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Cancer services delivery: focus on India
Delivering cancer care in India: doing things differently and getting it right
1,2 Soumitra Shankar Datta and Eduardo Cazap3
1 Senior Consultant, Dept of Palliative Care and Psycho-oncology,Tata Medical Center, Kolkata, India 700160
2 Honorary Researcher, Institute of Clinical Trials & Methodology, University College London, United Kingdom
3 Editor-in-Chief, ecancer, 13 King Square Avenue, Bristol, BS2 8HU, UK and President, Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
Corresponding Author: Soumitra Shankar Datta Email: firstname.lastname@example.org
This special issue aims to highlight some of the challenges of cancer care delivery in low- and middle-income countries (LMICs) and the way these could be overcome. We have six papers in this special issue on a wide range of topics such as 1) diagnostic performance and survival outcome of Sentinel Lymph Node Biopsy (SLNB) procedure in 1500 breast cancer patients from a tertiary cancer care centre 2) information sharing preferences of professionals looking after children with cancer 3) Outcome of clinico-radiologically advanced cancer (cT4b) of buccal mucosa 4) Pre-operative risk factors associated with a post-operative psychiatric diagnosis in oral cancer patients, 5) A public policy analysis with key stakeholders’ insights to understand India’s compliance with the WHO Framework Convention on Tobacco Control 6) Teaching breast cancer surgery in India: Challenges and opportunities.
Even frugal innovations can make a big impact on cancer outcomes. The paper on sentinel lymph node biopsy by Agarwal et al reports data on 1500 women with early breast cancer adopting a technique of combining blue dye and ICG methods. The authors feel this is the way forward for LMICs as it is a cheaper alternative to radioactive dye and more accessible to clinicians in LMICs. The technique when used appropriately would avoid unnecessary axillary dissections in many patients and possibly lead to improved quality of life. This is a perfect example of frugal innovation that may have far-reaching consequences. Not all that is done has to be expensive. We hope it will help readers to learn and adapt their practices in cancer care.
Survival in childhood cancers has improved in the past few decades  and it is not unusual to come across parents wanting detailed information on the outcome of childhood cancers. The special issue has a paper that reports on the communication preferences of professionals in paediatric oncology. The paper has used a qualitative research methodology. The authors suggest a model for communication that is suitable for LMICs to provide a stable foundation of care for children with cancer.
In another paper, Jain et al discuss the benefits and outcomes of upfront surgical treatments of cT4b buccal mucosa squamous cell carcinoma. The authors discuss this in the context of choosing a path of curative treatment for this group of patients, in contrast to being deemed inoperable had they adhered to some of the other treatment guidelines. Let’s hope this starts off a debate on the treatment of such cancers. There is another paper on post-operative psychiatric morbidities and their management strategies in oral cancers. Head and Neck cancers, although one of the commonest cancers in India , require intensive treatments and need to be managed holistically.
The special issue has an interesting article by Ghose et. al. on public policy analysis using a novel methodology of juxtaposing the findings of qualitative interviews of key stakeholders alongside analysis of secondary data available in the public domain. This paper also addresses the strengths and gaps of the tobacco control policy in India.
The last article by Agrawal et al discusses the challenges and opportunities of teaching breast cancer surgery in India and the authors cover the way students could be trained during their undergraduate, post graduate and super specialist training.
India currently has a high cancer burden . As editors, we hope that this special issue will contribute to the planning of future cancer services in India. Providing holistic care that is sensitive to the physical and emotional needs of the patient is crucial. We need preventive programs, early identification of patients as well as cost-effective cancer care that is evidence-based and accessible to the patient.
 Lam CG, Howard SC, Bouffet E, Pritchard-Jones K (2019) Science and health for all children with cancer Science 363 (6432) 1182–6
 World Health Organization: International Agency for Research on Cancer. Cancer Today: Data Visualization Tools for Exploring the Global Cancer Burden in 2020 [Internet]. [cited 2022 Apr 10]. Available from: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf
 Mallath MK, Taylor DG, Badwe RA, Rath GK, Shanta V, Pramesh CS, et al. (2014) The growing burden of cancer in India: epidemiology and social context Lancet Oncol. 15 (6) e205–12
Collaboration meeting between Tata Medical Center Kolkata, RadNet Cambridge and the Cambridge Breast Cancer Precision Medicine Virtual Institute.
A multi-professional group of six members of the CRUK RadNet Cambridge team, led by Prof Charlotte Coles and the Cambridge Precision Medicine Breast Cancer Virtual Institute, led by Prof Jean Abraham, visited Tata Medical Center (TMC) in Kolkata to meet with Dr Sanjoy Chatterjee and his colleagues from the Department of Oncology and the Tata Translational Cancer Research Center (TTCRC). This meeting was catalysed by the on-going Lancet Breast Cancer Commission. The aim of the visit was to exchange knowledge on the operational and scientific aspects of a translational research programme. A collaboration between the centres would increase the diversity of patient data contributing to both research programmes.
The Cambridge team shared their rich experience in research including translational and radiomic research. They detailed their multi omics research plans in solid tumours and highlighted their multi department collaboration to achieve the same. The team had received funding from CRUK through their RADNET project. They have also started one of UKs first Personalised Treatment research program in breast cancer. The TMC team shared their clinical trial portfolio including their success in developing a multi-institutional CHAVI repository for collaborative research.
TMC are keen to establish one of the first precision breast cancer programmes in India. Through three days of discussion, we were able to lay out the structure of an over-arching strategy that would allow complementary multi-omic tumour boards to be established in both centres and enable implementation of personalised patient management plans. In addition, TMC and the Precision Breast Cancer Institute team discussed strategies to mentor research nurses and co-ordination staff.
The RadNet Cambridge team also discussed collaboration in informatics and machine learning in radiotherapy, and work will commence to establish TMC as the first international site to join the Hamlet.rt radiomics study, led by Dr Raj Jena. TMC also shares an interest in patient reported outcome measures (PROM) research, and a proposal to collaborate on the development of PROMs to assess both physical and psychological morbidity in breast cancer patients was discussed.
We are very grateful to Prof Coles and her colleagues for their time and for sharing of knowledge and ideas during their visit. We look forward to ongoing collaborations between our two centres.
Publications (Since 2011):
- Chatterjee S, Choudhury Medical communication skills training in the Indian setting: Need of the hour. Asian J Transfus Sci. 2011; 5:8-10.
- Roy A, Bagchi I, Choudhury Need for motivation of plateletpheresis donors: a tertiary care cancer center experience from eastern India. Ann Med Health Sci Res. 2014; 4: S63-4.
- Dhar S, Basu S, Mishra Peripheral blood film examination a necessity for plateletpheresis in eastern India. Transfusion. 2014; 54:258.
- Basu S, Goel G, Bhattacharya Infection prevention in transfusion practice. Infect Control Hosp Epidemiol. 2015; 36:613-4.
- Dhar S, Basu S, Chakraborty S, Sinha Evaluation of the pneumatic tube system for transportation of packed red cell units. Asian J Transfus Sci. 2015; 9:195-8.
- Basu S, Dhar S, Mishra D, Chandy Clinico-serologic co-relation in bi-directional ABO incompatible hemopoietic stem cell transplantation. Asian J Transfus Sci. 2015; 9:181-4.
- Dhar S, Basu Red cell alloimmunisation in oncology patients: A study from eastern India. Transfus Apher Sci. 2015; 52:345-9.
- Datta SS, Reddy M, Basu Warm autoimmune hemolytic anemia with mimicking anti-e specificity causing intravascular hemolysis in a chronic ITP patient. Transfus Apher Sci. 2015; 53:205-7.
- Datta SS, Basu S, Chandy An analysis of transfusion support in haematopoietic stem cell transplantation–report from a centre in India. Transfus Apher Sci. 2015; 53:373-7.
- Datta SS, Reddy M, Basu S, Krishnan Blood Group Discrepancy-First Sign of Autoimmune Hemolytic Anemia after Hematopoietic Stem Cell Transplantation in a Child. Indian J Hematol Blood Transfus. 2016; 32(Suppl 1):211-3.
- Datta SS, Basu Importance of Clinically Significant Anti-M Antibody in Hematopoietic Stem Cell Transplantation. Indian J Hematol Blood Transfus. 2016; 32(Suppl 1):208-10.
- Javed R, Datta SS, Basu S, Chakrapani Resolution of Serologic Problems Due to Cold Agglutinins in Chronic Lymphocytic Leukemia. Indian J Hematol Blood Transfus. 2016; 32(Suppl 1):290-3.
- Javed R, Basu S, Mishra Evaluation of two methods for counting residual leukocytes in leuko-reduced platelets: Nageotte’s method and flow cytometry. Glob J Transfus Med. 2016; 1:43-5.
- Choudhury N, Roy A, Datta SS, Gombert K, Dalen Awareness of cancer among blood donors in a tertiary cancer centre in Eastern India. Indian Journal of Pathology and Oncology. 2017; 4:12-7.
- Javed R, Basu Should we reconsider platelet content criteria for single donor platelets in West Bengal, India? Asian J Transfus Sci. 2017; 11:69-70.
- Basu D, Basu S, Reddy M, Gupta K, Chandy M. Clinical and laboratory profile of anti-M. Immunohematology. 2017; 33:165-9.
- Basu D, Basu S, Reddy M, Gupta K, Roy Fibrin in blood samples interferes with blood grouping by automation. Transfusion. 2018; 58:1831-2.
- Basu D, Basu S, Roy J, Reddy M, Chandy M, Bhaumik Incompatible crossmatch: First sign of a hemolytic transfusion reaction due to out-of-group platelet transfusion. Asian J Transfus Sci. 2019; 13:57-9.
- Javed R, Radhakrishnan V, Basu S, Chandy Challenges in transfusion and the role of Thalidomide in E-β-Thalassemia-A case report. Clin Case Rep. 2020; 8:2208-10.
- Datta SS, Basu Randomization amid a pandemic – a critical appraisal regarding convalescent plasma therapy clinical trials for COVID-19 patients. ISBT Science Series. 2020; 15: 417-8.
- Basu D, Basu S, Radhakrishnan VS, et Comparison of Quality and Efficacy of Apheresis Platelets Stored in Platelet Additive Solution Vis a Vis Plasma. Indian J Hematol Blood Transfus. 2021; 37:648-57.
- Basu S, Basu D, Ghara Blood Product Support in HSCT. In: Chandy M, Radhakrishnan VS, Sukumaran RK. (eds) Contemporary Bone Marrow Transplantation. Organ and Tissue Transplantation. Springer Books, 2021.
- Datta SS, Basu S, Ghara N, Kole P, Khemka Utility of platelet cross-matching in a case of neonatal alloimmune thrombocytopenia associated with a de novo MECOM variant. Blood Res. 2021; 56:53-6.
- Datta SS, Basu S, Reddy M, Gupta K, Sinha Comparative evaluation of the conventional tube test and column agglutination technology for ABO antibody titration in healthy individuals: a report from India. Immunohematology. 2021; 37:25-32.
- Mandal A, Chakrabarty R, Datta Whole blood derived covid convalescent plasma: A practical experience from India. Transfus Apher Sci. 2021; 60:103140.
- Datta SS, De D, Naik Diagnosis and management of hemolytic uremic syndrome in children: A transfusionist’s perspective. Glob J Transfus Med. 2021; 6: 96-9.
- Datta SS, Chakrabarty Has plasma therapy failed in Covid-19 or we have failed in using it properly in India?-Lessons learned through the pandemic. Transfus Clin Biol. 2022; 29:92-3.
- Datta Breast milk contains red cell isohaemagglutinins: Doubts and dilemmas. Vox Sang. 2022; 117:866.
- Mukherjee S, Mukherjee S, Mahto R, et Importance and results of sterility testing of various products in a microbiology laboratory of eastern India. Indian J Med Microbiol. 2022; 40:138-40.
- Datta SS, Basu D, Basu Screening of group O platelet donors for high-titer ABO antibodies- limitations, feasibility, and future. Transfus Apher Sci. 2022; 61:103394.
- Basu D, Basu S, Datta Are we missing reverse TRALI? – A real world experience from a tertiary care oncology centre in India. Transfus Apher Sci. 2022; 61:103466.
- Datta SS, Basu S, Basu D, Reddy M, Chatterji Positive direct antiglobulin tests in cancer patients hospitalized with COVID-19: A brief report from India. Transfus Clin Biol. 2022; 29:253-6.
- Naikoo NN, Basu S, Bajpayee A, Mishra DK, Datta Comparison of three methods for enumeration of residual white blood cells in single donor apheresis platelets: A pilot study from Eastern India as a part of quality monitoring process for leukoreduction. Glob J Transfus Med. 2022; 7: 174-7.
- Mathur A, Jindal A, Tiwari AK, et A multicenter prospective observational study on the use of type and screen method versus conventional type and crossmatch policy for pre- transfusion testing in the Indian population. Immunohematology. 2022; 38: 100-5.
- Ramakrishnan S, Kumar J, Datta SS, Radhakrishnan V, Nair R, Chandy Should we adopt an automated de-centralized model of chimeric antigen receptor- T cells manufacturing for low- and middle-income countries? A real world perspective. Front Oncol. 2022; 12:1062296.
- Datta Transfusion Management in a Bleeding Patient with Rare H-deficient Blood Group Variant [published online ahead of print. 2022]. Indian J Hematol Blood Transfus. DOI: 10.1007/s12288-022-01595-1.
- Das SS, Das S, Shastry S, Shenoy V, Mandal S, Datta Real-world data from India on clinical practices in the management of autoimmune haemolytic anaemia: A survey-based cross- sectional assessment. Transfus Clin Biol. 2023; 30:137-42.
- Datta SS, De Positive direct antiglobulin tests in cancer patients on immune checkpoint inhibitors: A case series from India [published online ahead of print, 2023 Mar 16]. Transfus Clin Biol. 2023; S1246-7820(23)00039-3.
- Reddy M, Basu S, Basu D, Datta A rare case of Bm (B weak) phenotype detected in a healthy blood donor from Eastern India. Glob J Transfus Med. 2023; 8:79-81.
- Naikoo NN, Basu S, Bhattacharya S, Goel G, Chatterji S, Datta A cross-sectional study on immunoglobulin G serology against severe acute respiratory syndrome coronavirus 2 among health-care workers and blood donors in an oncology center in Eastern India along with an assessment of their knowledge, attitude, and practice toward blood donation during COVID-19 Glob J Transfus Med. 2023; 8:51-6.