Balco Medical Centre: Setting Benchmarks in Affordable, World-Class Cancer Care

Shahid Akhter, Consulting Editor, FEHealthcare, spoke to Dr. Bhawna Sirohi, Medical Director, Balco Medical Centre, Raipur, about the urgent need for quality benchmarks in cancer care, the vision of cancer care for all, and strategies to make treatment holistic, affordable, and accessible across India.

 

What core standards should a hospital meet before it can truly be called a cancer centre?

One in nine of us will get cancer, as stated recently by the director of ICMR. and the W.H.O. statistics are that 1 in 4 of us will develop cancer in countries like India. It is imperative that we are prepared for it. It is predicted that a cancer outbreak will occur, primarily linked to lifestyle-related diseases. Cancer centres, are being seen as revenue-driven models, which is sad, because at the bottom of it is a patient who sometimes travels very far distances to come and get cancer care that has an element of financial toxicity involved and has an element of time toxicity that is involved because cancer care can be long. It can be short as well if you receive an early diagnosis. But cancer care can also be long if you are diagnosed in later stages; that means multiple visits to the hospital. That does involve a lot of time, toxicity, and of course, finances and logistics. 

 

I spent 20 years in London, and the great thing about the NHS was, of course, universal health coverage with its challenges. But the greatest thing was the peer review of a cancer centre. So for a cancer centre to be called a cancer centre, you had to have some tick boxes, like you had to have a multidisciplinary team (MDT); that is, you had to have a surgeon, a medical oncologist, a radiation oncologist, a radiologist, a pathologist, and a nuclear medicine person who all sit under one roof and make a plan for the patient. And it was mandatory for every cancer patient to be discussed in the MDT. And I am very glad to see that the NABH, that is, our national accreditation body, version six, mandates that all cancer patients should be discussed in an MDT. The second important point was that cancer was a notifiable disease-there was central registry. Cancer is notifiable in 17 states of India. If cancer is notifiable in every state, we know what the true burden for our country is. When we understand the actual burden, our prevention strategies and all key stakeholders align towards a single vision. The third point is patient outcomes. This data was available to know the effectiveness of treatments being given—mainly mortality (30-day, 90-day post-surgery, radiotherapy or chemotherapy), morbidity, and survival. Publication of these outcomes is important to know how the country or the cancer centre is doing.

 

Who decides the quality benchmark for a cancer centre?

Currently nobody does in India. For example, in India, any surgeon can operate on a cancer even though we have trained surgical superspecialists, and the same goes for chemotherapy as well. A patient actually puts in a lot of trust when they come to a hospital—I feel it is our duty to deliver the best we can, and if we do not have the right expertise or training, we must have the wisdom and caring to refer them on to a higher centre. Peer review is extremely important for cancer centres. For a cancer centre to be called the cancer centre, they must fill certain tick boxes. They must have a multidisciplinary team (MDT) or hold a virtual discussion with the team, publish outcomes, and conduct an audit of their outcomes. They must ensure that they have a hospital-based cancer registry and be part of the national effort to understand the true burden of the state.

We did an exercise for the Punjab CM in 2012-2013, and evaluated the cancer centres in the state to see if they should treat cancer patients. I chaired that committee and did give strict recommendations to some centres and closed those that did not meet the necessary minimum standards. I believe that every state in India needs to undertake similar evaluations. For a centre to be called a cancer centre, they must have certain minimum criteria for infrastructure, expertise, and outcomes (and be part of the national cancer registry, have a cancer survivorship plan, palliative care, and focus on preventive oncology). Furthermore, simply administering radiotherapy or chemotherapy alone does not constitute cancer care. Once again, it is important to emphasise that cancer care requires a multidisciplinary effort. So I think it is our duty to provide the patient unbiased care which can only come from MDT discussions. Shared decision-making: keeping patient preferences in mind is critical to this. Additionally, research must be integrated with patient care. Every cancer centre must strive for research. So service, education, and research—all three have to be delivered in the cancer centre as three core pillars.

Cancer centres are mushrooming all over in India with no quality benchmarks defined for them to deliver on. Ayushman Bharat is a great scheme, but there is no accountability on the part of the cancer centres apart from uploading reports/used vials/MDT numbers, etc. There is no focus on obtaining outcomes data.

The Quality Council of India is making some efforts, but none of this has made a difference on the ground level.

What makes Balco Medical Centre unique in delivering world-class, affordable, and preventive cancer care for all?

I'm extremely proud to be working at Balco Medical Centre–Vedanta Medical Research Foundation, which was the brainchild of Mr. Anil Agarwal, our chairman. He wanted to give back something to the state, which has given him lots as well. And as part of this, they've invested almost 500 crores through BALCO. They set this up as a not-for-profit, state-of-the-art 170-bed cancer centre, which has, I would say, the best infrastructure globally. I have worked for cancer centres in the United Kingdom and all over India—NHS, corporate, and government centres, like Tata Memorial Hospital—and I can say that we have the best infrastructure that you can think of. And today, we can boast of having the most amazing team that looks after cancer patients as well. We are able to deliver world-class affordable cancer care to all patients irrespective of their financial status. The team is doing complex surgeries and precise radiotherapy and leading the way with molecular tumor boards in precision oncology.

The USP of this centre is the vision that we provide cancer care for all under one roof. The vision is to have a cancer-free society. And I think the thought behind that was, can we prevent cancer? Cervical cancer is an example of a type of cancer that is 100% preventable. We, along with the government, have a duty to ensure that all efforts are made for HPV vaccination to prevent cervical cancer and to provide screening for all eligible Indian women.

In Chhattisgarh, 60 to 70% of cancers are preventable. We make an effort to drive screening in villages all over with a mammography van that screens for three common cancers in India—breast, cervix, and head & neck cancers. The aim is to diagnose cancers early and refer them for early treatment.

 

How does Balco Medical Centre ensure that Ayushman Bharat patients receive complete cancer care despite funding gaps?

Ayushman Bharat scheme is a blessing for us. If it were not for this scheme, most patients would have never had access to any cancer care. Yes, in the scheme, we cannot afford to give costly immunotherapy or targeted therapy. But again, these are the drugs that are not even in the WHO's essential list of medicines. There are some challenges in the scheme, and paramount is not being able to fund diagnostics. We are able to bridge that gap by tying up with like-minded organizations all across the country, like the Indian Cancer Society. Nargis Dutt Foundation, Cankids, Cuddles Foundation, etc., and the Balco Medical Center Charitable Fund, for which we fundraise ourselves. We ensure that we fund the necessary diagnostics, allowing us to enroll the patient in the Ayushman Bharat scheme and provide comprehensive treatment. We have appointed patient navigators- KEVATs who help patients to navigate this journey.

We have patients in Chattisgarh who have enormous access issues. They travel very far distances to get to us, a lot of them from tribal areas as well. So coming to the hospital is a challenge that costs money. So we aim to try and decrease the hospital visits, and KEVATs help in that. Cancer care comes with financial toxicity and emotional toxicity. Patients are carrying a tremendous burden on their shoulders when they walk through our doors. Somehow we want to ease that burden. So when they come, we have free pickup and drop-off service from the station. We have a Sukh Sarai where they can stay free of cost and get a good diet as well.

We provide a free high-protein diet to those who come for chemotherapy—dates, bananas, threptin biscuits/millet bars, and almonds. The most important unique selling proposition (USP) of our organization is providing care closer to home, while also offering all services under one roof.

We aim to provide the best cancer care for every single patient who walks in through the doors of Balco Medical Center.