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

Shahid Akhter, Consulting Editor, FEHealthcare, spoke to Dr. Bhavna 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; 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 NBI, that is, our national accreditation body, version six, mandates that all cancer patients should be discussed in an MD. The second important point was that cancer is a notifiable disease. Cancer is notifiable in 17 states of India. If cancer is notifiable, 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. This is because every UK cancer case had to be reported to the NHS, which had a clear idea. If a patient is treated in this center, this would be the survival, and this would be the mortality. The third important matrix was the publication of outcomes. What was the 30-day mortality after surgery? How many patients were living? How many patients were dying after surgery, radiation, or chemotherapy? If there was a surgeon in the NHS who was not removing an adequate number of lymph nodes for colorectal cancer surgeries, his name was in Daily Mail and he was sent for retraining. 

 

Who decides the quality benchmark for a cancer centre?

In India, everybody operates on colon cancer. General surgeons do. Colorectal cancer surgeons do so. There is no quality control. A patient actually puts in a lot of trust when they come to a hospital, which is like a temple; you know, for them, there are gods sitting inside, and they put in so much trust. I feel it is our duty to deliver the best we can. And I feel peer review is very, very important for cancer centres. For a cancer centre to be called the cancer centre, they must fill these tick boxes. They must publish outcomes. They must ensure that they know the cancer burden of the state.

I did an exercise for Punjab, and we evaluated some cancer centres to see whether they are fit to be cancer centres. Additionally, we closed some centres that did not meet the necessary standards. I believe that every state in India needs to undertake similar evaluations. For a centre to be called a cancer centre, they must publish outcomes. They must have a registry. They must actually have a survivorship plan. They must have a palliative care plan. They must have a preventive oncology plan. 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. There are patients who require comprehensive care. Some patients may just need surgery and radiotherapy. So I think it is our duty to provide the patient unbiased care. 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.

Most of the cancer centers have radiotherapy machines, and they are running at full capacity. For example, Raipur had only 4 or 5 cancer centers, but at least 5 or 6 more are planned in the next 3 or 4 years, which is typical of most major cities in India. We need more cancer centers. With the cancer burden, we need more cancer centers, and we also need more trained cancer specialists, trained cancer nurses, trained cancer pathologists, and radiologists. Because cancer care is a specialized field, high-quality pathology and radiology enhance our treatment approach. Getting the right diagnosis at the right time is very, very important. Therefore, capacity building for the country must consider all of these branches as well. We also need nuclear medicine specialists. Today, we are short of almost 4000 medical oncologists in the country. It's very hard to find recruits. As a nuclear medicine specialist and the medical director of a cancer center, I know how difficult it is to recruit for some of these branches. We need to improve the system so that patients can confidently visit a cancer center, knowing they will receive the best treatment.

 

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 with the 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 institute and, as a state-of-the-art 170-bed cancer centre, which has, I would say, the best infrastructure globally. I have worked for cancer centre in, London, United Kingdom, all over India, corporate in India, government centre, like Tata Hospital in India. And I can say, hands on heart that we have the best infrastructure that you can think of. And today we can boast of having the most amazing cancer team that looks after the patients, as well. 

The USP of this centre is the vision that we provide cancer care for all. When I came, I read this: the mission was that we want 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. And the government and us, we have a duty to our country and the citizens of our country that we make and drive all efforts to for HPV vaccination to prevent cervical cancer and screening for all Indian women who are eligible.

So that was the vision behind the cancer free society. So to prevent cancer so that it doesn't happen only and I would say 60 to 70% of cancers in these girls in Raipur where we have the medical centre, the cancers are preventable. And the greatest USP of our cancer centre is, cancer care for all. Whatever society, whatever section of society you belong to, whether it's economically poor or economically well established or, we are able to provide cancer care for every single patient, every patient who walks in through the doors of Balco Medical Center gets the best treatment under the sun.

 

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

Yes, 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 that we are able to provide. The Ayushman Bharat scheme is available to all patients who are eligible. In fact, the Ayushman Bharat scheme faces several challenges. It does not fund diagnostics. So we are able to tie up with like-minded organizations all across the country and the Balco Medical Center charitable fund, which makes sure that we fund those diagnostics so that we can then take the patient up on the Ayushman Bharat scheme and make sure that we do end-to-end treatment.

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.  Can we decrease the hospital visits, even if it's by 1 or 2 visits, we want to do that, and whenever the patients come, give them timely treatment. Because financial toxicity comes with side effects. And of course a cancer patient also has emotional toxicity. They 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 serai where they can stay free of cost and get food as well.

We provide a high-protein diet. Again, we tie up with like-minded foundations who help us deliver that. The most important unique selling proposition (USP) of our organization is providing care closer to home, while also offering all services under one roof. So we offer medical, surgical, and radiation services. In our tumor board or multidisciplinary team meetings, we discuss every cancer patient collaboratively to develop the best treatment plan, which I believe is unique in central India.