Cancer therapy comes closer to people’s homes: How day care centres at district hospitals will change cancer care (original) (raw)

Union Finance Minister Nirmala Sitharaman announced on Saturday a major upgrade to the country’s medical infrastructure— the establishment of day-care centers for cancer treatment at district hospitals. This initiative aims to improve access to essential cancer treatments at the district level while also easing the heavy patient burden on large tertiary care hospitals in metropolitan cities.

Saturday’s Union Budget announcement is significant, as India has a vast network of at least 759 district hospitals, which serve as crucial access points for tertiary healthcare at the district level. “Our government will facilitate the establishment of Day Care Cancer Centres in all district hospitals over the next three years. Two hundred centres will be set up in 2025-26,” Sitharaman said.

Why is this significant ?

The decision also carries significant public health implications. First, cancer cases are on the rise in India, with one in nine people likely to develop the disease in their lifetime. According to Global Cancer Observatory data for 2022, the most common cancers among men are oral cavity, lung, and esophageal cancer, while breast, cervical, and ovarian cancer are the most prevalent among women. Second, as cancer cases continue to increase, these day-care centers— which typically provide chemotherapy, administer essential medications, perform minor procedures such as biopsies, and manage complications— will enhance access to critical treatments at the district level. This is particularly beneficial for rural populations, who will no longer have to travel to large cities where treatment costs are significantly higher, once the day care centres are set up.

What Are the Current Challenges in Setting Up These Centres?

While experts welcomed the government’s intent to bring cancer care closer to people’s homes, they pointed out a lack of clarity regarding the services these centres would provide and who would deliver them.

“No details have been provided on the kind of services that will be offered at these centres, so it is difficult to assess their potential impact. Ideally, a cancer day-care centre should be equipped to administer chemotherapy, perform minor procedures such as biopsies, and provide blood transfusions, among other essential services,” said Dr Abhishek Shankar, an oncologist at the All India Institute of Medical Sciences (AIIMS), Delhi. However, these centres are unlikely to offer radiotherapy, which requires substantial investment in large radiotherapy machines.

Dr Shankar also highlighted key challenges the program is likely to face. “Many district hospitals currently do not offer biopsy services, even for in-patients. In fact, there are some medical colleges in the country that do not provide any cancer treatment at all. How will they then be able to offer biopsies or chemotherapy at a day-care centre?” he questioned.

Beyond infrastructure limitations, there may also be challenges related to patient trust and demand. “People travel to major centres like AIIMS Delhi because they trust that they will receive proper care from skilled doctors. For these district-level centres to succeed, the government will need to build trust in the system so that patients feel confident seeking treatment there instead of traveling to cities like Delhi and Mumbai,” he added.

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Dr Shayam Agarwal, chairperson of medical oncology at Sir Ganga Ram Hospital, raised another crucial issue—the availability of trained doctors to staff these centres. “This is a very good step because 70% to 80% of cancer treatment can be delivered through day-care centres. These centres will also save patients from having to travel long distances for repeated chemotherapy cycles. However, you need a trained medical oncologist to administer these drugs and a surgical oncologist to perform biopsies. It’s crucial to have well-trained doctors at these centres who can also manage any potential side effects.”

He further pointed out a major concern regarding workforce availability. “Oncology is a highly specialized field, but with the increase in medical seats, India now produces nearly 300 trained oncologists every year. The real question is whether these doctors will be willing to join centres in smaller districts. To attract and retain talent, the government will need to offer competitive salaries,” he emphasized.

What are the advantages of having a cancer day care centre close to a patient’s home?

Certain chemotherapy treatments for common cancers like breast, head and neck cancer can be administered closer to people’s homes and according to Dr Sudeep Gupta, Director, Tata Memorial Centre, Mumbai, travelling 400 kms to get chemotherapy is not a good idea. “It will also be easier for old patients who also keep visiting the hospitals. At Tata Memorial Hospital in Parel, for instance both daycare centres together administer approximately 400–500 chemotherapy sessions daily. District hospitals are an appropriate location for delivering the chemotherapy treatment,” he said.

What are other important announcements made by the government?

Cancer treatment received priority in the current budget, with Sitharaman announcing exemptions or reductions in customs duty for several life-saving drugs, including cancer medicines. She announced that 36 life-saving drugs used to treat cancer, rare diseases, and other severe chronic illnesses will be exempt from customs duty, while another six will be subject to a reduced concessional duty of 5%. Additionally, bulk drug purchases for manufacturing these medicines will either be exempt from customs duty or available at a concessional rate. Sitharaman also stated that 37 new medicines and 13 patient assistance programs will be exempt from customs duty. Notably, during the interim budget, the government had already reduced customs duty on three advanced anti-cancer therapies.