Innovations in Public Health Care System in Odisha District Cancer Chemotherapy Program

Problem Statement The incidence and prevalence of Cancer particularly cancer oral cavity, breast, cervix, GI tract, lungs, ovary and prostate are very fast increasing in the State of Odisha. It is cases of cancer in Odisha: 3-4 lakhs New Detection: 50-60 thousand per annum. Annual Death: nearly 10-15 thousand Drop out rate: 60-70% as per statistics of AHRCC, Cuttack due to various reasons. The main reasons are cost of treatment, side effects of drugs, long distance, long waiting time, inadequate support system etc.

There is strong stigma, miss-conceptions and fear for cancer, is prevailing in the community. Facilities for cancer detection, consultation and management at District level are non existence which contributes for delayed reporting of symptomatic cases to tertiary centres. As there are very few facilities, providing comprehensive cancer care in Odisha the burden of cancer cases at tertiary level is huge hence it becomes difficult to provide them qualitative care. Hence it was dire necessity to start Cancer Unit at every District Hospitals with trained doctor and staff nurse to give cancer consultation and administer follow up cancer chemo to patients to maintain the continuity of treatment and reduce unnecessary load on tertiary centres.

Program Description Keeping above challenge in mind the Health & Family Department, Government of Odisha has launched the District Cancer Chemotherapy Program during 2015-16 . An expert committee consisting of Director, Acharya Harihar Regional Cancer Center, Cuttack, State Nodal Officer, NCD and Associate Prof medical oncology was deputed to MP to study their Model. On the basis of report submitted by expert committee a road map was prepared to initially start district cancer chemo therapy in 7 districts, Koraput, Nabarangpur, Sundergarh, Bargarh, Phulbani, Balasore and Mayurbhanj were selected.

The one doctor and two staff nurses from each district were sensitized and motivated at AHRCC, CTC to undergo training. Doctors were sent to Sarvodaya Hospital, Faridabad and Ujjain District HQ Hospital, MP for 4 weeks. And staff nurses were sent to DHH Ujjain for 2 weeks to undergo training on administration of chemotherapy to cancer patients under the direct guidance of Dr. Dinesh Pendharkar an eminent oncologist of Asian Cancer Institute, Mumbai and Dr.C.M.Tripathi, State Nodal Officer, Cancer, MP during April-May, 2016

After completion of training , Cancer consultation camps were organized at District Hospitals of all 7 districts under technical guidance of Dr.Pendharkar, Director, Acharya Harihar Regional Cancer Center, Cuttack and State Nodal Officer, NCD in May, 2016. In these camps 309 cases of cancers were examined and 107 patients were identified who needs chemotherapy. Chemotherapy drugs required for treatment of these patients were indented and supplied to districts. The 6 bedded district cancer chemo wards were established.

Since end of May, 2016 till 31stthAugust, 2016, nearly 101 cancer cases have been administered Cancer Chemotherapy at District HQ Hospitals. More and more cancer patients will be administered chemotherapy as per direct guidance of Medical Oncologists of AHRCC, Cuttack and Dr. Pendharkar. It has been planned to organize Camps quarterly at DHH. In these camps not only patients are being identified for chemo administration but status of cancer patients were assessed for further requirement of treatment like surgery, RT or palliative. Through camps all the cancer patients of districts who have completed treatment are being followed up.

Setting of Cancer Unit at District HQ hospitals under the trained doctor and staff nurses has resulted as a boon for all cancer patients of districts. Now they will get all types of consultations on cancer and for their problems at District itself.

The completion of treatment of all registered cancer patients will be ensured through district centers which will definitely increase the survival rate of cancer patients and confidence of cancer patients on system. The out of pocket expenditure of patient towards direct and indirect cost of treatment will drastically reduced.

Data base of individual patients attending district cancer chemotherapy center has been prepared which can be used for up-scaling of community based cancer registry in future. All Districts Cancer Chemotherapy Centers will be connected with AHRCC, Cuttack through Telemedicine port for continuance guidance to chemo trained doctors and staff nurses and patient follow up.

Scalability It has been planned to extend this program in another 8 districts. The cancer patients of nearby districts can be tagged with nearest centers and benefits can be extended to all cancer patients of 30 districts of Odisha with these 15 centers As the cost of setting up District Cancer Chemo center is only Rs. 4-5 lakhs and involves only one doctor and two staff nurses per centers so the program can be scaled up in more and more districts.

Hence this may be great step towards SDG

SDG SDG Visit to MP

Visit to MP

Visit to MP

Financial guidelines

Cancer Camps at Koraput

Cases at Koraput camp

Cancer Camps at Nabarangpur

Cancer Camps at Sundergarh

Total no. of patients attended camp Oral/Head & Neck cancer Out Come of Camps   Types of cancer Sl. No. Place of Cancer Camp Total no. of patients attended camp Male Female Child New old Oral/Head & Neck cancer Breast Cancer Cervical Cancer Lungs GI tract Prostate cancer Hodgkins lymphoma NHL Thyroid Ovary Other 1 Phulbani 30 18 12 6 24 2 3 Baripada 22 9 13 21 4 5 Balasore 54 23 31 53 15 14 7 Nabarangpur 83 39 44 79 8 17 Koraput 20 Sundergarh 35 16 19 10 25 11 Bargarh 41 Total 309 149 160 33 276 88 72 26 38 50 % 48.2 51.8 0.6 10.7 89.3 28.5 23.3 8.4 2.9 12.3 1.9 1.4 16.2 Cancer Outcome of Camps at

Surgery CT RT Palliative 16 6 7 5 12 2 1 8 11 23 13 10 22 3 32 29 9 19   Under treatment Incompletely treated Reason for drop out Pts completed treatment on follow up Pt need further treatment and referred to AHRCC, CTC for Pts needs Chemo at DHH Surgery CT RT Palliative 16 6 economy 7 5 12 2 1 8 11 23 financial 13 10 Poor financial Condition 22 3 32 29 9 19 4 NK NA 15 66 76 72 55 73 25 107 21.4 24.6 23.3 17.8 19.7 7.1 8.1 34.6

Outcome of District Cancer Chemothepay Programme Cancer cases attended Chemo Administered District center: Nabarangpur: 29 19 Koraput : 49 21 Sundergarh : 71 6 Bargarh :79 31 Kandhamal : 9 5 Balasore : 18 4 Baripada : 54 3 TOTAL : 309 101 No. of cycles:245

District Cancer Chemo Center at Sundergarh DHH and Chemo administered

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