How Tata Memorial Centre battled Cancer Treatment Drop-outs during COVID

By Arunima Rajan

There was no slowing down Tata Memorial Centre’s grit and commitment to quality cancer care for immunologically-compromised patients even during the COVID outbreak.

Tata Memorial Centre, established in 1941, is the most comprehensive cancer centre in India. Despite the pandemic and disruption of care due to state and central governments' movement restrictions, TMC treated 60,699 patients in 2020. Even during this pandemic year, this specialised hospital performed 6002 major and 8309 minor surgeries for cancer.

In an exclusive interview with Arunima Rajan, Prof. Dr. Shailesh V Shrikhande, Deputy Director of TMC and Head of Division of Cancer Surgery, speaks about how the hospital took an informed decision to continue offering surgeries and consultation despite being located in a megalopolis rife with social inequality. He notes that TMC offered clinical choices, based on substantial scientific evidence and rationale, after evaluating the risks of COVID balanced against the benefits of surgery for cancer patients.

What are the lessons that your hospital has learned from practising medicine in 2020, and how are you making sure that you are prepared next time?

One of the significant learnings was that we must improve our focus on diagnostics. Diagnostics and widespread testing are the basis of informed policy development for crisis management, which was evident during the ongoing COVID pandemic. Right from the initial stages of the pandemic itself, we did in-house COVID testing. We created dedicated fever clinics and COVID blocks. Our strength in diagnostics enabled us to deliver better infection control even though our speciality is complex and often high-risk cancer care.

The second lesson was that we must augment the treatment capacity of our organisation. It is essential to increase the bed, especially ICU bed, capacities or have provisions in hand to ensure makeshift arrangements, to reduce stress situations where patients cannot receive the necessary cancer treatment. We also co-ordinated with some other hospitals, namely Shushrusha Citizens co-operative hospital, Vikhroli and COVID treatment centres (NSCI, Worli) to augment our ability to not only treat cancer patients who needed COVID care but also care for our employees afflicted with COVID.

The third lesson was the necessity to protect your frontline workers and staff. Your frontline healthcare professionals and staff must be well equipped with the latest information and trained well to handle and manage the state‐of‐the‐art protection provided to them.

Telemedicine got clinical spotlight due to COVID. Has the system adapted to telemedicine?

Cancer constitutes an emergency. One of the first decisions that the leadership made was to decide on not stopping cancer care services. We consulted Mumbai municipal corporation and devised plans to take care of cancer patients with and without COVID. Yes, our hospital systems have adapted to telemedicine in a big way. Our hospital has continued to provide service despite obstacles during this pandemic. It has enabled the hospital system to improve the referral process, seek clarification when required and enable better medical education and training virtually. Lastly, it has substantially enabled patients by making healthcare accessible at his fingertips.

How has the pandemic impacted your financial bottom line? How can one mitigate such risks in the future?

Pandemic has resulted in reduced patient caseloads by 20%. In 2019, the total number of patients registered at TMC was 82,538 patients, and in 2020, it was 60,699 patients. Gastro-Intestinal and Hepatobiliary and Pancreatic Cancer Division of the hospital alone did 1364 elective surgeries and 250 emergency surgeries last year. But now, caseloads are nearing normalcy, and financial implications are not that severe. Mitigation in the future is possible by being prepared for worst-case financial scenarios and making adequate provisions.

We must also have an alternative funding source and do not only depend on grants and patient income. I must specifically compliment the Department of Atomic Energy for their sustained support in these extra-ordinary times to our centre, a Grant in Aid, Central Government Organization.

What changes do you foresee in healthcare delivery business model?

Metamorphism of patients into smart consumers would be one of the significant changes in the coming years. Given the advent of smartphones, information is available to consumers at their fingertips. Digital Health (wearables such as smartwatches etc.) will soon disrupt the healthcare landscape in unforeseen ways. These devices are changing the industry in a way that was never possible before as they enable users to be monitored continuously (e.g. patient follow up after cancer treatment in remote locations).

The emergence of new healthcare companies adapting to consumer demands is bound to change the healthcare delivery model drastically. Lower cost and smaller sized nursing centres and clinics could be the future. Such providers are empowering patients, providing greater transparency and choice.

New innovative diagnostics and treatment would also develop. Robotic Surgeries to personalised precision oncology are the changes that are bound to shape the future of India's healthcare market.

Enumerate three structural changes to improve healthcare delivery in India?

India's cancer centres operate across different sizes, scales, and ecosystems. Understanding the essential aspects of the creation, organisation, accreditation, and activities within these settings is crucial for developing an affordable, equitable, and quality cancer care, research, and education system. The Indian healthcare system must build capacity through cancer centres and networks. We must optimise the workforce and access to reliable, sustainable medicines and health products. Lastly, we must partner with communities and civil society for a better collaborative approach towards improving healthcare delivery in India.

What role should the government play going forward?

Cancer planning should be led by a designated responsible authority such as the Department of Atomic Energy, which has been successfully managing Tata Memorial Centre over the years and has been instrumental in its growth. Also, working with all relevant stakeholders, including knowledgeable members of the public and professionals. Sustainable success will require a commitment to regular reviews of progress and revision of the plan, increasing investment in information systems, strengthening governance structures and, because cancer services are currently less well funded than other disease programmes in many Low to Middle-Income Countries (LMIC), ensuring a continual, appropriate increase in the share of the health budget.

What are the measures you are adopting in your hospital to protect against COVID beyond masking and social distancing?

We are keeping it simple. Patient safety and segregation without compromising cancer care have been our top priority throughout. We are pleased with the outcomes of the various measures we have put in place. Our proven and published experience has been a leading light for many across India and beyond. Our employees had to adjust to new routines during the pandemic. Still, they happily adopted to it, and this has been a distinctive feature of the service culture of Tata Memorial all along. We have sustained vital measures such as social distancing, handwashing and proper sanitisation. Furthermore, we have embarked on a vaccination drive for all our employees since last month.

What were some of the tech innovations that helped your organisation in the battle? Anything that you want to acquire or is in your wish list?

There are roughly one million new cancer cases in the nation. Almost 0·2 million will require an operation. Most patients will encounter illness progression and death in the absence of receiving surgery. Due to COVID-19 in India, death is 0·99 per million of the population with a case fatality rate of about 3%. The cancer mortality in the absence of definitive surgery will far exceed the mortality due to COVID-19 infection.

Telemedicine has helped us achieve a lot more than what we imagined it was possible. We want to acquire technology related to Virtual reality (VR), Artificial Intelligence (AI) and Machine Learning (ML). Such technologies will be especially crucial since Ayushman Bharat programs are also in the process of adopting them.