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 recent Ficci and Ernst & Young Report on cancer released in October 2022 India is estimated to report cancer incidences of 1.9-2 million cases in 2022, whereas the real incidence is 1.5-3 times higher than the reported cases. Experts estimate that the country would require an additional 10,000-15,000 day-care beds and at least 25,000 surgical beds if all reported cancer patients are to avail treatment.

This will add further pressure on availability of hospital beds, which is 1.3 per 1000 people here, as against 2.9 per 1,000 in the US, 4.3 per 1000 in China, and 13 per 1,000 in Japan.

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

E&Y estimates that industry average capital expenditure per bed is Rs 50-80 lakh in metro and tier-1 cities, and Rs 30-35 lakh in tier-2 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 this expansion drive. Dr C Pramesh, director, Tata Memorial Cancer Hospital, Mumbai said that the institution had 640 beds in Mumbai and around 100 beds in Kharghar (a Mumbai suburb) about 8-9 years back.

?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) are also coordinated by Tata Cancer,? he added.

Enhancing cancer care infrastructure is definitely the need of the hour as the 2020 WHO ranking on cancer burden in terms of new yearly cases reported, ranked India at the third position after China and the US respectively. Pramesh said the age-adjusted cases of cancer in India are static, but in absolute terms, the numbers are rising.

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

A leading private sector cancer care provider in the country, HealthCare Global Enterprises (HCG), with 1,979 beds across 19 cities is also expanding. Dr B S Ajaikumar, Executive Chairman, HCG said that they expect at least a 10 per cent rise in footfalls in their mature centres like Bengaluru. ?Almost 80 per cent of chemotherapy is an out-patient-department (OPD) procedure. We have a presence in Bengaluru, Mumbai, Kolkata, and Ahmedabad among other major cities. We are now creating hub-and-spoke infrastructure surrounding our major centres at Cuttack, Chennai, Vijayawada, Vizag, Angol, Gulbarga,? Ajaikumar said. The idea is to expand to tier-2 and 3 cities.

Others like Apollo Hospitals, Fortis Healthcare, Manipal Hospitals are also not left behind.

?There are around 1.3 million patients per year in India and they are spending an average Rs 4,00,000-5,00,000 for cancer care. This is less than a fifth of what it costs in most other countries. India is into the most advanced treatments like 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 like CAR T Cell treatment is also in India now. Apollo, which has around 13 cancer centers across the country, is planning 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 back up 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 gets 7,000 in-patient admissions of cancer patients every year, and 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 in the country. Dr Ritu Garg, Chief Growth & Innovation Officer at Fortis Healthcare said that they plan to add 1,500-2,000 beds across their network over the next 1-2 years. Of this, around 30 per cent beds could be for treating cancer patients with the incidences rising.

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

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

Pramesh said that any research project that Tata Cancer 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 adds. So Tata Cancer focuses on innovative applications like lowering the dose of immunotherapy - giving one-tenth of the dose of immunotherapy in head and neck cancer patients give much better outcomes than routine care, but not at high costs.

?The country 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 (SCT), 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 startup.

DEMAND-SUPPLY GAP

• Only 175 districts in the country covering 40-45% of the population have Comprehensive Cancer Centers
• Economic burden in terms of GDP losses is $11 bn in 2020; to increase to $36-40 bn by 2030*
• Penetration of Radiotherapy (RT) equipment is low with 640 installations per mn population against requirement of 1400-1500
• 5 CT scanning machines per mn population compared to 40 in high-income countries

*Based on reported cancer incidence and mortality across age groups and years of potential productive life lost (YPPLL) due to the same.

Note: Cancer incidence estimated in 2022: Rs 19-20 lakhs

Note: Cancer incidence estimated in 2030: Rs 42 to 45 lakhs. With conservative cancer incidence estimate of Rs 29 to 30 lakhs in 2030

Source: FICCI Heal and Ernst & Young Report