04/02/2025
Cancer Care: A People-Centered Approach
With a growing focus on personalised medicine, early detection and intervention, as well as holistic care; recent approaches in cancer treatment are improving recovery rates and quality of life by putting people first
The observance of World Cancer Day serves as a crucial reminder of the global fight against cancer and the importance of innovation in diagnosis, treatment, and prevention. Observed annually on February 4, World Cancer Day has adopted the theme 'United by Unique' for the years 2025 through 2027, to promote a people-centered approach to cancer care.
In the lead-up to World Cancer Day 2025, four doctors from Aster Medcity gathered for an insightful panel discussion hosted by The Times of India. The participating doctors were Dr Arun Warrier, senior consultant, medical oncology; Dr Jem Kalathil, senior consultant, surgical oncology; Dr Durgapoorna, senior consultant, radiation oncology; Dr Deepak Charles, consultant, hemato-oncology; all from Aster Medcity. As part of the Times Conversations series, the event aimed to bring together experts to discuss the latest in cancer care, highlighting the widespread impact of cancer on society.
incidence
Reacting to a recent report that indicated a steady increase in the incidence of cancer in Kerala, the doctors began by saying that the growing numbers can be attributed to lifestyle changes, particularly the westernisation of diets. Dr Durgapoorna said, "Factors such as smoking also play a significant role—when discussing preventable cancers, to***co use is always a key concern. In India, public smoking has been banned for over 15 years, leading to a decline in smoking rates. However, those who smoked before the ban was put in place are now showing cancer symptoms."
She also mentioned that people are dying at a lesser rate from other complications, in turn, presenting cancer as a major cause of death. "Additionally, fewer people are dying from other diseases, and life expectancy has increased overall. The average Malayali is now expected to live up to 80 years. With age, the likelihood of accumulating genetic mutations also rises, contributing to the higher incidence of cancer," she said.
# Detection and screening
Her colleague, Dr Warrier added that increased diagnostic activity will, no doubt, drive numbers up, but considered this to be a positive indicator. "There is significantly more diagnostic activity happening today, meaning the cancer was always present—we are simply detecting it more often. In a way, this can be seen as a positive development, as conditions that once went unnoticed are now being identified and addressed."
Using the example of colorectal cancer screening, Dr Warrier said, "When it comes to colorectal cancers, one major issue is that people are not undergoing colon screening, even though it is easily available. These cancers develop slowly over time, which is why, in the West, everyone is advised to have a colonoscopy at age 50. In terms of symptoms, some individuals may feel a persistent sensation in their stomach but choose to ignore it. If such a sensation lasts for more than one to two weeks, they should consult a doctor. Re**al bleeding is another common symptom, but many dismiss it as piles and self-medicate instead of seeking medical attention. Additionally, fear of the procedure itself is a barrier. Since screening requires inserting a scope into your body, many people avoid these tests because of an irrational fear of the scope." Dr Kalathil re-emphasised the importance of screening, he said, "Screening will help nip cancers in the bud, reducing the need for complex treatments and even preventing the need for surgery. By inserting a scope, doctors can remove polyps before they develop into cancer. The key message that needs to be emphasised is that screening can prevent cancers, not just detect them".
As emerging possibilities with AI are being increasingly being explored across various fields, cancer detection and care is no exception. “Medical professionals will not lose their jobs to AI tools; rather, they will lose their jobs to the ones who know how to use the AI tools,” said Dr Durgapoorna, “Just as computers once revolutionised various fields, AI is now poised to do the same. However, AI for cancer detection is still in its infancy.” Dr Kalathil added, “There are numerous trials ongoing, with at least one AI-related project being worked on every week”.
right treatment
Another concern that he spoke gravely about was the danger of flawed initial treatment, explaining that once the initial protocol was fumbled, the disease would progress rapidly. "Take breast cancer, for example—if a patient undergoes surgery to remove a lump in an unplanned or improper manner, it can lead to complications. To prevent such issues, it's crucial for the patient to consult a specialist such as an oncologist, who can ensure the treatment is properly planned and executed," said Dr Kalathil.
Building on the need for precise and well-planned treatment, Dr Warrier highlighted advancements in tumour management, sharing how early detection and evolving therapies, including targeted treatments and immunotherapy, were improving patient outcomes. He said, “We are now able to detect tumors earlier and treat them with less radiation, though traditional radiation therapy remains effective. Targeted therapies, enabled by next-generation sequencing, help address tumor mutations by using drugs that block specific mutations. These treatments have been available for the past five to ten years, but they can be prohibitively expensive. This is where immunotherapy comes into play. Unlike targeted therapy, immunotherapy works by enhancing the body's immune system to fight cancer. As a result, we are now seeing cases where even stage-4 lung cancer patients are achieving remission.”
Parallelly, significant progress is seen in lymphoma care, where emerging cellular therapies like CAR-T are transforming outcomes for patients with treatment-resistant disease, according to Dr Deepak Charles. “Lymphomas are a specific type of blood cancer, where conventional treatments that primarily rely on chemotherapy, still hold good. Radiation therapy also plays a role, depending on the case. The major advancements in treatment are in the field of cellular therapy, particularly CAR-T therapy. This approach is especially useful for lymphomas that are infractory to chemotherapy and relapse one or two years after initial treatment, requiring further intervention. Cellular therapy offers a promising solution in such cases,” said Dr Charles.
is evolving
Technological advancements are also shaping modern surgical approaches, with a strong focus on organ preservation and minimising surgical trauma while maximising effectiveness. Dr Kalathil outlined that the trend is shifting towards breast preservation, limb conservation, and less mutilating procedures. Robotics has enhanced surgical precision, allowing for better outcomes.
“Previously incurable conditions are now being managed with advanced techniques like complete cytoreduction, hyperthermic intraperitoneal chemotherapy (HIPEC), and pressurised intraperitoneal aerosol chemotherapy (PIPAC) for abdominal cancers in areas beyond reach. These methods now help control cancer in 50 to 60 percent of patients. Surgical advancements now range from super-radical procedures to conservative approaches, with technology bridging the gap to improve results and cosmetic outcomes,” said Dr Kalathil.
Expanding on what one can expect out of robotic surgery and its points of variance from manual surgery, he shared, “Minimally-invasive surgery is now well-established, but robotic surgery offers distinct advantages over traditional laparoscopic techniques, particularly in sites such as the lungs and chest. Since the surgeon is working around areas that contain vital organs, nerves, and blood vessels, robotic systems provide them with greater precision and control. However, the difference between a highly skilled laparoscopic surgeon and a robotic surgeon is not much. Yes, robotic surgery does have an edge in reducing post-operative pain and the duration of hospital stays. The main challenge is that many insurance providers do not cover these procedures, denying patients access to essential treatments. Expanding coverage for robotic surgery is crucial, as these are not just advanced options but vital treatments.”
struggles
The question of insurance remains a persistent challenge in cancer management for nearly all stakeholders. While insurance does cover most standard treatments, there are significant gaps, particularly when it comes to medication. Dr Warrier, paints a picture of this. “Chemotherapy is generally covered, but targeted therapies like Trastuzumab, used in breast cancer treatment, are sometimes denied. Even when a patient is eligible and the drug is approved by regulatory agencies, insurers may still refuse coverage. This is a major issue, as some of these drugs are extremely expensive. Despite being recognised as essential treatments, the lack of coverage can place a significant financial burden on patients,” he said.
misconceptions
Dr Durgapoorna and Dr Warrier also discussed several misconceptions regarding radiation therapy, such as- is it contagious? “Many people ask if it is safe for the patient to go home and interact with family members. I explain that while small children should not be brought into the LINAC console, it is otherwise perfectly safe. There is also concern about pain from radiation, but typically, there is no pain. However, in areas with mucosal membranes, such as the head and neck, patients may experience some discomfort. Otherwise, radiation therapy is generally painless,” said Dr Durgapoorna. “As for chemotherapy, not all patients will lose their hair. Newer treatment protocols, such as immunotherapy, often do not cause hair loss," said Dr Warrier.
On the topic of immunotherapies, CAR-T treatments are particularly notable, observed Dr Charles. “What we do in this process is extract the patient’s cells, modify them, and then reintroduce these modified cells to fight cancer cells. This involves a type of genetic engineering, and it can also help prevent future relapses,” he said. They are administered in treating childhood cancers, most of which involve hematological or blood-related cancers, particularly lymphoblastic leukemia.
“The good thing is that with current treatments, these cancers are almost entirely curable, which is very reassuring for families. Pediatric cancer treatment differs from adult cancer treatment due to the distinct biology of the disease in children. However, the positive aspect is that some of the protocols we use for children have also been applied in adult cancer treatment,” said Dr Charles.
treatment
“When determining treatment for different cases, there are general guidelines and standard treatments available. However, it’s important to recognise that each patient is unique, and treatments must be personalised. Personal choices also play a significant role, which we, as doctors, must respect,” claimed Dr Durgapoorna. Regarding personalised treatment, there are specific techniques being developed. “One area of focus is the use of AI in analysing CT-DNA, where small fragments of DNA are extracted to help detect potential secondary stages of cancer. By identifying and reading these small DNAs, doctors can potentially prevent relapses which occur suddenly. For instance, a patient with breast cancer might be fine for three to four years, only to suddenly find that the cancer has spread extensively,” said Dr Warrier.
care
In alignment with the theme United by Unique, there is increasing recognition that patients are individuals with psychological, and other needs, that need to be addressed.
“In Kerala, a crucial area that requires improvement is psychological support for patients,” said Dr Kalathil, “A psychologist needs to engage with patients before and after surgery, as well as before and after chemotherapy, helping them mentally prepare for treatment. Counseling is especially important for families, guiding them on how to care for and support the patient at home.”
Standardised scales such as patient-reported outcome measures (PROMs) have been developed to help assess the impact of treatment on a patient's quality of life. Dr Warrier said, “As healthcare becomes more data-driven, these tools provide objective insights. Patients complete the assessments themselves, and the reports are analysed by a dedicated team before being conveyed to doctors. Since oncologists may not have the capacity to gather such extensive data in routine practice, PROMs help bridge this gap while also encouraging patients to take more ownership of their recovery”. Dr Kalathil added, “Palliative care is also integrated early on in the treatment process, not just for end-of-life care. Its role evolves over time, providing continuous support to patients, especially if their condition worsens. This creates a significant gap in addressing the palliative and psychological needs of cancer patients, highlighting the importance of a more holistic approach to their care.”
There is a lot of fear surrounding screenings, fuelled by social media and other sources, with people worried that if something cancerous is found, they will face numerous challenges and that their lives will never be the same. The message that needs to reach people is that screening is intended for those without symptoms, to identify potential issues before they develop into cancer. This proactive approach is meant to prevent the need for cancer treatment in the future. Unfortunately, many people are unaware of this. For example, some women with breast cancer avoid mammograms and only return to the doctor after two or three years when their cancer has considerably worsened
! Dr Jem Kalathil, senior consultant, surgical oncology
There is significantly more diagnostic activity today, meaning the cancer was always present—we are simply detecting it more often. In a way, this can be seen as a positive development, as conditions that once went unnoticed are now being identified and addressed
! Arun Warrier, senior consultant, medical oncology
When determining treatment for different cases, there are general guidelines and standard treatments available. However, it’s important to recognise that each patient is unique, and treatments must be personalised. Personal choices also play a significant role, which we, as doctors, must respect
! Dr Durgapoorna, senior consultant, radiation oncology
The good thing is that with current treatments, childhood cancers are almost entirely curable, which is very reassuring for families. Pediatric cancer treatment differs from adult cancer treatment due to the distinct biology of the disease in children. However, the positive aspect is that some of the protocols we use for children have also been applied in adult cancer treatment
! Dr Deepak Charles, consultant, hemato-oncology
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