Lok Sabha Question No. 260 (UNSTARRED), answered on 2024-07-24
Subject: High Quality Cancer Care
Ministry: ATOMIC ENERGY
Asked by: Shri Brijmohan Agrawal

## GOVERNMENT OF INDIA DEPARTMENT OF ATOMIC ENERGY

## LOK SABHA UNSTARRED QUESTION NO-260

ANSWERED ON- 24/07/2024

## HIGH QUALITY CANCER CARE

## 260.      SHRI BRIJMOHAN AGRAWAL

Will the PRIME MINISTER be pleased to state:-

- (a) the details of the specific measures being taken to ensure that patients receive highquality cancer care at affordable cost;
- (b) the  details  of  the  specific  research  outputs  introduced  in  the  field  of  cancer  care during the last four years; and
- (c) the details of the manner in which the National Cancer Grid is involved in cancer care, along with a list of centres, research institutes, etc., State-wise?

## ANSWER

## THE MINISTER OF STATE  FOR  PERSONNEL,  PUBLIC  GRIEVANCES & PENSIONS AND PRIME MINISTER'S OFFICE (DR. JITENDRA SINGH)

- (a) The  details  of  specific  measures  being  implemented  by  TMC  to  ensure  that patients receive high-quality cancer care are as below: Tata Memorial Centre (TMC) an aided institute under the aegis of Department of Atomic Energy, has been  providing high quality cancer care at an affordable cost by  following  unique  model  of  60:40  ratio  under  which  60%  patients  received treatment at  highly  subsidized  or  almost  free  treatment  and  rest  40%  are  private patient pay for their care. The rates for even the private patients are low compared

with the rates as charged by the private hospitals in the country.

- 1) Resource stratified  guidelines  for  management  of  cancers  based  on  the  costeffectiveness and infrastructure availability.
- 2)   The guidelines are linked with Ayushman Bharat Pradhan Mantri Jan Arogya Yojna  (AB-PMJAY)  to  ensure  quality  of  care  delivery  to  the  AB-PMJAY beneficiaries.

- 3) Standardisation of diagnosis by National Cancer Grid (NCG)  surgical pathology quality-assurance program, which helps ensuring correct diagnosis at all the participating centres.
- 4) Quality improvement programme, which train the centres in improving quality of all the care pathways.
- 5) Group negotiation for all the high-value anticancer drugs resulting in a median 82%  price  reduction  leading  to  improvement  in  access  and  affordability  of drugs.
- 6) Training of health-care professionals including nurses, pathologists and technicians from across the country to deliver high quality cancer care.
- 7) Virtual  Tumour Boards  to  provide  inputs  on  diagnosis  and  treatment  from  a multidisciplinary  team  of  cancer  experts  for  all  the  complex  cancer  cases  at any of the cancer centres at any location.
6. (b) The  details  of  the  specific  research  outputs  introduced  by  TMC  in  the  field  of cancer care over the past four years is as below:-
- 1) Optimization of treatment of childhood acute lymphoblastic leukemia to increase cure rates - the largest trial done till date anywhere in the world.
- 2) Repurposing of drugs (aspirin, metformin and curcumin) to provide costeffective treatment options for common cancers.
- 3) Training the early career oncologists in conducting high-quality cancer research. Till date more than 400 oncologists have been trained.
- 4) Effect of Pèri-tumoral Infiltration of Local Anaesthetic: A major randomized controlled  trial  (RCT)  conducted  by  TMC  with  a  simple  intervention  of injecting local anesthesia around the breast tumor prior to surgery increased the cure rates by 26%. Expected to save 1,00,000 lives annually.
- 5) TMC has undertaken a study i.e. 'TMC Study - Platinum in TNBC' presented at the San Antonio Breast Cancer Symposium in Texas, which is the largest and most important breast cancer conference in the world proving that an inexpensive drug called platinum improves the cure rate in breast cancer.
- 6) The large yoga randomized clinical trial proved that Yoga increases the qualityof-life and cure rates in women with breast cancer with 15% relative improvement

in  Disease-free  Survival (DFS) and 14% in Overall Survival (OS) after  yoga intervention (Nair NS, et al).

## 7) CAR T-cell therapy:

- i. Collaboration  between  TMC and IIT (B) to develop the first indigenous CAR T Cell Therapy Product.
- ii. The  first CAR-T  Cell  therapy for  a  patient  of acute Iymphoblastic  leukemia in  India was  performed  on  June  4,  2021  at ACTREC.
- iii. The first CAR T Cell Therapy for a patient of lymphoma was performed on June 21, 2021 in TMH.
- iv. The  above  2  trials  led  to  approval  and  commercialization  of  the indigenously developed CAR T product from DCGI in December 2023.
- 8) Low  dose  Immunotherapv:  Immunotherapy  regimens  for  the  treatment  of advanced  Head  &  Neck  Cancers  are  accessible  to  only  1%  to  3%  patients because  of  their  high  cost.  Researchers  at  TMC  have  developed  a  low  dose immunotherapy  regimen  which  improves  outcomes  and  quality  of  life.  This has  brought  the  cost  of  treatment  down  from  Rs.  60  to  70  Lacs  per  year  to below 5 Lacs per year. This was proved in a first ever randomized study and had  a  podium  presentation  at  Annual  ASCO  Meeting  in  USA  and  is  now considered as an alternative standard of care for those who cannot access full dose. It has also opened doors to investigate low dose immunotherapy for other cancers.
- 9) Nutraceutical  'AKTOCYTE':  Launch of Nutraceutical 'AKTOCYTE' by the Department of Atomic Energy Set to Transform Cancer Care. The Department of Atomic Energy in collaboration with M/s. IDRS Labs Pvt. Ltd. Bengaluru has launched a Food Supplement/Nutraceutical AKTOCYTE which is aimed at enhancing the quality of life for cancer patients undergoing radiotherapy.

AKTOCYTE  has  received  approval  from  the  Food  Safety  and  Standards Authority of India (FSSAI), which have shown remarkable results, particularly in pelvic cancer patients suffering from radiotherapy-induced side effects. This

product  will  be  a  landmark  contribution  towards  affordable  cancer  care  in India  and  the  AKTOCYTE tablets  will  now  be available  in  the  market.  The development  of  AKTOCYTE  tablets  is  supported  by  decades  of  scientific research at DAE.

- (c) The  National  Cancer  Grid  (NCG)  was  created  in  2012  with  the  broad  vision  of delivering high-quality and uniform standard of cancer care to all the patients across India. Now the NCG has grown to a large network of 340 cancer centres, research institutes, patient advocacy groups, charitable organizations and professional societies.  Between  the  member  organizations  of  the  NCG,  the  network  treats  over 850,000 new patients with cancer annually, which is about 60% of all of India's cancer burden. lncorporating all stakeholders of cancer care in lndia, it is a strong, unified and powerful voice in the fight against cancer.
- 1) Expansion of the network from 17 centres to 320 centres across all the States and Union Territories (state-wise list at https://ncgindia.org).
- 2) Establishment  of  Koita  Centre  of  digital  oncology  (funded  by  a  Charitable Foundation)  to  leverage  digital  technologies  to  improve  cancer  care  from prevention to treatment. This is in complete alignment with Ayushman Bharat Digital Mission.
- 3) Integrated  data  collection  &  aggregation  -  a  'National  Cancer  Database  to guide all the cancer policies and national cancer control plan. Initial databases established for five common cancers.
- 4) Partnering with digital tech companies to deliver cancer care near to patient's home.
- 5) Initiation  of  national  tumor  tissue  biobank  across  NCG  to  understand  the cancer causation, identification and development of new anticancer treatment and preventive technologies.

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