The incidence of cancer across the globe has been on a steep rise with many factors contributing to the surge. India is said to be one of the countries where the rise of cancer cases will be highest. As per a WHO estimate, one in 10 persons in the country has the risk of being afflicted by cancer in their life. Apart from the suffering and mortality at the individual level, cancer inflicts a huge burden on public health infrastructure and expenses of the government.
While cancers are of many kinds affecting various organs, blood cancer is a prominent type. Blood cancer taken together constitute about 20–30% of all cancers. Though the management of blood cancer is more challenging than other cancers, the speed and magnitude of new concepts of treatment and management has been equally breathtaking, which have revolutionised cancer therapy. Nowadays, a blood cancer patient’s survival rate has increased manifold and is much more than other cancers. Some are also curable, thanks to stem cell therapy like bone marrow transplant (BMT) and other latest modules.
Advances
Every cancer is now considered as heterogynous with many variables like disease specific molecular/cytogenetics features, co-morbidities, and response to therapy, etc. BMT is a curative option for many types of the blood cancer which can be taken up either upfront or after the first relapse depending on the situation and following SOPs. Availability of suitable HLA-matched stem cell donor was a major limitation besides cost of this curative option. Recent advances in the immunology of donor stem cells and patients have expanded the scope of stem cell donor by standardizing and approving 50% HLA match donor. This has revolutionized the scope of BMT.
CAR-T cell therapy is a novel and evolving curative option that has provided new dawn for resistant blood cancer patients. Randomized trials across the globe in various blood cancer patients have shown encouraging results. This is going to open one new chapter in the field of management of all types of haematological cancers. At present this is very expensive and hopefully the cost will be reduce to an affordable range, once India starts opening up to this opportunity.
Success rate
Riding on the new concepts and modalities of management, and judicious utilisation of BMT procedure, the success rate has increased significantly. In chronic myeloid leukemia, normal life expectancy is more than 90% of cases. Pediatric acute lymphoblastic leukemia and acute pro-myelotic leukemia are curable in 80-90% of cases. Patients of chronic lymphatic leukemia achieve long-term survival in more than 90% cases. Hodgkin’s lymphoma is now curable in 80% of cases, non-Hodgkin’s lymphoma in 60-70% of cases and acute myeloid leukemia in 50-60% of cases.
Odisha scenario
Despite all the challenges, Odisha has taken huge strides in making treatment for various blood cancers and blood diseases accessible and affordable for the people of the state. Under the proactive steps taken by Chief Minister Naveen Patnaik, Odisha was the first state in the country to provide BMT - which costs lakhs of rupees - to patients completely free of cost by setting up a full-fledged BMT unit at SCB Medical College and Hospital, Cuttack.
The government has spruced up infrastructure and equipped public health facilities with advanced diagnostic labs like flow cytometer, M Band with immunotyping, free light chain ratio and stem cell enumentation, etc. Availability of all the expensive investigations and drugs has given new hope for such high risk patients who, otherwise, were not able to receive the treatment.
The government is also planning to provide free of cost molecular/other investigations required for blood cancer patients and BMT patients (not available in Odisha at present) till such are available here. Supportive therapies like blood components, antibiotics and growth factors, etc. are essential for delivering overall therapy as per the SOPs. Fortunately, all these are available in Govt. institution adequately free of cost.
All these new developments at govt sector has created a tremendous increase in the number of the patient being treated in the government facilities. There have been more than 10 times increase in the turnout of such patients.
The theme of this year’s Wold Cancer Day is ‘Close the Care Gap’. The Odisha government has been taking a lead on this front. However, the pressure on the existing capacities is on a constant rise and needs continued focus for ensuring accessible and affordable care to all.
Dr RK Jena
HoD Clinical Haematology, SCBMCH Secy, Indian College of Haematology