Using large-scale dataset to identify opportunity for implementing technology based intervention to improve cancer care in India : innovation report

Cancer incidence in India is increasing, owing to a mix of risk factors such as changes in diet and lifestyle, high tobacco consumption rates and an aging and population with cancer being more common in older populations. In India, the crude cancer incidence rate increased by 28·2% from 63·4 per 100,000 in 1990 to 81·2 per 100,000 in 2016. Kerala and Mizoram had the highest rate of crude cancer incidence (figure 1) (Lancet Oncol, 2020). The age-standardised incidence rate of breast cancer in females from 1990 to 2016 increased by 39·1%, with increase observed in every state of the country. The age-standardised incidence rate of cervical cancer decreased by 39·7% in India from 1990 to 2016 (Lancet Oncol, 2020). The trends observed in the top seven cancer type-specific incidence rates in India is shown in figure 2. As per the latest National Cancer Registry Programme Report (2020) by the Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR) the number of cancer cases in India in 2020 was 1.39 million (100.7 per 100,000 population) (Mathur, 2020). Lung, oral cavity, stomach, and colorectal cancers are the most common cancers in men. Cancer of the breast and cervix uteri are the most common cancers in women. Lung cancer is the leading site in metropolitan cities and the southern region, whereas mouth cancer was the leading site in the West and Central regions. The highest burden of breast cancer is observed in metropolitan cities (Naik, 2021). Within India, the incidence of cancer varies dramatically based on the geographical location (north/south/northeast, rural/urban, and Ganges belt/Deccan plains). The highest rate of incidence of cancer is observed in the North-East (NE) region. The trend for crude cancer disability-adjusted life-years (DALY) rate in India shows an increase by 25·3% from 1990 to 2016. Among females, breast, cervical, and stomach cancer were responsible for the highest DALYs in 2016. The highest cancer DALYs among males in India in 2016 were due to lung cancer, followed by lip and oral cavity cancer, other pharynx cancer, and stomach cancer. (Lancet Oncol, 2020) The DALY due to different types of cancer in 2016 is provided in figure 3. As the country suffers from a lack of adequate healthcare infrastructure, there is a wider dearth of awareness on cancers and a severe scarcity of skilled human resources for cancer, hence, conventional healthcare delivery methods involving interpersonal doctor-patient interactions might not be available to most of the people in India (Golechha, 2015). Despite the introduction of government-funded schemes and cancer care facilities at the medical colleges, for the average patient with cancer in India, health care remains highly privatised, with more than 80% of outpatient care and 40% of inpatient care provided by the private sector (Thakur et al, 2011). Consequently, expenditures on private health, especially on drugs, remain very high, exacerbating health inequalities.