer hospitals in India
Figures for India in 2012
Source: WHO and industry estimates