World Cancer Day is observed on 4 February every year. It is a global initiative led by the Union for International Cancer Control (UICC) to draw attention of governments and individuals to the growing cancer epidemic. The day provides an opportunity for all individuals across the world to unite together in the fight against cancer.
Theme
This year's theme is "close the care gap". This 3-year campaign aims to raise awareness towards inequity in cancer care. Inequity is not just the unequal distribution of resources but unjust and avoidable differences in cancer care. This year is dedicated to understanding the inequity in cancer care globally so that appropriate steps can be taken to resolve the problem.
Understanding the Problem
Access to quality and timely cancer treatment is a fundamental right of every individual. Sadly, half of the world's population lacks access to cancer care. Figures are more alarming for low- and middle-income countries like ours, and many are being denied basic cancer care. Even though significant progress has been made in the direction of cancer treatment, a person seeking cancer care faces hurdles at different phases of cancer treatment. These barriers could be cultural, educational, financial, socio-economic, geographical and gender or age-related discrimination. As per the statistics, the majority of cancers in our country are still detected in advanced stages. Consequently, cancer related deaths are quite high as compared to the west. It is crucial to understand and address these issues.
Delay in cancer care can occur at the primary, secondary or tertiary level. Primary delay is the time taken by the patient from the onset of symptoms to seeking advice from a healthcare physician. This delay is most often caused by the patients themselves, which could be related to lack of awareness or cultural, social, educational, gender, age and financial barriers. Often there is a history of trial of alternative therapies before presenting to a health care facility, and precious time is lost in the process. As per a questionnaire-based study done at a premier cancer institute in India, the average duration of this delay was close to three months.
Secondary delay is the time taken to establish the cancer diagnosis from the time of presentation to a health care facility. Tertiary delay is defined as the time interval between cancer diagnosis and initiation of cancer specific treatment. Unfortunately, not only primary but secondary and tertiary delay are a significant problem in our country. In addition to the barriers mentioned above, geographical and financial factors play an important role in causing secondary or tertiary delay. The majority of tertiary care centres are concentrated in urban areas, and patients from a rural background or those residing in small cities need to travel long distances to seek basic cancer care. Often the well-equipped government centres are overburdened and patients have to wait for several days to months before getting the desired treatment. Even though a fair number of private hospitals are providing excellent quality cancer care, these centres are beyond the reach for many because of financial reasons. India spends less than 2 percent of gross domestic product (GDP) on public healthcare, while the United States spends more than 17 percent of GDP on public health care. Out-of-pocket expenditure remains the main mode of payment for more than three-fourths of cancer expenditure in our country. Unequal distribution of standardised cancer care, scarcity of tertiary care cancer centres, lack of adequate infrastructure and insufficient number of trained oncologists further contribute to delay in cancer care delivery.