Oncologists call for standardised treatment

The Indian Council of Medical Research is evolving standards of care and treatment protocols for 34 common types of cancer.

Purvish Parikh, managing trustee, Indian Cancer Care Society, and president, Indian Society of Medical and Paediatric Oncology, said the guidelines for some specific conditions were already available on the ICMR website, and subcommittees were working to define treatment for other conditions. “There are about 1,200 qualified oncologists for a population of 1.2 billion people. As a result, 60 per cent of patients with cancer are actually being treated by non-oncologists — general practitioners, or other specialists. This is where protocols vary and so do treatment options.”

Evolving guidelines by an apex body such as the ICMR would facilitate the much-needed standardisation of care in these sectors, he added.

“Non-oncologists will have to be partners, and clued into the latest developments in the field of cancer care. For practicing oncologists, it is a way in which they can fine-tune treatment,” Dr. Parikh explained.

Clinical Practice Guidelines (CPG) in Oncology were evidence-based, consensus-driven management guidelines for the clinician/practitioner, said Anitha Ramesh, Professor of Medical Oncology, Sri Ramachandra University (SRU), here. These guidelines aimed at ensuring that all patients received treatment, services that were most likely to lead to optimal outcomes.

Each CPG usually included information on the incidence of the malignancy, diagnostic criteria, stage of disease, risk assessment, treatment plans and follow-up and also preventive and supportive services, she added. The pressing need to evolve a set of guidelines appropriate to the context was behind the SRU’s recent initiative to bring together oncologists from different parts of the country together to arrive at consensus on standards for various cancers. It was also a run-up to the World Cancer Day observed on February 4.

“Most of the CPGs are based on guidelines from the U.S. or Europe. It is high time to evolve recent guidelines in oncology and analyse their applicability to the Indian patient scenario,” Dr. Anitha Ramesh said.

By selecting certain patients for certain types of treatment, not only would the outcome for that patient be better, but useless treatment could be avoided, said Dr. Parikh. “Earlier, if the primary cancer was in the colon and it had spread to the liver, the trend was to write the patient off, start palliative care maybe. But now, with better, targeted chemotherapy, patients have gone on to live for three to five years. One group of patients has also been cured,” explained S. Ayyappan, Director, Madras Cancer Care Foundation.

“The whole approach in cancer is now organ conservation without compromising the survival of the patient. With bone cancer, the old treatment methodology was amputation of the limb, now, conservation of the bone, and limb is a key element of treatment,” he added.

While different networks of oncologists have taken the initiative to standardise treatment over a period of time, the ultimate goal is to take it to medical schools.

To that effect, the Indian Cooperative Oncology Network recently inked a memorandum with the Union Health Ministry to impart oncology training to 336 medical colleges in India, Dr. Parikh said.

This will be one of the answers, oncologists agree, as it will orient all medical practitioners of the existence of guidelines, familiarise them with the procedures, and also underline the need to constantly update oneself of the advancements in medical and surgical management of cancer.