Budget impact on cancer care: ‘With a day care centre in my district, I can save on chemo treatment and travel costs, save my mother’ (original) (raw)

Twenty-four-year old Abhishek Gautam from Agra is waiting for his mother’s chemotherapy session at the AIIMS cancer day care centre. He is awaiting his turn as 60 patients are either in the middle of therapy or waiting to get their infusions. Once he does get a slot, he will have to stay over eight hours till the chemo gets over and doctors give a go-ahead for discharging his mother after assessing the side effects. “Her chemo has to be administered every 21 days. For her comfort, we travel in a third AC train from Agra thrice, sometimes four times a month for consultations. The drugs are expensive too,” says Abhishek, wondering how he could afford the time, money and effort for long-term treatment to save his mother’s life.

Outside the six treatment rooms, the waiting area is full of hundreds of patients waiting for various diagnostic procedures and consultations, straining their ears for the announcement of their names and numbers. They have come from Nagpur, Darbhanga, Agra and Faridabad. “I wish the cancer day care centres would come up in district hospitals as announced in the Budget sooner. My mother has stage 3 breast cancer. We have to leave at 6.30 am and reach AIIMS by 8.30 am so that we are inside the day care centre by 9 am. However, we never get a slot before 11.30 am,” says Sanjay Chauhan from Faridabad.

It is precisely to prevent this heavy patient burden on tertiary care hospitals in metropolitan cities, ease patient woes and improve access to essential cancer treatments at the district level that the government announced setting up cancer care centres at 759 district hospitals, pledging 200 of them by next year. As cancer cases continue to increase, these day-care centres — which will provide chemotherapy, essential medications, conduct biopsies and manage complications — will be a godsend for patients in Tier II and Tier III cities, who will no longer have to travel to metros where treatment costs are significantly higher.

THE COST OF TO AND FRO TRAVEL

In December, Abhishek took his mother for chemotherapy at NCI (National Cancer institute), Jhajjar after several rounds of rescheduled appointments. The family would take a train to Delhi and then a bus to Jhajjar. During the first and second chemo sessions, they missed their train back to Agra from Delhi and had to book a cab instead. Then they put in a request for her third chemo session at AIIMS Delhi. “Apart from travel costs, her injection, Trastuzumab, costs Rs 7,500. That is not available at NCI Jhajjar and we had to procure it from outside. Sometimes my mother needs a bed as post-chemo, she suffers from dizziness and vomiting,” says Abhishek.

Sanjay says it is precisely because of overcrowding at AIIMS that he initially went to a private hospital for her therapy. Now that he has exhausted his private health insurance for surgical procedures worth Rs 9 lakh, he has chosen to get her chemotherapy done at AIIMS. “But the chemotherapy injection costs Rs 27,000 which I have to get from outside,” he says.

WHY DISTRICT DAY CARE CENTRES CAN HELP IN EFFECTIVE OUTCOMES

Dr Atul Sharma, vice-chairman, Medical Oncology, Cancer Care/Oncology at Max Hospital in Delhi, has seen a deluge of patients coming for first-line chemotherapy during his stint at AIIMS Delhi. “Now with day care centres in district hospitals, the patient can get one round of chemotherapy there. Once the treatment protocol is set and should complications arise, subsequent therapy sessions can be given at the nearest urban centres,” he says. This could cut down delays and queues.

As of now, there is no clarity on who will be providing the drugs, be it the Centre or State. “The drug provisioning will help a lot of patients cut costs,” he says.

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HOW DAY CARE CENTRES CAN CUT OUT OF POCKET EXPENSES?

Patients usually have chemotherapy cycles every two or three weeks. “Currently patients have to repeatedly come for around six months to a tertiary care cancer centre for chemotherapy. If this centre happens to be closer to their homes, their out-of-pocket expenses will go down,” says Dr Sharma. The cost multiplies because at least two family members have to accompany a patient and even arrange lodging in a city.

Dr Sharma says all that all patients need to do now is go to the tertiary hospital, get a shot of chemotherapy there, then go back to their district hospital for the remaining sessions. At the end of the chemotherapy, they can do a follow-up visit to the tertiary centre. This would cut down the frequency of travel. “If the government is able to provide the kind of chemotherapy drugs available at big institutes like AIIMS, the patient can indeed save a lot of money and resources,” he says.

WHAT ARE THE THREE THINGS REQUIRED FOR CANCER DAY CARE CENTRES IN DISTRICTS?

According to Dr Sharma, the government should first and foremost appoint a physician with some basic knowledge about chemotherapy and cancer drugs.

Second, the nursing staff should have some form of training to handle these drugs and prepare mixes for the patient. They should also be trained to deal with side effects of chemotherapy like excessive diarrhoea, vomiting and a fall in blood count. Third, the government should subsidise drug costs.

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IS THERE ENOUGH CANCER AWARENESS?

While the government is expanding treatment infrastructure, Sanjay feels that the government should simultaneously drive an awareness campaign on cancer along the lines of HIV and Covid. “My mother didn’t tell me about the tumour she was feeling. She hesitated for a long time. She also wasn’t aware that this could lead to something serious. The government has worked a lot on generating awareness about mouth cancer but it has not done enough on generating awareness about breast cancer,” he says.