Chandigarh: The Post-Graduate Institute of Medical Education and Research (PGI) has submitted suggestions to the Parliamentary Standing Committee of Rajya Sabha on the cancer care plan and management, strongly advocating the need to have a policy of reverse-referral to the regional cancer centre after treatment at tertiary facility and making expensive biological cancer therapies affordable.
The institute has vouched for making expensive biological therapies (targeted therapies, immunotherapy) affordable. An effort at the government or administrative level is necessary to carry out negotiations with the manufacturers of these newer therapeutic interventions (novel targeted drugs and immunotherapeutic) so that these are available to patients coming to the PGI at highly discounted rates.
“This will enable eligible patients (including lung cancer patients under treatment the department) to have access to highly effective treatment strategies and potentially improve both survival and quality of life while simultaneously avoiding chemotherapy in many cases,” the institute has said.
There is a need to have a policy of reverse-referral to the regional cancer centre once the tertiary level care is provided and every district hospital needs to be equipped with the facility of infusion of standard chemotherapy protocol, it says.
As an institute of national importance, the PGI says it is willing to mentor and train existing medical staff of district hospitals in administering standard chemotherapy and managing patients with basic side-effects of anticancer treatment. A team of PGI expert points out in the suggestions cancer management is a multidisciplinary service that needs a highly interactive and co-operative work amongst medical, surgical and radiation oncologists but there is a remarkable deficiency of subject expert in the field of medical and surgical oncology in various hospitals. As a result, many cancer patients are unable to get benefit from services of multidisciplinary tumor board for their seamless management.
The tertiary care hospital has suggested to the Centre every medical college must have a department or a unit of medical and surgical oncology and a well-defined tumour board to deliver cancer care to every patient.
If the tumour board at a regional centre faces difficulty, the case may be referred to a tertiary care centre for further evaluation and management.
The PGI has also proposed development of early detection clinics at all district hospitals in collaboration with oncologists with the Public and Social Health Department. These clinics need to be equipped with screening facilities as well as outreach vehicles that can provide screening services on the doorstep. There is a need to develop image-guided biopsy facility along with immunohistochemistry testing at every medical college.
It has further suggested for tertiary-level centres such as the PGI, AIIMS, Tata Memorial Hospital and JIPMER, there should be a provision for reimbursement of second-line regimen as well. These centres have large burden of patients who have relapsed/refractory malignancies and need advanced treatment.