It created quite a sense of desperation among the public as well as health planners when, in 2012 December, the Regional Cancer Centre (RCC) here released its consolidated data of 30 years that showed a 280% increase in cancer incidence in the State in the previous three decades.
The report said from 3,696 new cases of cancers in 1982, the numbers had grown to 14,016 by 2011.
But, the more troubling news is that extrapolating the data from the Population-based Cancer Registries (PBCRs) of Thiruvananthapuram, Kollam and Malabar cancer centres, it is projected that the State, which had reported an estimated 66,000-plus new cancer cases in 2016, will see an approximately 45% increase in cancers in the next 10 years and the figure will touch nearly 97,000 new cases in 2026.
Health planners are not sitting idle in the face of such an unnerving scenario.
Quality of life
An action plan aimed at reducing the burden of cancers and enhancing the quality of life of people with cancer in the State through an equitable cancer prevention and control programme is ready for rollout early next year: the Kerala Cancer Control Strategy (KCCS) 2017-30.
The strategy will be a comprehensive one covering all aspects of the cancer control continuum, implementing systematic, equitable and evidence-based actions for prevention, early detection, diagnosis, treatment and palliation using available resources.
The draft of the KCCS has been developed by WHO India and WHO Geneva, with assistance from the Health Department and cancer specialists in the State, to support the State government in strengthening prevention and management of cancers in the State.
Kerala Cancer Care Grid, a proposed voluntary network of all cancer care facilities in Kerala in both public and private health sectors, will be the crucial vehicle that will help the State achieve the avowed goals of the KCCS by implementing an equitable and accessible cancer prevention and control programme
It was last year that the WHO proposed cooperating with the State Health Ddepartment, by offering its technical support in strengthening the health system to address the rising challenge of non-communicable diseases (NCDs) and to assist the State in achieving the health targets that it has set for itself, in sync with the targets under the UN’s Sustainable Development Goals.
Focus area
One of the focus area was NCD prevention — including cancers and mental health issues — and how the health system can be strengthened to enable preventive strategies, while at the same time ensuring that those with NCDs are given the best of care. It had been pointed out that population-level risk control of NCDs would require more than just working with the community and that work would have to be done at the health policy level to create an enabling environment for the preventive strategies to work. The WHO, with access to the best of global health practices, was best suited to help a State like Kerala, which had a very advanced and robust health system.
The draft KCCS strategy document prepared by the WHO points to the increasing burden of cancers, the high prevalence of risk factors, the late stage at which most cancers are presented in hospitals and the inequity in access to cancer care as some of the current challenges faced by Kerala. It points out that despite making substantial investment in improving diagnostic and treatment capacity for cancer in the Regional Cancer Centre (RCC), Malabar Cancer Centre (MCC) and five government medical colleges, there are districts such as Idukki, Wayanad, Palakkad and Kasaragod where access to cancer care facilities are virtually nil. Avoiding delays in diagnosis and treatment, standardisation of treatment protocols, completion of treatment and regular follow-up are areas that the State really needed to focus its attention.
Approximately 34% of cancers in the State are currently managed in the private sector. Varying levels of care in public sector and private health facilities, lack of a protocol-based management or referral pathways and the absence of a comprehensive framework for cancer prevention and control are the other identified challenges. It points out that there is no single State Cancer Registry in Kerala that can offer comprehensive and current information on the pattern, incidence and trends of cancer across all regions. Another major drawback in getting consolidated information was the fact that unlike States such as West Bengal or Karnataka, cancer is still not a notifiable disease in Kerala
The Kerala Cancer Control Strategy for 2030 is proposed along the cancer continuum from prevention to palliative care, with focus on equipping the health system with infrastructure and human resource to ensure affordable and accessible services to all, enhancing leadership and governance and devising financial protection mechanisms to reduce out-of-pocket expenditure. It proposes implementing strategies for risk reduction, early detection and prompt treatment of cancers, improved cancer literacy programmes, people’s participation and policy support towards an effective cancer care programme.
Strengthening the health-care delivery for cancer through the setting up of the Kerala Cancer Care Grid; improving the monitoring and evaluation of cancer incidence and mortality through the establishment of a State Cancer Registry; partnership and networking with civil society and investing in research are the other major strategies proposed under the KCCS
