In recent years, I've watched a revolution in cancer care slowly take place in our country. Advances in medicine that range from molecular profiling to non-invasive robotic surgery to designer drugs and personalised therapy have meant that we are able to detect tumours with greater certainty, diagnose with greater accuracy and treat with greater precision.
It is not my intention to make light of the challenges that still exist but I do believe we have good reason to be optimistic about the future. Here are four of my predictions about what the next year would look like for cancer care in India.
Improved screening and early detection
We are already aware of the benefits of early detection and how this leads to better prognosis and more successful treatment outcomes. I foresee this trend growing in 2017. It will be driven by a growing awareness and understanding amongst physicians and the public alike. As part of this, I would like to see more emphasis given to regular follow-ups to screen and detect recurrent cancers i.e. cancers that come back after they were treated. As genetic counselling and preventive oncology clinics continue to mushroom in the country, people will be in a better position to take definite steps that help prevent the disease.
Conventional lines of treatment will become 'new and improved'
For several years, the mainstays of cancer treatment have been surgery, radiation and chemotherapy. In recent years, we have improved these existing choices. Robotic and minimally invasive surgeries have made hospital stays shorter and procedures less risky.
I would like to see more oncologists treat cancer patients through medical, nutritional and psychological interventions that not only add "years to their life" but "life to their years."
CyberKnife (non-invasive focussed radiation for the tumour, with sub-millimetre accuracy) and TomoTherapy H (a radiation device that has a built-in CT-scanner for greater accuracy) enable us destroy the cancerous cells with minimal damage to the normal and healthy nearby tissue. Chemotherapy can now be partly replaced, for some patients, with a mix of biologics (the use of molecules and compounds produced by living cells) and immunotherapy (using the immune system to fight the tumour) that have fewer side effects. The next year will continue to give us, here in India, better treatment choices, as well as new lines of treatment such as immunotherapy, for many more cancers.
Genomics to become a greater part of our lives
A few years ago, sequencing a part of a person's genome would have seemed like something from a sci-fi movie. Not anymore. We will see an increased use of next generation sequencing, which can detect specific mutations (changes) in DNA that may predispose a person to cancer. This will enable us to recommend screening or other specific interventions. Analysis of the "gene signatures" of different cancers—i.e. which genes are more active in cancerous cells compared to normal ones—will continue to give us insight into what tumours will respond to a certain type of medication, giving the oncologist greater understanding while planning a line of treatment. Advances in "radiation genomics" will bring us to a place where, for some cancers, we will be able to predict and identify patients who may be more responsive to radiation therapy.
Spread of quality cancer care to tier 2 and 3 cities
An increasing number of cancer hospitals in the metros are either setting up facilities in tier 2/3 cities or tying up with hospitals in these areas to make available quality cancer care that will help to ease the burden on hospitals in the metros, while also reducing costs, travel time and accommodation hassles for patients living in these areas. This is a welcome trend that has steadily been gaining momentum, and will continue to do so in 2017.
A cancer diagnosis need not always be accompanied with a sense of dread and a feeling of hopelessness. I have a different way of looking at this. I would like to see more oncologists treat cancer patients through medical, nutritional and psychological interventions that not only add "years to their life" but "life to their years."