Maharashtra witnesses approximately 130,000 new cancer cases annually, and ranks second nationally in its incidence, behind Uttar Pradesh. The Tata Memorial Hospital (TMH) alone receives 40,000 new cases annually from across India. Further, mortality due to cancer remains excessively high with deaths in up to half of the reported cases. Overall, the toll of cancer remains devastating for patients and the families, which is unacceptable, especially given that there are significant preventive and curative interventions available. Hence, the government of Maharashtra has made it a priority to develop and implement a comprehensive cancer control plan with several partners, such as the National Cancer Grid (NCG), TMH and Tata Trusts.
Prevention and early diagnosis of cancer remain the key, as the National Health Policy 2016 also identifies. Realizing this, in December, Maharashtra launched an ambitious month-long oral cancer detection programme, which involved training doctors, creating massive awareness and engaging partners such as Rotary Club and Lion’s International as well as Indian Medical and Dental Associations. After Screening 20 million citizens, 300,000 individuals were diagnosed with pre-malignant conditions and referred to district hospitals for further management. I can assure that this systemic endeavour of awareness generation and cancer screening as part of the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke programme will continue rigorously, further exploring the integration of the AYUSH network into it through appropriate training
Head and neck cancer are the commonest cancers in Maharashtra, with tobacco products being the most important risk factor. Tobacco in one form or the other remains the risk factor in 30-40% of all cancer cases. Hence, using the full force of the regulatory powers for cancer prevention, Maharashtra became one of the first states to ban gutkha products as well as the sale of tobacco and fast-moving consumer goods products under one roof. The results are somewhat encouraging as the Global Adult Tobacco Survey 2 shows. Nevertheless, the challenge remains of the 6% of the youngsters in the age group of 15-17 consuming tobacco as well as that of smokeless tobacco. Hence, Maharashtra will continue the sustained enforcement of the Cigarettes and Other Tobacco Products Act, 2003.
But what about the treatment of patients, especially in the rural parts of the state? I am delighted to declare that Maharashtra became the first state in the country to partner through the public health and medical education departments with the NCG and Tata Trusts to develop a comprehensive cancer control plan. Maharashtra established the first state chapter of NCG, under which all the government medical colleges are partnering with TMH for creating trained human resources through massive fellowship programmes for doctors, nurses and technicians. Maharashtra also became the first state where all government medical colleges are receiving weekly training through technology-enabled virtual tumour board (VTB). VTB is a unique solution, comprising a multi-disciplinary team of leading oncology professionals across the country, providing expert opinion on complicated cancer cases and enables even the remotest parts of the state to have access to leading experts, thereby significantly reducing the need for patients to travel to major cities
TMH has also reached out to its former students working across Maharashtra, who have formed a voluntary group of doctors called Maharashtra Cancer Warriors (MCW). In the past two years, these 52 MCWs have provided free services through district hospitals to more than 16,000 OPD and 5,500 IPD cases and have performed 1,150 cancer surgeries in 29 districts. This is a truly a shining example of professional social responsibility.
At the same time, to support such dedicated human resources, Maharashtra is massively investing in developing the infrastructure for cancer care. The efforts include establishing the State Cancer Institutes at Aurangabad and Nagpur, providing equipment to government medical colleges and facilitating other institutions such as the state-of-the-art facility being set up in Chandrapur under the leadership of my colleague Sudhir Mungantiwar, and the National Cancer Institute in Nagpur set up by the Dr Aabaji Thatte Trust. The focus, hence, is on a distributed model of cancer care to provide cancer services closer to the patient’s home involving partners such as the Tata Trusts.
While efforts to create infrastructure and human resources through public facilities continue, the financial burden due to out-of-pocket expenses for cancer treatment remains catastrophic. Hence, the critical role of Mahatma Jyotiba Phule Jan Arogya Yojana, the health insurance scheme of the state implemented through its approximately 500 empanelled hospitals, including in the private sector. In these facilities, patients from economically weaker sections of the society are entitled to cashless services up to a limit Rs1.5 lakh per family per year. Considering that cancer surgeries remain the most availed of services under this scheme, the government continues to explore inclusion of other cancer-related procedures into the scheme. Over and above this, the chief minister’s relief fund remains one of the key sources for providing emergency financial assistance to patients in need of cancer treatment and the overall relief distributed has been 57 times that of the previous regime.
These experiences have convinced me that cancer can only be defeated through the collective efforts of all stakeholders. The health and medical education ministers of Maharashtra, secretaries and the entire medical and public health staff have demonstrated exactly this, through their incessant efforts and proactive partnerships with philanthropic organizations. I feel privileged to lead this movement which demonstrates that with the pooled strength of science and indefatigable human spirit, we can surely eliminate the scourge of cancer for today’s and the generations to come.
“Cancer is a word, not a sentence” — John Diamond