How Is Assam Faring In Its Decentralised Approach To Cancer Care?

The Northeastern region of India, including Assam, has become the country's cancer capital, with alarmingly high incidence rates compared to the national average. 

At the all-India level, 80-110 out of every one lakh people are diagnosed with cancer. However, in Assam, the figure is 206 per lakh, placing it fourth in the country. Mizoram tops the list with 270 cases per lakh, followed closely by Arunachal Pradesh at 230 and East Khasi Hills in Meghalaya with 228 cases per lakh.

The statistics paint a grim picture: every year, 60,000 new cancer cases are diagnosed in the Northeast, with Assam alone contributing 50,000 of these. Tragically, around 25,000 people in Assam lose their lives to cancer annually. 

Over the past five years, 1,14,169 people have died of cancer out of 1,89,478 reported cases in Assam. 

According to the Union Ministry of Health and Family Welfare, the steady rise in cancer cases in Assam is paralleled by an equally concerning rise in fatalities.

The Northeast’s cancer crisis is fueled by multiple factors, including lifestyle habits such as tobacco consumption, dietary patterns, and environmental hazards like arsenic contamination in groundwater. For example, in 19 districts of Assam, people are exposed to high levels of arsenic in groundwater, which exceeds safety thresholds of 0.01mg/L.

For years, Assam’s cancer care infrastructure remained inadequate, forcing patients to travel long distances to a handful of overburdened apex hospitals. 

The financial and emotional toll on patients and their families was staggering. Dr. Dwipen Kalita, a senior oncologist and surgeon at the State Center Institute based in Guwahati mentioned, "A few years ago, patients would leave disheartened after a cancer diagnosis because they simply couldn’t afford the treatment—all their money would be spent on scans and tests alone.” 

Recognising this critical gap, the Government of Assam, in collaboration with Tata Trusts, launched the Assam Cancer Care Foundation (ACCF) in December 2017.

This public-private partnership was sought to develop a first-of-its-kind three-tier cancer care model aimed at making diagnosis and treatment more accessible and affordable. In the following article, we attempt to analyse how the ACCF has fared in meeting this objective. 

Focus on the small

Instead of relying solely on a few major hospitals, the initiative is establishing smaller regional cancer centres linked to apex hospitals. These centres handle early diagnosis and treatment, reducing the burden on larger institutions and bringing quality cancer care closer to home for thousands of patients.

One of the patients, Narayan Gogoi (name anonymised), who is undergoing treatment for stage III tobacco-related cancer, hails from Sibsagar in Upper Assan.

“I never imagined reaching Guwahati for advanced treatment. If it was a decade ago, I would have had to travel between the cities of Bombay and Chennai in search of doctors and overspend to the point of hopelessness. The Cancer Care Centre in Dibrugarh gave me my first hope with diagnosis and initial care. Now, although the severity of my condition has increased and I’m referred to the Guwahati Centre for the final surgery, I continue to hold onto the belief that this journey will lead to recovery and a second chance at life", he says.  

Progress is visible.

Of the 17 proposed cancer hospitals, nine are operational, including the recently inaugurated centres in Guwahati and Silchar. Prime Minister Narendra Modi previously inaugurated seven centres in Dibrugarh, Barpeta, Tezpur, Lakhimpur, Jorhat, Kokrajhar, and Darrang. The remaining hospitals in Nagaon, Goalpara, Nalbari, Golaghat, Tinsukia, Sivasagar, Diphu, and Dhubri are in various stages of completion. 

Once fully functional, this initiative will create the largest cancer care network in the subcontinent, drastically improving access to treatment.

The demand for these services underscores their necessity. For example, Dibrugarh, the most crucial centre in Upper Assam, has seen nearly 44,000 patient visits since its inception in 2017.

Other operational hospitals, such as those in Barpeta, Jorhat, Lakhimpur, Tezpur, Darrang, and Kokrajhar, have also recorded significant patient footfalls, highlighting the urgent need for expanded services. 

On the other hand, you can witness a sharp fall in the number of patients being treated at Guwahati. This is likely because the demand for cancer treatment such as radiation and chemotherapy is already getting met at the regional nodal level, reducing the need for patients to travel to the city for treatment. 

Infrastructure, however, is only one aspect of the battle against cancer. The ACCF is also focusing on building a skilled workforce, promoting early detection through awareness programs, and integrating a unified technology platform to streamline care. 

As one of its key features, ACCF offers comprehensive cancer care encompassing diagnostics, medical oncology, radiation oncology, and surgical oncology alongside a palliative and supportive care unit offering pain management, counselling, and rehabilitation to help patients. 

The Foundation also accentuates affordability through subsidised treatment costs. Other features include telehealth services for remote consultations and follow-ups, ensuring access to cancer treatment in rural locations and tele-radiology permitting remote diagnosis via imaging. 

The Virtual Tumor Board set up by the centre connecting the three-tier hospital network in real-time supports multidisciplinary case discussions for tailored treatment regimens, while the DiNC (Digital Nerve Center) combines data and technology to simplify cancer care delivery throughout ACCF's network.

A recent visit to the Guwahati centre confirmed the efficacy of ACCF in Cancer Care in Assam and the region. 

On inquiring about its numerous facilities, we learned that early cancer detection and precise staging are made possible by its advanced diagnostic services, which include molecular diagnostics and imaging (PET-MRI, PET-CT), and a medical cyclotron that produces the radioactive material Fluorodeoxyglucose (FDG) needed for PET-CT and is the only one of its kind installed in eastern India in a government setup. 

Senior oncologist and surgeon Dr Dwipen Kalita, who we talked to, highlighted the multiple facilities provided by the State Cancer Institute. He mentioned how with time, the introduction of procedures such as electrocautery—using heat from an electric current to destroy abnormal tissues, typically tumours or lesions, has helped prevent 80 per cent of blood loss during surgery. 

Moreover, he mentioned how the progressive betterment in radiation technology has supported changing the course of cancer treatment in the last decade. Earlier, a cobalt machine used radioactive Cobalt-60 to emit gamma rays to treat cancer and although cost-efficient and requiring minimal maintenance, it had lower precision and a fixed energy output of 1.25 MeV, making it less effective for deep-seated tumours.

The cobalt machine was successfully replaced by a Linear Accelerator (LINAC) that generates X-rays or electron beams using electricity, thus offering higher precision, variable energy levels (4-25 MeV), intensity-modulated therapy and a reduction in damage to healthy tissues. LINAC, being more technologically advanced, however, requires complex maintenance.

“The advancement in radiation therapy will be further escalated with the introduction of the proton therapy facility that all of us look forward to”, Dr Kalita expressed with confidence. 

The State Cancer Institute is in the process of establishing a proton therapy facility, a sophisticated radiation treatment requiring significant infrastructure and investment, that uses protons to precisely target cancer cells while minimizing harm to adjacent tissues. 

The Guwahati Centre also employs nuclear medicine and advanced surgical techniques, such as robotic surgery, to remove tumours precisely and least invasively, which was our subject of engagement with Dr. Kalita, who has been performing these surgeries for over two decades.

"Robotic surgery has revolutionized cancer treatment by enhancing precision, removing deep-seated tumours with minimal setbacks, and enabling faster recovery, allowing surgeons to perform complex procedures with greater accuracy”, he expressed, and further mentioned how regular workshops and conferences assist all doctors in learning about modern technology and furnishing practical skills.

Upon speaking with a few patients, we got insights into the impact of ACCF’s work. Meena Das (name anonymised), an individual belonging to an average-income household in Guwahati, undergoing stage I colon cancer treatment commented on the importance of mental and emotional well-being not only at the time of therapy but in general.

“Mental health influences physical health. One of the reasons for my condition was severe emotional distress and depression due to personal circumstances. The Foundation has assisted in taking care of almost 90 per cent of my total expenses, thereby lifting the financial burden off my family’s shoulders and bringing me immense solace but it’s the conduct of the professionals and staff that has changed my outlook on life. I view the world and the human race with an entirely different perspective and I don’t feel alone in this any more. I will fight and I will live”, she said.

Among these stories, one case highlighted how community screening camps saved lives by enabling early detection of malignancies. Rina Kalita (name anonymised) came from a village in the Nabari district in Assam and was diagnosed with stage II breast cancer.

Her diagnosis was, however, crucial as she showed no signs or symptoms of the disease. "I saw a lump once on my left breast that felt hard upon touching but there wasn't any pain. My son on his way back home from work learned about the ongoing community screening camp and decided to take me there. This was a blessing and also the turning point of my life." 

She mentioned how the surgery and other procedures were carried out with prudence and accuracy, and profoundly thanked the government for saving her life. "I cannot put in words how this initiative of the Government has brought back joy in my life as well as my family's."

Till the time of writing, 9,57,151 people have been screened for non-communicable diseases such as various forms of cancer in 9,571 camps organized by the Foundation throughout the state.

"Our department is not about giving up; it’s about ensuring comfort, dignity, and quality of life for those who have reached an incurable stage of cancer. It provides relief and support during unimaginable physical and mental conditions and compassion when it’s needed most,” said a healthcare professional in palliative care at the State Centre Institute who preferred being anonymous. 

“The load on our hospital at Guwahati has been significantly unburdened because nodal hospitals have become adept at providing basic radiation and chemotherapy sessions to patients. Only those requiring high-end surgeries now come to Guwahati”, he added. 

Such advanced facilities are generally available in central and private hospitals and seldom in state government hospitals. While ACCF’s facilities are primarily concentrated within Assam, the underlying model of distributed care has inspired similar initiatives by Tata Trusts in other Indian states such as Maharashtra, Jharkhand and Andhra Pradesh. 

Finally, the Foundation also provides a unique human touch to terminally-ill patients at the last stage of their lives.

Dishanta Patowary, a medical student who was posted at the Palliative Care Unit of the State Cancer Institute mentions how the team comprises not only doctors but various motivational speakers and spiritual leaders.

“The entire team of doctors and nurses, spiritual leaders from all religions and motivational speakers work in unison to help the patient, cheer them up during this difficult phase”, he added.

Dishanta further emphasised that the unit provides care to not only cancer patients but anyone with a terminal illness and said, “It is not a technical but an empathy-centric unit where one has to communicate effectively and break the bad news with utmost compassion.” 

The Assam Cancer Care Foundation, by investing in cancer care infrastructure, training healthcare professionals, and encouraging early diagnosis, is addressing one of India’s most pressing public health challenges.

As more hospitals become operational, the state moves closer to ensuring that no cancer patient is denied quality care due to financial or geographical constraints.

This decentralized approach significantly cuts down expenses, reduces patient burden on individual centres, and improves access to timely and quality care. 

Simultaneously, this initiative could also eventually promote Assam as a crucial medical tourism hub for high-end cancer treatment not just in the country but also the larger Southeast Asian region.

Nabaarun Barooah is an author and commentator. Kohhua Kaushik is a student of biotechnology.