1) As we observe World Cancer Day this year, could you provide an overview of some interesting trends in Cancer Care in India that may have come to your notice (incidence, patient profile, survival rates, etc.)?

We see significant epidemiological shifts in cancer incidence. Some cancers like anal cancer, and stomach cancer are either stabilizing or decreasing and pancreatic, prostatic, and colonic cancers are increasing in incidence. It is speculated that this is related to the adoption of Western lifestyles. Consumption of more meat, fewer vegetables, and fruits, and exercising less are some of the causes. There is also a significant tendency towards obesity.
Given the widespread availability of diagnostic facilities
and oncologists, many cancers are being diagnosed early, are being offered good anticancer therapy thereby improving survival and even cure. A very significant increase in lung cancer in women is being seen as probably related to increased smoking in women. There is a considerable increase in the younger age group as well. This trend underscores the importance of early detection and lifestyle modifications even among younger populations.

2) What are the biggest challenges facing cancer care today, particularly in terms of accessibility and affordability of treatments?

The cost of investigating and treating cancer is high though it is much less than the Western countries. Patients who cannot afford optimal investigations and management can get sub-optimal anti-cancer therapy and may survive less. Lack of widespread health insurance is the main cause in this regard. Central health schemes and to an extent state and private schemes have mitigated this to an extent.
Accessibility can be an issue in rural areas, tier-3 and 4 cities. India faces challenges in terms of cancer care infrastructure including a shortage of oncologists, limited access to advanced treatment facilities in rural areas, and high out-of-pocket expenses for cancer treatment, which often leads to financial burdens on patients and their families. Access to essential cancer medicines, including chemotherapy drugs and supportive care medications, can be limited in certain regions due to factors such as supply chain issues, regulatory barriers, and high costs.

3) What are some of the most promising areas of cancer research currently underway, and how might they change the landscape of cancer treatment shortly?

The main focus of cancer research is cancer genetics, anti-cancer immunity, and targeted therapies. The advent of targeted agents has improved cancer control and reduced its adverse events. To take an example, it has revolutionized the treatment of lung cancer where treatment is individualized by finding appropriate targets in the tumor. Immunotherapy which stimulates the body’s immunity to destroy cancer is used in several cancers. One of the problematic areas is the low percentage of patients responding to this treatment. Plenty of research is focused on improving the efficacy of immunotherapy using additional drugs. Gene therapy has been so far not effective in cancer and active research may correct this lacunae.

4) How has technology (like AI, telemedicine, or advanced imaging) transformed cancer diagnosis, treatment, and patient care?

Telemedicine can improve cancer care, especially in rural areas and tier 3-4 cities by making expert advice and care available over a long distance. Even teleradiology and telepathology are revolutionizing this aspect.
AI is being widely adopted in the fields of onco pathology and onco radiology. This has reduced mistakes in diagnosis because of fatigue and inter-observer variation. Clinical usage of AI has lagged and may take a lot more time to be adopted.
Advanced imaging techniques, such as PET scans and molecular imaging, provide detailed anatomical and functional information about tumors, helping oncologists to accurately stage cancer, assess treatment response, and detect disease recurrence. These imaging modalities enable more precise treatment planning and monitoring, leading to improved outcomes for cancer patients.

5) Based on recent studies, what lifestyle changes would you recommend to individuals seeking to reduce their risk of developing cancer?

• Plenty of exercise reduces cancer incidence by 15%
• Avoiding meat, and animal fat and eating fresh vegetables and fruits.
• Avoid smoking and alcohol
• Get vaccinated for HPV and HBV
• Avoid obesity
• Protection against UV exposure
  In addition to the above many cancers can be detected early by screening programs like breast, colon, stomach, oral cancers, etc
  The awareness about the preventability of cancer requires widespread educative programs including governmental action against smoking and fast food

6) What are the gaps in cancer care in India that need to be urgently addressed?

• Lack of cancer infrastructure in rural areas. Rural areas in India often lack adequate cancer care infrastructure, including oncology centers, specialized hospitals, and trained healthcare professionals
• Lack of preventive efforts
• Lack of health insurance. Cancer treatment can be prohibitively expensive in India, especially for patients who do not have health insurance coverageLack of cancer research including clinical trials
• Lack of cancer registries.