Establishing oncology services in all the new government medical colleges of J&K

Cancer is an important cause of morbidity and mortality all across the world and the disease is showing rising trends and the number of new cases is going to increase with each passing year. Nearly 19.3 million cancer cases ( around 2 crore new cases) are diagnosed  annually across the world (WHO data 2021).The reported cancer incidence in India for the year 2023-24 is estimated to be 19 to 20 lakhs, whereas real incidence is 1.5 to 3 times higher than the reported cases. The number of Indians suffering from cancer is projected to increase to 29.8 million in 2025 (ICMR New Delhi).

The UT of J&K is not far behind and the trends in cancer cases run parallel to the trends else were in the country because of multiple factors. As reported earlier, over 51,000 cancer cases have been registered in J&K over the past four years (2019-2022). Around 36,000 patients have died in Jammu and Kashmir in the last five years after being diagnosed with cancer, and the number of such deaths in J&K is increasing (Greater Kashmir;18 January, 2023). Sensing the gravity of the situation MOH&FW GOI and NMC are contemplating to start Oncology services in all Medical Colleges across India (Medical Dialogue; 16^th July,2023).

India’s active National Cancer Control Programme was launched by the Government in 1975 and revised in 1984. The main focus is primary prevention and early detection of cancer, which includes:

• Tobacco control measures to prevent tobacco-related cancers
• Screening for cancers of the uterine cervix, mouth, and breast
• Extending and strengthening therapeutic services in Medical Colleges.

The objectives of the programme are to be met by creating and developing Comprehensive Oncology Services in existing Medical Colleges across the country. The main functions of these Oncology Services is cancer detection and diagnosis, treatment, aftercare and rehabilitation, education and training, cancer registration, and research. The core requirements to establish successful and comprehensive Oncology Services includes the Departments of Medical Oncology, Radiation Oncology (Radiotherapy) and Surgical Oncology with support from the departments of Anesthesiology, Pathology, Biochemistry, and Radiology with appropriate equipment and staff.

These Comprehensive Oncology Services in new Medical Colleges will help to make cancer care accessible across all the socioeconomic groups and geographical areas. Although the national cancer control program has been beneficial, given the geographic expanse and the vast population, cancer care facilities remain unavailable to the majority of the population from lower socioeconomic strata and those living in remote areas. A wide disparity exists in the level of cancer care across various centers in India. Efforts are underway to create a national cancer grid linking major Oncology Centers across the country to facilitate:

• Development of a cooperative cancer management network for the transfer of standard treatment guidelines and expertise
• Facilitation of uniform standards for education, training, and human resource development in cancer care
• Creation of a cooperative oncology research network to conduct studies of national importance.

In J&K (UT) besides SKIMS, the 2 old Government Medical Colleges at Srinagar and Jammu are providing commendable cancer care services in the Government sector as private Oncology services are near negligible. These three centers have well established Comprehensive Oncology Services which include Medical Oncology, Radiation Oncology (Radiotherapy) and Surgical Oncology as all the three departments are very vital for cancer care and are complimentary to each other because 70-80% of cancer cases require tri modality treatment which includes Chemotherapy and other newer and targeted anticancer drugs under the supervision and care of Medical Oncology, Surgery and Radiotherapy.

Medical Oncology is the pivotal department in cancer care and has central role in the comprehensive cancer care. The central Government has been kind enough to boost the health care services in the region of J&K (UT) which is geographically very diverse with some remote, hilly and difficult to access areas by establishing 02 AIIMS like Institutes (0ne each at Kashmir and Jammu) and 7 new Govt.

Medical Colleges all across the length and breadth of J&K. All these new Govt. Medical Colleges have the department of Radiation Oncology (Radiotherapy) with staff in place (Radiation Oncology/Radiotherapy is already included as a specialty and this is the branch where establishment cost is very high compared to the other 02 sister branches of Medical Oncology and Surgical Oncology). Given the data about the constant rise of cancer cases in the years to come and the topography of UT of J&K and in-order to establish Comprehensive Oncology Centers there is a dire requirement of establishing Medical Oncology and Surgical Oncology departments to deliver the holistic cancer care services in these newly established Medical Colleges and it will prove a huge impetus to the cancer care to people at their door steps (at least to begin with GMCs of  Anantnag, Baramulla, Udhampur, Doda and Rajouri).

For the creation of departments of Medical Oncology and Surgical Oncology no additional cost is needed as these departments need OPDs, wards and operation theaters which are already put in place in these new Medical Colleges. Only requirement will be to create the man power and it can be started with 01 faculty member at Assistant Professor, Associate Professor and Professor level in each department of Medical Oncology and Surgical Oncology the way there are established Departments of Medical Oncology, Radiation Oncology (Radiotherapy) and Surgical Oncology at GMC Srinagar and GMC Jammu (The man power is now readily available in our UT). The resident staff can be utilized among the General Medicine and General Surgery departments already existing in these new Medical Colleges.

Comprehensive cancer care means that you don’t have just one Oncologist, but that you have a team of specialists for cancer care— Medical Oncologists, Surgical Oncologists and Radiation oncologists— who work together on treatment plan. Only with this comprehensive and multidisciplinary approach we will be sure that all the potential treatment options are evaluated and considered. What a comprehensive cancer center does is that it bring together a critical mass of people, experts who devote their life’s work to fighting cancer. “It’s not about the building or the technology in the rooms. It’s the people and their collective expertise all focusing on the same problem, each from a different perspective.”

Dr Mir Mohammad Hussain MD General Medicine, DM Medical Oncoloy, Post DM Fellowship in Blood & Marrow Transplantation AIIMS New Delhi. Currently works as Assistant Professor Medical Oncology SKIMS Srinagar.