No Country for the Sick

Cancer to kill 9.6 million people in 2018

According to WHO’s International Agency for Research on Cancer (IARC, 2018) the global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. By the end of the century, cancer will be number one killer globally, and the single biggest barrier to increasing life expectancy. Based on a report released by the IARC (2018), one in five men and one in six women will develop cancer during their lifetime, and one in eight men and one in eleven women will die from the disease.

The rising burden of cancer – characterized by an increase in the number of new cases and deaths – is due to several socio-economic and demographic factors, growing and aging populations. The higher cancer rate is particularly true in rapidly growing economies, where the increasing incidence of cancer is attributed to lifestyle changes, such as inactivity and obesity.

India’s position in the global cancer burden

The recently released “Global Burden of Cancer 2018” report by the Global Cancer Observatory predicts cancer to be the second biggest cause of mortality after cardiac diseases, in India. The WHO 2018 data shows India to have 1.16 million new cancer cases this year, more than 50 percent of which will be diagnosed in women. Moreover, breast cancer incidence has gone up by 39.1 per cent between 1990 and 2016, and is the most common type of cancer among women in India (WHO, 2018)

Understandably, the term cancer resonates shock and fear; this is for reasons:

1. High treatment costs
2. Poor chances of survival

It is important to consider that the financial burden associated with cancer treatment can force patients and households to acute misery and even insolvency. On an average, a household spends about ₹ 36,812 only for therapy, excluding non-medical costs (Mahal A, Aug 2013). Furthermore, out-of-pocket (OOP) expenditure on cancer hospitalisation is about 2.5 times the overall average household hospitalisation expenditure, while catastrophic expenditure on cancer inpatient treatment is highest among all non-communicable diseases. (Mohanti BK, 2018). Poor health financing mechanisms and heavy reliance on OOP healthcare payments compel several cancer patients to resort to distressed means for treatment-financing (Owen O’Donnell, 2008).

Haryana’s cancer scenario: 13 people in Haryana die every day due to cancer

A large number of people continue to fall prey to cancer in Haryana, with death tolls on the rise. A total 12,091 people died in Haryana due to cancer in less than three years, i.e., between April 2015 and January 2018. According to the 2018 Budget session of the Haryana Assembly, in the last three years, following number of cancer related deaths were reported in respective districts: (Rawal, 2018)

Table 1- District wise figures of death reported from Cancer. Source: (Rawal, 2018)

Based on the Lancet Oncology report on the state-wise burden of cancer in 2018, Table 1 shows the incidence and deaths of cancer patients in Haryana in subsequent years:

Table 2- Incidence of cancer and the mortality in Haryana. Source: (WHO, 2018)

Why this huge surge in cancer incidence in Haryana over the last three years?

There have been severe lapses in Haryana’s rapid industrial development in the districts of Gurugram, Faridabad, Panipat, Sonepat, Karnal, and Rewari (Kumar, 2018). Based on the report, these districts generate huge amount of industrial waste, which is disposed directly in rivers without having undergone appropriate recycling in Sewage Treatment Plants (STPs). The report adds that cities like Gurugram have three STPs but their capacities to recycle are only 160 Million Gallon Daily (MGD), whereas the city generates over 400 MGD sewerage and industrial liquid waste. Additionally, improper sanitation and an excessive use of fertilizers that contaminate the soil and water, add to the cancer incidence challenge.

The questionable state of medical services in Haryana

It is a matter of astonishment and worry that in a state like Haryana which has 22 districts and covers the area of about 44,212 km2, no new government hospitals have been built since October 2014. With a population of more than two and a half crore (or 25 million), Haryana severely lacks hospitals specifically for cancer-related treatment (Arora, 2018).

Furthermore, there is no cancer ward in most state-run civil hospitals across districts (Arora, 2018). The proposed National Cancer Institute, a centre for excellence in cancer OPD and treatment was proposed in Jhajjar by All India Medical Institute of Medical Sciences (AIIMS), work on this was started in 2014 and was supposed to be finished by 2017. Since then, it has surpassed several deadlines and is still not functional. Ironically, a developed district such as Gurugram, which had a cancer ward in civil hospital until last year, was shut down due to the resignation of a cancer specialist. In the entire state of Haryana, only the Post Graduate Institute of Medical Sciences in Rohtak district has a cancer ward. As a result, large number of cancer patients are compelled to either wait in long queues in Rohtak, or travel long distances to AIIMS, Delhi or the Post Graduate Institute of Medical Sciences, Chandigarh. The cost incurred for treating cancer including diagnosis, medicines, radiotherapy etc., inter-alia depends on the type of cancer, the site/location in the body, extent of spread, and the stage at which the disease is diagnosed. Treatment for cancer is expensive. With public hospitals limited in number, and overcrowded with patients, cancer patients often lose out on early diagnosis, and subsequent treatment. The state government does not provide any direct financial assistance to cancer patients, which further adds to the problem. (Outlook, 2018)

According to the Ministry of Social Justice and Empowerment’s report based on 2011 census, 14 percent of the population of Haryana is Below Poverty Line (BPL), which means a huge segment of the population cannot afford private hospital (MoSJE, 2005). Merely, 61 government hospitals in the state do not suffice for such a large population (Health Department, 2017). These government hospitals are understaffed, and the lack of quality public healthcare delivery further jeopardizes the access to qualitative and affordable health care.

Checkmate cancer

It is usually difficult to diagnose cancer in a timely manner. However, research has shown that certain factors may increase the likelihood of a person to develop cancer, including factors beyond human control, such as age and family history. Those within control include lifestyle choices such as healthy eating, non-smoking and physical activity. The probability of getting breast cancer depends on smoking, obesity, inadequate physical exercise, and a poor diet. Also, ignorance and denial lead to delayed diagnosis and treatment. Figure 3 below shows common symptoms that may be a cause for concern.

Although preventive, curative, and palliative care programmes have been initiated at national and state levels, these measures seem to be negligible in both number and scale to combat the fast-paced spread of the disease.

It is important, therefore, to create greater awareness on dangers of pollution, obesity, harmful use of tobacco, betel nuts and alcohol; perils of a sedentary lifestyle, eating junk food etc. It is also equally important to take up periodic screening of people, especially those at risk of developing cancer. In the meanwhile, we can only hope that a medical miracle introduces a cure to cancer

References

Arora, P., 2018. Report: No new government hospitals in Haryana since October 2014 Retrieved from https://legaldesire.com/report-no-new-government-hospitals-in-haryana-since-october-2014/ {Accessed online at 03 Oct 2018). Legal Desire(Online), 8 March, pp. 1-3.

Health Department, H., 2017. District Wise list of govenrmnet hospitals in Haryana, Retrieved on September 28, 2018 from http://haryanahealth.nic.in/menudesc.aspx?page=180, Chandigarh: Health Department, Haryana.

Hope, V. G., 2015. Cancer Basics, Available at http://www.vgivehope.com/cancer-basics/, Chicago: Cancer Net.

IARC, 2018. Global Cancer Burden available at http://ci5.iarc.fr/CI5I-X/Default.aspx {Accessed on 03 Oct 2018}, Geneva: WHO.

Kumar, A., 2018. Over 12-000 die of cancer in-haryana over last three years acessed online at https://www.indiatoday.in/mail-today/story/over-12-000-die-of-cancer-in-haryana-over-last-three-years-1184224-2018-03-08. India Today, 2018 March, pp. 3-4.

LancetOncology, 2018. The global burden of cancer study in India available at https://doi.org/10.1016/S1470-2045(18)30447-9. Elsevier, 19(10), pp. 1289-1306.

Mahal A, K. A. F. V. E. M., Aug 2013. The Economic Burden of Cancers on Indian Households available at https://doi.org/10.1371/journal.pone.0071853. PONE, 3(12), pp. 7-10.

Mohanti BK, M. A. S. K. D. S. D. S., 2018. Economic burden of cancer in India: Evidence from cross-sectional nationally representative household survey, Available at https://dx.doi.org/10.1371%2Fjournal.pone.0193320. PlOS One, 13(2): e0193320.(13), pp. 4-7.

MoSJE, 2005. State Wise percentage of population below poverty line by social groups Acessed at http://socialjustice.nic.in/UserView/index?mid=76672{Acessed on 03 Oct 2018}, New Delhi: Government of India.

Outlook, 2018. In India, 39% Of Cancer Deaths Happen In Haryana. Available at https://www.outlookindia.com/website/story/in-india-39-of-cancer-deaths-happen-in-haryana-why/309256 (Acessed on 03 Oct 2018), New Delhi: Outlook India (Online).

Owen O’Donnell, E. v. D. P. R.-E. S. R. A. A. H. C. G. H. N. H. N. H. I. K.-m. K. e. a., 2008. Who pays for health care in Asia, Available at https://doi.org/10.1016/j.jhealeco.2007.08.005. Journal of Health Economics, 27(2), pp. 50-62.

Rawal, S., 2018. 12000 died In Haryana due to cancer in 3years, Retrieved from The Statesman, online at https://www.thestatesman.com/cities/12000-died-due-cancer-3-years-1502596701.html {Acessed on 03 oct 2018}, Chandigarh: The Statesman (Online).

WHO, 2018. Cancer Incidence time trends Available at http://ci5.iarc.fr/CI5plus/Default.aspx, Geneva: WHO.