New Delhi: When a Gurugram-based senior bank executive was diagnosed with a rare and complicated colon cancer in February, she consulted at least five different oncologists from Delhi, Mumbai and Chennai in quick succession.
She even considered going to the US for treatment of the lymphoglandular complex-like colorectal carcinoma, before finally going ahead with a treatment plan and choosing a team at a Delhi hospital. But this was because the middle-aged woman learnt that she could get a review and opinion from top cancer doctors in the US without having to travel abroad.
“It’s generally believed that oncologists in the US are generally ahead in learning curves from their counterparts in India, and we thought of going there to give her a chance at looking at a cure or at least an expanded survival,” her husband told ThePrint.
But, he added, going to the US for the treatment would not have been an easy decision—financially or otherwise.
“When we came to know that we can get the treatment plan reviewed by some of the top oncologists in the US without needing to visit there, it came as a big relief.”
The family now plans to get a consultation at the Chennai branch of the Memorial Sloan Kettering Cancer Center, which was started in 2022. MSKCC in New York is considered among the best for oncology treatment and clinical research globally.
The package, which includes a review of pathology, up to three imaging studies, and a video consultation with an MSK oncologist and a local doctor, will cost about Rs 5 lakh.
The cost of cancer care for patients visiting the US, on the other hand, can be over Rs 1 crore for just a few months.
For decades, the perceived higher quality of care, access to specialised treatments, and sometimes cost-effectiveness, have been pushing hundreds of patients—if not more—from India, mainly celebrities, high-profile politicians or others with deep pockets, to seek treatment for complex diseases, such as cancer, in the US.
But realising that far more patients can benefit from the expert advice of oncologists and experts in other specialties from developed countries, such as the US, the UK, France, Germany and Singapore, this is now being offered in India.
In July last year, Ramaiah Memorial Hospital, a 500-bedded multispecialty health centre in Bengaluru, tied up with the New York-based Mount Sinai Hospital, one of the largest and oldest American teaching hospitals.
This collaboration, among other things, aims to bring international expertise to its patients for complex cases of cancers and heart ailments, as of now.
Apollo Hospitals—India’s largest corporate hospital group—is all set to launch a platform called ‘Expert Opinion’ in June. It has tied up with 64 top doctors from countries including the US, UK and Singapore, among others, for cancers and complex neurological and vascular conditions.
“All the Indian patients, whether or not they are undergoing treatment at any Apollo hospitals, will need to do—once we launch the service—is seek appointment with a chosen expert and talk to them for their guidance and review of pathological reports or treatment plan,” Dinesh Madhavan, president, group oncology and International Apollo Hospital Enterprises, told ThePrint.
Each specialist, Madhavan underlined, would be dedicated to treating organ-specific cancers, ensuring that patients receive care from experts who have devoted their careers to mastering the treatment of their specific cancer type.
In a country where over 14.5 lakh new cancer cases are diagnosed every year, and the cases are increasing at a rate of nearly 13 percent every year, bringing international expertise closer to patients in need offers hope, said Dr Vijay M. Patil, a senior medical oncologist with P.D. Hinduja Hospital in Mumbai.
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Joint tumour boards
MSKCC in India is built on the concierge model of care following a tie up with the teleconsultation service provider—iCliniq. This model works on co-ordinating with patients or their representative to schedule the requested services which are clinically advisable.
On the other hand, Apollo Hospitals and Ramaiah Memorial Hospital have opted for a tumour board model, where a multidisciplinary team comes together to discuss and review complex cancer cases, aiming to develop the best possible treatment plan for each patient.
Ramaiah Hospital in Bengaluru started its tumour board about five years ago. The hospital also facilitated oncologists’ specialisation in select types of cancers.
Dr Vinayak Maka, a senior medical oncologist with the hospital, told ThePrint, “But at Mount Sinai, they have been doing this for nearly 30 years. So, this is the kind of expertise that we are trying to leverage for our patients. As of now, we are doing monthly meetings where we discuss our complex cases with them and take their inputs.”
As of now, Dr Maka said, the hospital is not charging patients extra fee for opinions from Sinai doctors. However, this could change in the future when patients are offered the option to seek independent, online consultations with these physicians.
While Apollo has yet to determine a fee for its ‘Expert Opinion’ platform, the service will entail a thorough evaluation of the patient’s medical records, pathology, and imaging studies to ensure an accurate diagnosis and a personalised treatment plan through a model similar to a tumour board.
The pool of experts is likely to comprise specialists in medical oncology, radiation oncology, surgical oncology, molecular pathology, radiology, and sub-specialty oncology.
“By incorporating the knowledge and expertise of both national and international oncologists, patients gain added confidence in their care journey,” Madhavan said. “No two cancers are the same, which is why we emphasize personalised and precision treatment.”
Clinical trials of innovative therapies
A scientific paper published in the American Society of Clinical Oncology Journal last year said that while India is home to about 17 percent of the world’s population, and accounts for approximately one fifth of all patients with cancer, the proportion of active global clinical trials in India is less than 2 percent.
“A key benefit of Indian hospitals tying up with leading hospitals abroad could be the access to breakthrough oncology therapies for Indian patients, which are otherwise not happening at a pace required,” said Dr Patil. He has previously been associated with the Tata Memorial Centre (TMC), Mumbai, the leading institute for cancer treatment and research in India.
Dr Pawan Singh, a hemato-oncologist with Yatharth Hospital in Noida, agreed. “Patients undergoing clinical trials for new medicines have only a 50 percent chance of accessing it—depending on which arm they are in—but those who are not part of any clinical trial will not have any chance at all.”
He added, “I believe that all cancer patients, particularly those who have complex and advanced disease, should be participants in some trial or the other.”
Dr Maka said that various patients have been advised to opt for clinical trials as part of Ramaiah’s collaboration with Mount Sinai, but most refuse due to a lack of awareness.
But hopefully, going forward, as their understanding on the subject grows, patients might opt for it, he added.
Advantage with international opinion?
But whether roping in international experts could give a therapeutic advantage to patients is still under debate.
Dr Arjun Singh, Head and Neck Oncologist and Scientist-Surgeon at TMC, said cancer treatment in India is provided based on guidelines developed by robust evidence.
“We have a very different presentation of cancer in terms of genetics, causative factors and other sociodemographic factors compared to the western countries. For example, oral cancer is one of the most common cancers here due to smokeless tobacco use, while the West do not see this kind of cancer,” Dr Singh said.
“Our national guidelines also include regional data to ensure the correct perspective is delivered for patients and doctors. Our challenges are also different with only a fraction of the society being able to afford and access diagnostics at the right time.”
This, the TMC oncologist said, leads to disease progression that reduces survival.
“Moreover, drugs are also not the same with many standard practice drugs in the US yet to come to India, not to mention affordability. While US doctors might have their own perspective of managing cancers, it might not always be relevant or advantageous in the practical India context, both for the ones that can access their consultation and those that can’t,” he said.
But a discussion in academia and innovation should always be encouraged to see things in a new light, Dr Singh added.
(Edited by Sanya Mathur)
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