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 Table of Contents  
EDITORIAL
Year : 2021  |  Volume : 1  |  Issue : 2  |  Page : 49-50

Bengal’s journey in oncology: Back to the future


Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India

Date of Submission03-Jun-2022
Date of Acceptance06-Jun-2022
Date of Web Publication24-Aug-2022

Correspondence Address:
Jai Prakash Agarwal
Department of Radiation Oncology, Tata Memorial Hospital, Dr. Ernest Borges Road, Parel, Mumbai 400012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjoc.bjoc_5_22

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How to cite this article:
Gupta T, Chatterjee A, Agarwal JP. Bengal’s journey in oncology: Back to the future. Bengal J Cancer 2021;1:49-50

How to cite this URL:
Gupta T, Chatterjee A, Agarwal JP. Bengal’s journey in oncology: Back to the future. Bengal J Cancer [serial online] 2021 [cited 2022 Dec 8];1:49-50. Available from: http://www.bengaljcancer.org/text.asp?2021/1/2/49/354413



Bengal has a long and illustrious association and contribution to the principles and practice of Oncology in India. The history of the modern study and treatment of cancer in India is replete with contributions from Bengal.[1] The spectrum of these contributions ranges from some of the earliest epidemiological,[2] clinical,[3] and autopsy[4] studies done in oncology on the subcontinent to the setting up of government and nongovernmental philanthropic centers for the treatment of cancer in India. The existence of such an illustrious past makes it incumbent to take stock of the present and maximize achievements in cancer care in Bengal so as to do true justice to this long and cherished tradition of state-of-the-art and humane care to the troubled and hapless sufferers of this dreaded disease.

Cancer is a significant health problem in Bengal, contributing to 12%–15% of all mortality in the 15–69 age group and forms the second most common cause of mortality due to noncommunicable diseases (NCDs) after cardiovascular disease.[5],[6],[7] Registry-based data from Kolkata estimates age-adjusted rate of incidence for cancer in males and females as 91.2 per 100,000 and 89.2 per 100,000, respectively. The projected number of incident cancer cases in 2025 is 60,169 for males and 61,470 for females. Preparations must begin in earnest to handle this impending crisis effectively.

The current scenario in the third decade of the twenty-first century offers significant challenges in terms of societal change, sustained economic growth, and adequate outlay and outreach in healthcare. Certain positives in terms of decreasing population, slow but steady increase in governmental healthcare expenditure, and clear appreciation of cancer as a national and global noncommunicable epidemic have emerged in recent years. Bengal has benefited from the same. Bengal also has the advantage of a relatively large and trained pool of manpower in contemporary oncology care across sectors and therefore there exists significant scope for equanimous interaction between multiple governmental and nongovernmental stakeholders. The presence of a Governmental Health Scheme for residents of the state also allows patients to access a wider range of facilities and helps in reducing waiting times. Access to healthcare continues to improve with improvement in transport logistics, literacy, and availability of plentiful online sources of information. The presence of a vibrant media in the vernacular medium further enhances the potential scope and outreach of any awareness program in the context of screening, diagnosis, and treatment of common cancers.

However, significant challenges remain if the legacy of yesteryear is to be maintained and the potential of today is to be realized in the times to come. First, greater impetus needs to be provided to screening programs for common cancers using nationally and locally viable methods[8],[9] (visual inspection [VIA] and visual inspection with Lugol’s iodine [VILI] for cervical cancer, clinical breast examination [CBE] for breast cancer) to detect more early-stage disease and facilitate early detection, effective management, and possibly greater cure. Both short-term and long-term strategies need to be formulated in this regard as the tangible benefits of screening take time to become apparent and may need reiteration at regular intervals for policy makers for continued support.

There has been a significant capacity-building process ongoing as a part of which current facilities have undergone significant upgradation, especially in the context of provision of state-of-the-art teletherapy units in the form of linear accelerators, in addition to newer facilities being provided in terms of day-care and inpatient resources for chemotherapy and surgery. The most pressing need of the hour is to train and continuously update existing manpower in the usage of these cutting-edge facilities via collaboration within and outside the state and to maintain motivation and morale by means of regular continuing medical education (CME) activities including hands-on training. An equally important aspect is the establishment of protocol and guideline-based cancer care. A significant lacuna relates to the lack of speciality and super-speciality training in multiple aspects of oncology (surgery, radiotherapy, chemotherapy, radiology and biological imaging, palliative care, and nursing care) and this is an issue that needs expedited rectification in the form of structured introduction of formal fellowships and degrees in this regard. Another gap that needs to be bridged in this regard is the gap between the steadily increasing numbers of residency positions in Radiation Oncology with the relatively tepid concurrent growth in the treatment unit (telecobalt and linear accelerator) numbers. The persistent problem of nonexistence of locally pragmatic evidence-based care pathways has been addressed in recent times by the formulation of resource-optimized guidelines that are regularly revised and updated by a team of experts with options of ideal and optimal approaches across various common and uncommon cancer types.[10] One can surmise that Bengal would greatly benefit from integration of multiple cancer treatment facilities into bodies formulating such guidelines. Maintenance and updating of equipment is another highly important issue as this will need to be done with prominent national and international vendors in accordance with global standards so as to provide optimal performance and safety during the usage of sophisticated equipment. A very important aspect is the development of a structured multidisciplinary approach to each patient and the implementation of regular tumor boards for discussion of cases across specialities to build an indispensable team-based approach to cancer care. The integration of uniform guideline-based cancer care would act as a prelude to participation in national multiinstitutional studies for common cancers to foster a data-driven approach to cancer care and rapid implementation of any beneficial changes in practice. Concurrently, there is also an urgent need to upgrade communication, archival, and connectivity in terms of implementing systems such as Picture Archiving and Communication Systems (PACS) and server-based electronic patient data storage to facilitate outreach from tertiary centers to strengthen district and community cancer care centers in a hub and spoke model to reduce economic burden and need to travel long distances for diseases which can be easily treated locally. Electronic record linkage to mortality databases will also facilitate monitoring of cancer survival and mortality trends over time. Efficient performance of the hub and spoke model can be enhanced by central servers providing up-to-date inventories of available resources such as available beds, waiting lists for surgery, and radiotherapy at various locations in real time to allow for timely diversion and allocation of resources to benefit patients all over the state.

All the above measures would contribute to the building of trust of the state’s populace in its own health infrastructure and reduce the continuous flow of patients to distant parts of the country and reduce the massive economic and logistic strain that is entailed as a consequence and provide enduring long-term benefits. A robust system of process auditing and appropriate reframing of policies and legislation in this regard would also be of much help.

In conclusion, Bengal today has a uniquely vibrant potential to provide pragmatic, precise, and potent multidisciplinary cancer care to its populace. Significant challenges remain and will require concerted efforts of all stakeholders and hand-holders to realize this potential.

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Smith RD, Mallath MK History of the growing burden of cancer in India: From antiquity to the 21st century. J Glob Oncol 2019;5:1-15.  Back to cited text no. 1
    
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Mitra S Carcinoma of the Cervix in India. Br Med J 1937;1:747-50.  Back to cited text no. 3
    
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Rogers L Does cancer occur in native races of India? J Trop Med 1900;2:280.  Back to cited text no. 4
    
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Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, et al; ICMR-NCDIR-NCRP Investigator Group. Cancer statistics, 2020: Report from national cancer registry programme, India. JCO Glob Oncol 2020;6:1063-75.  Back to cited text no. 5
    
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ICMR - National Centre for Disease Informatics and Research [Internet]. [cited 2022 May 31]. Available from: https://www.ncdirindia.org/. [Last accessed on 2022 May 30].  Back to cited text no. 6
    
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The India State-Level Disease Burden Initiative – Public Health Foundation of India [Internet]. 2018 [cited 2022 May 31]. Available from: https://phfi.org/the-work/research/the-india-state-level-disease- burden-initiative/. [Last accessed on 2022 May 30].  Back to cited text no. 7
    
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Shastri SS, Mittra I, Mishra GA, Gupta S, Dikshit R, Singh S, et al. Effect of VIA screening by primary health workers: Randomized controlled study in Mumbai, India. J Natl Cancer Inst 2014;106:dju009.  Back to cited text no. 8
    
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Mittra I, Mishra GA, Dikshit RP, Gupta S, Kulkarni VY, Shaikh HKA, et al. Effect of screening by clinical breast examination on breast cancer incidence and mortality after 20 years: Prospective, cluster randomised controlled trial in mumbai. BMJ 2021;372:n256.  Back to cited text no. 9
    
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Pramesh CS, Badwe RA, Sinha RK The national cancer grid of India. Indian J Med Paediatr Oncol 2014;35:226-7.  Back to cited text no. 10
    




 

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