India's cancer treatment infra in rapid expansion mode as cases soar

Capacity build-up via hub-and-spoke route; experts say country would need 10,000-15,000 more day-care beds and 25,000 surgical beds if all reported patients are to avail treatment

As the country observed the Nat­i­onal Cancer Aw­a­reness Day on Monday, India’s major hospital chains revealed that they are enhancing infrastructure by opting for the hub-and-spoke route, creating more day-care-beds to treat its growing population of patients.

According to a Ficci and Ernst & Young (EY) report on the disease released last month, India is estimated to report 1.9-2 million cancer cases in 2022, whereas the real incidence is 1.5 to three times higher. Experts estimate that the country would additionally require 10,000-15,000 daycare beds and at least 25,000 surgical beds if all reported cancer patients are to get treatment.

This will add further press­ure on availability of hospital beds, which is 1.3 per 1,000 people at present, as against 2.9 per 1,000 in the US, 4.3 per 1,000 in China, and 13 per 1,000 in Japan.

Almost 75 per cent of specialty health care is provided by the private sector, say hospital chains. Large corporate hospital chains are now on an expansion mode to cater to the growing demand from cancer patients.

EY estimates that the industry’s average capital expenditure per bed is Rs 50-80 lakh in metro and tier-I cities, and Rs 30-35 lakh in tier-II cities. “Assuming bed addition requirements mainly in tier-2 cities, total capital expenditure for addition of 35,000-40,000 beds would range from Rs 10,500 crore to Rs 14,000 crore,” the report says.

Tata Memorial Centre, a private philanthropic venture supported by the government, is at the forefront of the expansion drive. C Pramesh, director, Tata Memorial Cancer Hospital, Mumbai, said that the institution had 640 beds in the city and around 100 beds in Kharghar (a Mumbai suburb) eight-nine years ago.

“By the end of 2023, we would have 3,000 beds across India, quadrupling our bed count in the last few years. From being present only in Mumbai, we have now expanded to eight centres across the country. Around 280 cancer centres that are part of the National Cancer Grid (NCG) (a government of India-backed network of care centres) are also coordinated by Tata Cancer,” he added.

Enhancing cancer care infrastructure is the need of the hour. The 2020 World Health Organization ranking on cancer burden in terms of new yearly cases reported placed India at the third position after China and the US. Pramesh said the age-adjusted cases of cancer in India were static, but in absolute terms the numbers were rising.

Of the reported cases in India, head and neck, gastrointestinal and lung account for 50 per cent of the cases among men, while breast, cervix uteri and gastrointestinal organs make up 50 per cent of the cases among women.

HealthCare Global Enter­pri­ses (HCG), a leading private sector cancer care provider in the country with 1,979 beds across 19 cities, is also expanding.

B S Ajaikumar, executive chairman, HCG, said that they expect at least 10 per cent rise in footfalls in their mature centres such as Bengaluru. “Almost 80 per cent of chemotherapy is an outpatient-department (OPD) procedure. We have presence in Bengaluru, Mumbai, Kolkata and Ahmedabad and a few other major cities. We are now creating a hub-and-spoke infrastructure surrounding our major centres in Cuttack, Che­nnai, Vijayawada, Vizag, Angol and Gulbarga,” Ajaikumar said. The idea is to expand to tier-II and III cities.

Others like Apollo Hospitals, Fortis Healthcare and Manipal Hospitals are not far behind.

“There are around 1.3 mill­i­on patients per year in India and they are spending an average of Rs 400,000-500,000 for cancer care. This is less than a fifth of what it costs in most other countries. India has the most ad­van­ced treatments such as proton therapy, genomic treatment, ro­botics and the use of artificial in­telligence for diagnosis and treatments,” said Dinesh Mad­havan, president, group oncology and international, Apollo Hospitals Enterprises. He added that modern trends such as CAR-T cell treatment were also available in India now. Apollo, which has 13 cancer centres ac­ross the country, is aiming to ex­pand it to 24 within three years.

India’s second largest hospital chain, Manipal Hospitals, sees over 400,000 patient visits every year for cancer treatment. “While we do not have standalone hospitals providing only oncology services, most of our hospitals are equipped to treat cancer. In fact, we believe that a multi-specialty environment is often better as it provides the comprehensive clinical backup that a patient might require across various therapeutic areas while undergoing treatment for cancer,” said Dilip Jose, MD and CEO of Manipal Hospitals, adding that they are continuously augmenting their cancer treatment capabilities.

Fortis Healthcare, which gets 7,000 inpatient cancer admissions every year, is now focusing on bringing in cutting-edge technology to augment its cancer infra.

It runs one of the largest bone-marrow transplant centres in the country for blood cancer patients. Ritu Garg, chief growth and Innovation officer at Fortis Healthcare, said they plan to add 1,500-2,000 beds across their network over the next one or two years. Of this, around 30 per cent beds could be for treating cancer patients as incidences rise.

Most hospitals are trying to adopt new-age treatments for home care, remote monitoring, and also optimising hospital stays to reduce the cost burden on patients.

Garg said that they try to optimise patient stays in their hospitals so that several procedures can be done outside.

Pramesh said that any research project that Tata Memorial funds typically looks at low-cost affordable innovation that would have significant differences in outcomes. “Several new-age technologies are very expensive, and the incremental benefit to the patient may not justify the cost,” Pramesh added. So Tata Memorial focuses on innovative applications such as lowering the dose of immunotherapy — giving one-tenth of the dose of immunotherapy to head and neck cancer patients yield much better outcomes than routine care, but not at high costs.

“India has around 60,000 beds, which are catering to on­cology patients. Regular monitoring is very critical in cancer care. We are seeing adoption of new-age treatments like stem cell therapy, artificial intellige­nce, home care and remote pat­ient monitoring getting develo­ped in the segment,” said Mu­dit Dandwate, chief executive officer of Dozee, a contactless re­m­ote health monitoring start-up.

(With inputs from Shine Jacob in Chennai)