Journal of Cancer Research and Therapeutics, Vol. 5, No. 4, October-December, 2009, pp. 223-224
From 3D to 5D radiotherapy: A blitzkrieg of DTH!
ACTREC, Tata Memorial Centre, Navi Mumbai - 410 210
Code Number: cr09057
Surfing the waves of sustained economic growth and the growing confidence of the private health care sector in the last decade, the practice of Radiotherapy in India has made a rapid transition from 3D to 5D. At the beginning of the decade, 3 dimensional conformal Radiotherapy (3D CRT) was gaining foothold in major radiotherapy centres across India. Requiring only a modest infusion of technology, funds and training, the returns of sparing more normal tissues by shaping or conforming the radiation beams to the 3 dimensions of the tumour and target volume were impressive. But the real technology transition came to India in this decade with the installation of few dozen LINACs capable of delivering Intensity Modulated RT (IMRT). The last few years have witnessed the installation of at least a dozen machines with even greater precision achievable by incorporating the 4th dimension of real time organ or tumour motion (4D RT) and Image Guided RT (IGRT). For the first time, private health care sector surged ahead of publically funded academic centres in terms of acquiring high end technology and delivering some form of IMRT or IGRT to large number of patients. The newly acquired high end LINAC technology and specialized machines were more than a status symbol and became a critical element in the marketing strategy of new entrants as well as established corporate hospitals. The new world of radiation technology in India is witnessing tangential launch of knifes, arcs, tomos, gyros and robots in a crowded cyber space. Not to be left behind, less conspicuous variants of IMRT and IGRT technology are being promoted as ′the best machine′ or ′first in India′, ′first in western India′, ′first in this city′ or ′first in this part of the city′. One is reminded of how the crowning glory of Miss Universe and Miss World on Indian beauties had a trickle down effect of bestowing pride and some business opportunity on local talents like Miss Chandigarh and Miss Chembur. Not surprisingly, the market mantra of finding something different in ones machine or acquiring a machine with some difference and then going to the town with ′my machine is the best in….′ seems to be a successful business model.
Before the nuances of IMRT and IGRT could be understood and their indications for the clinical spectrum seen in Indian clinics could be firmed up, stories of their inappropriate use in various centres started gaining credence. In this state of technology flux and increasing use and misuse of overpriced IMRT and IGRT, the corporate health managers introduced the 5th dimension of radiotherapy - ′5D RT′. I have used the term 5th D for ′Direct to Home - DTH′ approach, akin to DTH Television with which we are getting familiar. In a country pregnant with talent hunts, reality shows and breaking news on hundreds of TV channels, DTH TV beamed the good, bad and ugly of TV directly into our homes in a tech savvy fashion which the local cablewallah could never do. But has DTH RT brought in the same quality, choice and value for money for the consumers of cancer care in the country? The DTH RT approach unleashed in the recent past has employed all forms of media including newspapers, popular weeklies, elite magazines, in flight magazines, bill boards, bus stops and even popular TV shows for unabashed advertisements which is sometimes in the garb of popular articles and interviews. The public and the professionals were struck with the loud and unambiguous message of how a new space age radiation technology would be the game changer in cancer management. Talking to my colleagues from different oncologic disciplines within and outside the Tata Hospital, I realized that many of us were concerned about the instant effect of this DTH blitzkrieg, with the public imagination going in an overdrive. The stories we shared ranged from parents wanting new age radiation technology to cure their child′s leukaemia without chemotherapy, anxious women wishing away surgery and chemotherapy for their breast cancer, octogenarians hoping to get rid of their football sized abdominal tumours and relatives of terminally ill patients wanting to switch over from homeopathy to this technological breakthrough. I suppose cancer victims have always nurtured such hopes and this advertising blitzkrieg only boosted their confidence to share it with their cancer specialists. Working on the psyche of the customer is time tested marketing mantra and seems to be doing the trick in selling very expensive cancer care. I am personally aware how the public demand and euphoria with DTH RT is making some corporate hospitals to redraw their technology shopping list and business plans to remain competitive.
I hope that the fraternity of oncologists would agree with me in drawing some of these conclusions. Firstly that hype cannot sustain hope for long, even for the ever so hopeful cancer victims. For hope to be converted into reality we need to generate evidence for clinical benefit of technology. While the responsibility of providing this proof rests primarily on those who acquire expensive technology in public funded hospitals, the private sector could play a crucial role in hastening the process of technology evaluation and public education. Secondly, the Indian corporate health sector must remind itself that the Indian consumer has proven it time and again that it is quality and cost conscious. This DTH blitzkrieg of technology breakthrough is unlikely to hold public imagination for long. The fear is that overpriced or inappropriate technology could still rule the roost with ingenious marketing strategies especially if the media is cleverly embedded in the promotional strategy. Lastly, it is the message for professional bodies and national agencies. Professional bodies such as the Association of Radiation Oncologists of India which holds annual scientific meeting and takes up issues for the welfare of fellow professionals could do a great service by timely responding to such DTH initiatives in the interest of our patients. One cannot imagine the chaos that could be created if encouraged by the public response to this DTH RT programme, similar initiatives are launched for the expensive new drugs or if our cancer surgeons start advertising like some of their plastic surgery colleagues do for cosmetic surgery. The cancer control programme and governmental agencies could perhaps take a leaf from this DTH blitzkrieg model and employ the same strategy and advertisement agencies to effectively convey the message of cost effective cancer prevention and early detection to the Indian public at large.
Copyright 2009 - Journal of Cancer Research and Therapeutics