AML is the most common form of leukaemia in adults. It affects the blood and bone marrow, causing the growth of abnormal cells called blasts, which eventually outnumber healthy cells. Photograph used for representational purposes only
| Photo Credit: Getty Images/iStockphoto
Cancer is among the greatest health challenges of the current century. The sheer complexity of the disease, and challenges in finding the right course of treatment for each patient have resulted in an ever-increasing burden worldwide. Concurrently, intensive research has yielded newer therapies, efficient diagnostic methods, better prognostic methods, and improved disease monitoring and supportive care. However, these advances are not uniform across the world.
In the case of patients with acute myeloid leukaemia (AML), an aggressive form of blood cancer, these advances only reach a miniscule fraction in low and middle-income countries such as India. Several barriers in accessing, and getting the right care, result in abysmal outcomes for patients and increase the health burden. After the United States and China, India had the highest number of cases of AML in 2021. Effective cancer care depends on three critical factors: early screening, accurate diagnosis to determine prognosis and to tailor therapeutic regimens, and timely initiation of treatment to improve survival rates. Hence, it is necessary to recognise and address these barriers in AML care to improve the lives of thousands.
The challenges of AML care
AML is the most common form of leukaemia in adults. It affects the blood and bone marrow, causing the growth of abnormal cells called blasts, which eventually outnumber healthy cells, affecting the production of red blood cells, white blood cells, and platelets. It can progress quickly and even spread to the brain and spinal cord. Hence, early detection and treatment are essential to improve outcomes.
In India, the situation is unique as patients present with the disease almost a decade earlier (median age 40 years) as compared to high-income countries. Despite being younger, patients present at late stages, have poor nutritional and performance status, and face delays in treatment initiation, leading to poor outcomes. Moreover, high incidence rates of fungal infections and multidrug-resistant bacteria during chemotherapy also contribute to mortality rates. Furthermore, the disease is not reported in a large-scale and systematic manner, painting a misleading picture of its real burden.
Patients face several hurdles during the initial phases of treatment. Some of these include disorganised referral systems, lack of well-equipped diagnostic facilities, inadequate hospital infrastructure, and lack of access to cutting-edge therapies. This impact is more pronounced in rural and semi-urban areas. Additionally, many patients lack access to adequate funding, hindering effective treatment. For those eligible for government schemes, there is a significant delay in receiving financial aid. Furthermore, financial programmes do not cover the initial diagnosis. Treatment involves staying for prolonged periods in cities that have state-of-the-art facilities, causing logistical bottlenecks and absenteeism from work for patients and caregivers who travel long distances seeking care. These hurdles become more pronounced when the socioeconomic status, location of patients, and choice between public and private hospitals are taken into account, necessitating a more nuanced approach. In tertiary care hospitals that have medical expertise and can provide affordable services, resources are often stretched to the limit when treating patients with cancer.
Addressing the challenges
While the government has taken several positive steps to make cancer treatment accessible and affordable, such as the Ayushman Bharat scheme, there is more that needs to be done by both the private and public sector to improve outcomes. Strengthening the infrastructural framework can be done at multiple levels depending on the challenges faced. Some of the solutions include:
Diagnosis: Raising awareness among primary care physicians to facilitate appropriate referrals to specialists, decentralising diagnostics to improve access, ensuring that all cases of AML are registered and reported systematically to facilitate data collection and resource allocation.
Treatment: Creating and training a healthcare workforce that is dedicated to AML care, preparing standardised guidelines for AML therapy and infection control, forming public-private partnerships to enhance access to resources such as beds, healthcare workers, and labs.
Policy changes: Forming groups to conduct clinical trials and collect data from different centres, enhancing access to novel drugs, standardisation of quality of generic cancer and anti-microbial drugs, including low and middle-income countries in clinical trials for new drugs.
For every patient, the journey from diagnosis to treatment is unique, and survival often depends on how easily they can navigate these stages. Several barriers such as access to advanced diagnostics, the availability of treatment options, and financial constraints influence timely and effective treatment. Strengthening the healthcare infrastructure around AML care in India is essential to overcome these barriers. By improving early diagnosis, expanding access to innovative treatments, and making care more affordable, the healthcare system can help patients navigate these challenges with ease. In doing so, the country can improve survival rates and ensure that more patients receive the care they need at the right time.
(Dr. Nitin Sood is Senior Director, Medical Oncology, Medanta, Nitin.Sood@Medanta.org)
Published – February 21, 2025 09:00 pm IST
