ICMR Recommends Interventions To Meet Gap In Machines Needed For Cancer Care

A recent ICMR study has highlighted a substantial shortfall in radiotherapy utilisation across all cancer types and underscored the need for interventions to meet the gap in machines required for equitable cancer care. Published in the BMC Cancer journal, the study stated that 28.5% of cancer patients receive radiotherapy, which is lower than the estimated optimal rate of 58.4%.

Breast, head and neck, lung and cervical cancer account for 60% of India's radiotherapy needs, it said.

Data from the Australian Collaboration for Cancer Outcomes Research and Evaluation were used by the researchers of ICMR-National Centre for Disease Informatics and Research, Bengaluru, for conducting the study.

Epidemiological data on stage, subsite and histology from the National Cancer Registry Programme were used to assess the optimal utilisation proportion for India. A sensitivity analysis was carried out.

Similarly, the optimal radiotherapy fraction has also been calculated. These measures have been used to estimate the existing radiotherapy utilisation gap by comparing with the current radiotherapy utilisation from the cancer registry as well as to estimate the optimal radiotherapy machines required for the country.

"This study provides a comprehensive assessment of radiotherapy demand and existing gaps in radiotherapy utilisation and in the number of machines in India based on an epidemiological analysis of the cancer burden from the National Cancer Registry Programme. Our analysis shows that approximately 58% of all cancer cases in India should ideally receive radiotherapy based on clinical indications."

"However, the current radiotherapy utilisation in India is only 28.5%, which is less than half of the required level," the researchers said.

The study also recommended that India would require 1,585 to 2,545 machines, which may increase to a range of 2,016 to 2,291 external beam radiotherapy machines if the assumptions from previous benchmark studies are followed.

The burden of four cancer sites -- breast, head and neck, lung and cervical cancer -- constitutes around 60% of the total radiotherapy requirement for cancer care in India, the study said.

This points towards an increasing demand for radiotherapy in the coming years as there is expected to be a 70-100% increase in breast, head and neck and lung cancer in low- and middle-income countries. Radiotherapy utilisation of most cancer sites is lower compared to optimal radiotherapy utilisation.

Among the major indicated cancer sites, the deficit is more prominent in lymphoma and lung cancer (relative deficit of more than 70%), followed by prostate, breast and oesophagus, it said.

The study mentioned that India accounts for 7% of global cancer incidence, ranking third after China and the USA. By the end of 2025, the incidence of cancer in India is projected to reach 1.57 million cases, posing a significant public health challenge.

As the fifth leading cause of death in the country, cancer demands urgent attention to improve prevention, diagnosis and treatment, it said.

Radiotherapy, a cornerstone of cancer treatment, plays a crucial role in controlling tumour growth, reducing tumour size pre-surgery, and alleviating pain in advanced stages.

However, its availability in low and middle-income countries like India remains insufficient due to high setup and operational costs, creating a significant gap between demand and resources.

The World Health Organization recommends a minimum of one radiotherapy machine (external radiotherapy machine) per million population, with an optimal target of four per million, the study stated.

For India's projected population of 1.45 billion in 2025, this translates to a need for a minimum of 1,450 machines. Yet only 794 megavoltage machines are currently available. The shortfall is about 45% from the minimal required standard, the study said.

The study highlighted that in India, greater investment is needed to expand radiotherapy facilities to meet the growing demands of cancer patients.

"Aside from increasing the number of equipment, addressing the inequitable distribution of radiotherapy services is also crucial. To align with the country's cancer burden and ongoing cancer control efforts, India must meet evidence-based targets for radiotherapy machine availability.

"As a part of this, India is also ramping up efforts to develop and deploy affordable indigenous radiotherapy machines to improve access and reduce dependence on costly imports," the study stated.

Furthermore, a detailed situational study of radiation equipment deployment with its features and complexity, utilisation and throughput is required for informed planning and policymaking. Cancer screening and early detection programmes can facilitate the diagnosis of cancers at earlier stages. This could reduce the required quantum of radiotherapy shortly and thus, improve the overall survival of patients, the study said.

The cancer registry data informs the policymakers to identify gaps in radiotherapy access, assess resource needs and guide decisions to ensure equitable and effective cancer care delivery.