Abolishing inequity in cancer care: Time to take the action!

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.

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 understand 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 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 the basic cancer care. Even though a 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, 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 primary, secondary or tertiary level. Primary delay is the time taken by the patient from the onset of symptom to seeking advice from the 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 a trial of alternative therapies before presenting to health care facility and precious time is lost in the process. As per a questionnaire-based study done at 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 health care facility.  Tertiary delay is defined as the time interval between cancer diagnosis and initiation of cancer specific treatment. Unfortunately, not only the 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.  Majority of the tertiary care centres are concentrated in the urban areas and patients from rural background or those residing in small cities need to travel for 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 system. In comparison, 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 fourth 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.

Possible Solutions
We must implement appropriate strategies to remove these barriers so that early detection and timely treatment of cancer is achieved for majority. We have a fair number of public and private hospitals which are delivering excellent cancer care at par with international standards. It is time that we focus on providing affordable, equitable and universal cancer care to all. However, this appears to be the greatest challenge for our country. The government and policy makers must invest in strengthening the health care system. Efforts should be made to improve cancer care access to the whole population in uniform manner irrespective of geographical and socioeconomic barriers.  Simultaneously, we should work towards increasing awareness in general public to improve the understanding of cancer so that myths, misconceptions and stigma related to cancer can be minimized. This eventually will percolate into prevention, early detection and timely treatment of cancer.

We must believe in power of cooperation and collective efforts should be done at all levels.  Not only government, health care providers, patient support groups but the general public as a whole must be involved. Together we can reduce the sufferings from cancer. Let us close the cancer care gap for ourselves and for our loved ones!

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