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SCIENCE

An incomplete healing
Rohit P.S. SEPTEMBER 30, 2018 00:02 IST
UPDATED: SEPTEMBER 29, 2018 22:50 IST

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Inadequate facilities for reconstructive

surgery and limited staff are affecting
cancer treatment in government hospitals

E ight-year-old Syed Farhan from

Warangal, Telangana was diagnosed earlier
this year with Ewing’s sarcoma, a rare type of
cancer that occurs in bones or in the soft
tissue around the bones. He then underwent
six cycles of chemotherapy, to have an
aggressive tumour in his right tibia shrunk
just enough for surgical resection.

Prohibitive costs

More than a month after his chemotherapy

concluded at a private health institution, the
boy has not undergone surgery to remove the residual growth, which may fuel the
disease’s spread. His family is deterred by the cost which is not covered under
Telangana’s health-care insurance meant for below poverty line families.
Reconstruction with an expandable implant, to suit the growing limbs of a child,
followed by tumour resection, can cost over ₹6 lakh. The family plans to get further
treatment at the State-run Regional Cancer Centre (RRC), while attempting to raise
funds only for the implant, but it may have to wait long for surgery.

Farhan’s plight is shared by many cancer patients who cannot avail of appropriate
timely reconstruction surgeries in private health care due to the cost and in turn
have to look to public institutions. However, the absence of dedicated plastic surgery
departments or limited staff where they do exist, results in an inordinate delay at
RRCs.

“We have one dedicated specialist now but the wait [for] to avail complex
reconstruction surgery due to a large patient load at the hospital can get long. The
demand for plastic surgeons specialising in onco-reconstruction is only set to rise
given the burden of head and neck cancers on the country’s healthcare,” says Dr.
Arvind Krishnamurthy, Professor and Head of Surgical Oncology at Cancer Institute,
Adayar, Chennai. Head and neck cancers constitute over a third of all cancers in
India.

Need for reconstruction

Cancers of breast, skin and soft tissue, and those of the lower limbs also require
reconstruction. Resection without reconstruction could severely alter a patient’s
appearance besides robbing them of function or, as in Farhan’s case, leaving him
partially disabled.

The Kidwai Memorial Institute of Oncology in Bengaluru, another RRC, makes do

with surgical oncologists doubling up as reconstructive surgeons, performing
simple skin and tissue grafting. More complex procedures such as jaw- and tongue-
reconstruction, micro-vascular and breast reconstructions are not undertaken.

“For a year we had a plastic surgeon but now we do not have a specialist. Such
specialists shift to work in the private sector after gaining some experience due to
higher pay and a smaller patient load,” says Dr. Rajashekar Halakud, who heads the
Head and Neck wing in Surgical Oncology at the hospital. The hospital can now only
cater to half the total patient pool requiring reconstruction.
The M.N.J Institute of Oncology (MNJIO) in Hyderabad, one of the country’s 27 RCCs
and one of the two to have a reconstructive surgery department, annually performs
nearly 150 reconstruction surgeries, many delayed. Often, reconstruction is
recommended immediately after resection. Delay in the availability of specialists
can also delay tumour resection.

A footnote

“Major reconstructive surgeries are expensive procedures in private health care.

Governments should take responsibility and set up reconstructive oncology
departments, besides surgical oncology, in all institutes. That apart, under state
health schemes such as Aarogyasri and Ayushman Bharat, the importance of these
procedures is not adequately recognised,” says Dr. B. Mani Kumari, former head of
the Plastic and Reconstructive Surgery Department at MNJIO.

Marathon reconstruction procedures such as micro-vascular reconstruction earn

private hospitals at the most ₹45,000 under health insurance schemes. Doctors in
the private sector view this as inadequate compensation for such surgeries.

Dr. Krishnamurthy adds that private institutions see only a fraction of patient
numbers that regional centres see. However, medical tourism and patients who can
pay make up for the lack of big numbers.

He feels there is a need for greater recognition by governments of the skills of

surgeons performing complex oncology reconstructions especially in the context of
increasing cases of cancers being diagnosed in the country. He also emphasises the
point that rigorous training of surgeons is more important than hiring or setting up
more institutions.

rohit.ps@thehindu.co.in

Printable version | Oct 15, 2018 10:54:10 PM | https://www.thehindu.com/sci-

tech/science/an-incomplete-healing/article25084427.ece

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