Cancer Care in India

Oct 29, 2013

An Interview with Monica Malik, MD, DNB

  Monica Malik, MD
: Nizam’s
Institute of Medical Sciences
Specialty: Palliative care
Member since: 2005

The International Development and Education Award (IDEA) and Leadership Development Program (LDP) are ASCO initiatives aimed at expanding oncologists’ knowledge and skills through training and relationship building. Monica Malik, MD, DNB, of Nizam’s Institute of Medical Sciences, in Hyderabad, India, has participated in both and discusses her experiences with ASCO Connection.

AC: How would you describe the current state of palliative care in India?

Dr. Malik: The burden of cancer in India is enormous, and it is steadily increasing in magnitude. It is estimated that around six million people need palliative care at any given time, whereas only 2% of these patients actually have access to it. However, this scenario is gradually changing due to the dedicated efforts of a small group of crusaders. In Kerala, a small state in India where only 3% of its population resides, almost 90% of the population has access to palliative care services. This provides a shining example to demonstrate that, with a strong commitment, effective care is possible in resource-limited settings.

AC: What led to your interest in palliative care?

Dr. Malik:
My interest developed as I read the Oxford Textbook of Palliative Medicine during my residency. The book provided an insight into the vast divide between the available evidenceand current practice in the care of terminally ill patients. Palliative care education is lacking in the medical and paramedical community in our country, with no emphasis or structured curriculum. Even in the palliative care clinics, the major focus is on symptom management, and psychosocial aspects are rarely if ever addressed. The concept of active total care of the body, mind, and spirit with the aim of enhancing the quality of life for patients and their families is what attracted me towards pursuing this field.

AC: You recently were selected to participate in ASCO’s Leadership Development Program (LDP). What will be your focus?

Dr. Malik:
I am honored to be selected to participate in the LDP and work with the other participants and mentors. Our group is focused on how best ASCO can leverage its educational portfolio to maximize the impact of its quality improvement initiatives. We are looking at this from an international perspective as well. 

AC: How do you hope to use this leadership opportunity to further the development of care in India?

Dr. Malik:
Cancer care in India presents some unique challenges, including overpopulation, scarcity of resources, widespread use of tobacco, illiteracy, lack of sanitation, geographic and psychosocial diversity, etc. The magnitude of the problem warrants herculean efforts in the areas of preventive oncology, including health education and awareness, improving the quality and coverage of screening programs, and increasing the availability and affordability of comprehensive cancer treatment. I strongly believe that improving the quality of education in oncology and palliative care through positive changes in national education policy and the curriculum would lead to a long-term, sustained improvement in all aspects of oncology, including prevention, treatment, and research. Successful cancer control warrants implementation of effective strategies on a large scale, and the LDP offers the unique advantage of learning how to effectively facilitate this transformation.

AC: You are also a past recipient of the ASCO International Development and Education Award (IDEA). What impact did that have on you?

Dr. Malik:
Receiving the IDEA in Palliative Care (IDEA-PC) was immensely helpful in creating awareness about the need for palliative care in my institute and country. It stimulated interest on the subject among my colleagues and coworkers. This helped me address various myths prevalent among providers and caregivers and garner support for integrating palliative care services into the routine oncologic care of patients. In addition to cancer treatment, our clinic offers services such as pain management, home-based care education, counseling sessions, followup consultation, and easy access to oral morphine.

These small steps have resulted in significant improvements. We have also initiated various research protocols and formulated questionnaires with the aim of assessing the needs of our patients. Empowered by the ASCO IDEA-PC program and the support of my colleagues, we are planning to start a dedicated palliative care unit at our institute.

AC: How can organizations such as ASCO support cancer care in your region?

Dr. Malik:
ASCO has a fairly large membership in India and is well recognized in our country as the largest network of global oncology professionals. The ASCO meetings, journals, and guidelines have a wide outreach in India and are closely followed by many oncologists. Through its international education initiatives, ASCO is already addressing the unique challenges in cancer care in developing countries, and there are upcoming plans to conduct various training courses in India. The recently launched International Innovation Grant is aimed at supporting research specific to improving oncologic care in developing countries, and the IDEA awards provide global recognition and support to young oncologists. There is immense opportunity for oncology professionals in India to collaborate with ASCO with the goal of devising educational strategies and quality improvement measures tailored to address the challenges in our country.

AC: Is there anything else that you would like to share?

Dr. Malik:
The LDP and IDEA-PC programs have provided me with the unique opportunity to gain an understanding of oncologic care across the globe and network with oncologists from all over the world. Alongside glaring disparities, there are some striking similarities, the foremost being the challenge to provide cost-effective care without compromising quality. Another major area of concern is the global decline of ethical standards in health care. It was heartening to note that cancer care professionals across the globe recognize these issues and are keenly interested in devising strategies to address them. ASCO is uniquely positioned to facilitate collaborations and implement measures to solve these issues. A global group of highly committed professionals working towards common goals with the right support can truly make a remarkable difference.


Back to Top