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ICMR study finds only 28.5% of cancer patients receive radiotherapy in India
Radiotherapy is a cornerstone of cancer treatment in India, yet its expansion is hindered by high investment costs and effective planning, target estimation based on cancer burden are crucial to meet the radiotherapy demands of patients with cancer, noted a recent Indian Council for Medical Research (ICMR) study published in the UK-based BioMed Central (BMC) cancer journal early this month.
Major shortfall in radiotherapy access
India is faced with a substantial shortfall in radiotherapy utilisation across all cancer types and 28.5 percent of cancer patients receive radiotherapy, which is lower than the estimated optimal rate of 58.4 per cent. Breast, head and neck, lung and cervical cancer account for 60 per cent of India's radiotherapy needs.
This underscores the need for interventions to meet the gap in machines required for equitable cancer care,'' said the study. Data from the Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) were used by the researchers of ICMR-National Centre for Disease Informatics and Research, Bengaluru, for conducting the study. India accounts for 7 per cent of global cancer incidence, ranking third after China and the USA. By the end of 2025, the incidence of cancer in India is projected to reach 1.57 million cases, posing a significant public health challenge.
Cancer burden in India
As the fifth leading cause of death in the country, cancer demands urgent attention to improve prevention, diagnosis and treatment. Epidemiological data on stage, subsite and histology from the National Cancer Registry Programme were used to assess the optimal utilisation proportion for India.
A sensitivity analysis was carried out. Similarly, the optimal radiotherapy fraction has also been calculated. These measures have been used to estimate the existing radiotherapy utilisation gap by comparing with the current radiotherapy utilisation from the cancer registry as well as to estimate the optimal radiotherapy machines required for the country.
This study provides a comprehensive assessment of radiotherapy demand and existing gaps in radiotherapy utilisation and in the number of machines in India based on an epidemiological analysis of the cancer burden from the National Cancer Registry Programme.
The study also recommended that India would require 1,585 to 2,545 machines, which may increase to a range of 2,016 to 2,291 external beam radiotherapy machines if the assumptions from previous benchmark studies are followed.
This points towards an increasing demand for radiotherapy in the coming years as there is expected to be a 70-100 per cent increase in breast, head and neck and lung cancer in low and middle income countries (LMIC).
Among the major indicated cancer sites, the deficit is more prominent in lymphoma and lung cancer (relative deficit of more than 70 per cent), followed by prostate, breast and oesophagus, said the study adding that radiotherapy, plays a crucial role in controlling tumour growth, reducing tumour size pre-surgery, and alleviating pain in advanced stages.
Stating that high setup and operational costs are creating a significant gap between demand and resources, the study states that there is a need for greater investment to expand radiotherapy facilities to meet the growing demands of cancer patients.
Urgent need to expand machines and reduce inequities
The World Health Organization (WHO) recommends a minimum of one radiotherapy machine (external radiotherapy machine) per million population, with an optimal target of four per million, the study stated. For India's projected population of 1.45 billion in 2025, this translates to a need for a minimum of 1,450 machines. Yet, only 794 megavoltage (MV) machines are currently available.
The shortfall is about 45 per cent from the minimal required standard, the study said. It further notes that aside from increasing the number of equipment, addressing the inequitable distribution of radiotherapy services is also crucial.
To align with the country's cancer burden and ongoing control efforts, India must meet evidence-based targets for radiotherapy machine availability. The country is also ramping up efforts to develop and deploy affordable indigenous radiotherapy machines to improve access and reduce dependence on costly imports,' the study stated.
The study notes that there is need for detailed situational study of radiation equipment deployment with its features and complexity, utilisation and throughput is required for informed planning and policymaking. Cancer screening and early detection programmes can facilitate the diagnosis of cancers at earlier stages. This could reduce the required quantum of radiotherapy shortly and thus, improve the overall survival of patients, the study said.
