The real picture of cancer care in the developing countries.

Sir,

We congratulate Dr. Arif Jamshed and his team for an excellent update published recently.[1] It reflects the real picture of cancer care in the developing countries. The cancer care in India is no exception to this and to support this, we would like to present some facts.

Ours is a tertiary care center run by the state government, which caters to the poor patients residing near the outskirts of the city. At our center, from March 2011 to November 2012, 50 patients were admitted for acute lymphoblastic leukemia (ALL) therapy after detailed counseling about the finances, manpower, and the commitment required. Twelve patients refused therapy due to poor financial status and 4 patients expired of infections before the start of ALL therapy. Thus, almost one-third patients were lost before treatment started and only 68% of the patients received therapy. The total number of patients lost to follow up, stopped treatment, or shifted to palliation citing economical reason after starting ALL therapy were 7 of 34 (20.58%). This is much higher in comparison with 4%[2] and 10%[3] described in other studies. This 20.58% mark is seen even before the completion of full therapy in all these patients. The same scenario was observed during 2007 to 2010. Of 63 patients admitted for ALL therapy from February 2007 till March 2011, only 42 (66%) received therapy. Thirteen percent patients were lost to follow up during the maintenance phase of ALL therapy.

The predominant reason behind this was low economic status. This is similar to the study by Sitaresmi et al.[4] Many relatives deny therapy on the grounds of poor finances, inability to arrange enough manpower required during therapy, especially as both parents are the bread winners, and lack of infrastructure and low-cost facilities to stay near the treatment center. In spite of financial support from the government being available, it always gets delayed due to clerical or bureaucratic procedures. We have involved non-government organizations (NGOs) who help these patients financially. With this step, the number of patients lost during therapy is reducing to some extent.

The treatment outcomes for ALL therapy published from tertiary care centers funded by the central government or run by private associations are entirely different[23] than those from our center as well as many state government hospitals. We believe that these few hospitals do not represent the real picture of cancer care in India as the majority of cancer patients are treated at state government hospitals.

We agree with the author's opinion that the cancer care programs do not receive enough priority and adequate funds, and we believe that it is the main reason behind the poor outcome of cancer treatment in developing countries. We feel that urgent steps should be taken to improve the awareness and the outcome of cancer care in developing countries. We agree with the suggestions and the points raised by the author.