Healthcare - Oral Cancer Task Force

On the occasion of World Cancer Day, 4 February 2018, an independent Oral Cancer Task Force was launched to develop a strategy for oral cancer control in India over the next decade. The task force is working towards designing of a national, cost-effective, patient-centric and sustainable oral cancer control program. The multidisciplinary task force is comprised of leading specialists who are contributing their expertise to address the burden of oral cancer.

Task Force Members:

  1. Dr Kiran Mazumdar-Shaw (Convener)
    Founder & Managing Trustee, Biocon Foundation
  2. Dr G K Rath
    Chief, Dr. B R Ambedkar Institute Rotary Cancer Hospital, Professor of Radiation Oncology & Head, National Cancer Institute, AIIMS, Delhi
  3. Dr Pankaj Chaturvedi
    Professor and Head & Neck Cancer Surgeon, Tata Memorial Hospital, Mumbai
  4. Dr Moni Abraham Kuriakose
    Director, Cochin Cancer Research Centre
  5. Dr Kumar Prabhash
    Professor, Medical Oncologist, Tata Memorial Hospital,
  6. Dr Vijay Chandru
    Chairman, Strand Life Sciences, Bengaluru
  7. Dr Praveen Birur
    Professor & Head of Oral Medicine and Radiology, KLESIDS, Bengaluru, Lead - Oral Cancer Program, Biocon Foundation
  8. Dr K Govind Babu
    Senior Medical Oncologist at Kidwai Memorial Institute of Oncology, Bengaluru

Mission Statement: To ideate, educate and engage stakeholders, thereby effectively downstage oral cancer in India over the next decade.

Terms of Reference of the Task Force:

  • Create a master plan leveraging technology and partnerships
  • Develop a framework for operational control and impact measurement
  • Establish relevant benchmarks and reference points through primary and secondary research
  • Synchronize oral cancer control efforts with the broader national cancer control program
  • Enhance and update skills of healthcare professionals
  • Establish an environment that reduces the risk factors (tobacco, alcohol, areca nut, HPV) through policy change and public awareness
  • Strengthen the National Cancer Registry and surveillance systems
  • Map tertiary centres and provide linkages to care

Objectives of the Task Force:

  • Design, implement and show proof of concept to downstage oral cancer
  • Assist in policy decision using research evidence
  • Form guidelines and recommend best practices
  • Strengthen the healthcare delivery in India
  • Bring in new innovations and translational research
  • Skill enhancement of healthcare professionals

The Three Areas of Engagement:

  1. Prevention
  2. Management
  3. Research

1. Primary and Secondary Prevention Strategies:
Primary Prevention

  • Awareness and education programs through mass media and last mile reach
  • Tobacco de-addiction, behavioral nudging
  • Promotion of oral self-examination and healthy lifestyles
  • Engage universities for teaching curriculum on oral cancer
  • Develop training modules
  • Organize workshops on prevention of oral cancer for dentists
  • Involve other scientific organizations for oral health promotion

Secondary Prevention

  • Use of mobile device-based electronic data capture (mEDC) and monitoring of high-risk groups.
  • Engage and empower frontline healthcare providers for oral cancer screening
  • Empower Nodal Centers, PHCs and CHCs to reduce load at tertiary centers
  • Strengthen linkages and referrals to care
  • Support to maintain cancer registries
  • Evaluation and monitoring under the aegis of external observers

2. Management – Provision of Affordable & Quality Care

  • Mapping of centers across India for efficient referral system
  • Day care/Palliative care – hospice approach

3. Translational Research

  • Translation of research from bench to clinics

National Health Service (NHS) Guidelines:
Independent taskforce to develop a five-year strategy for cancer services. The taskforce is charged with delivering the vision set out in the NHS Five Year Forward View, working across the entire health system. It will consider prevention, first contact with services, diagnosis, treatment, support for those living with and beyond cancer, end-of-life care, the research environment, as well as how all these services will need to develop and innovate in the future.
Even with major improvements in prevention, the number of people diagnosed with cancer will continue to grow rapidly due to the ageing population. This will place significant additional demand on health and social care services.

Expected Outcomes:
To decrease prevalence of oral cancer by 10% and stage migration by 50% in the next five years.

Training workshops conducted by Biocon Foundation under the auspices of the OCTF:
1. Head and Neck Cancer Training in association with National Health Mission, Uttar Pradesh
As a first step to reduce the burden of oral cancer in Uttar Pradesh, Biocon Foundation organized a “Head and Neck Cancer Training Program” for the doctors in association with National Health Mission (NHM), on 14th July 2018, in Lucknow and on 22nd October 2018 at Varanasi, UP. The session was attended by around 150 doctors. The workshop was inaugurated by Dr. Amaresh Singh (DGM, NCD Cell, UP) and it was conducted by experts in the field like Dr. Pankaj Chaturvedi (Head & Neck surgeon, TMH, Mumbai), Dr. Arjun Singh (TMH, Mumbai), Dr. Naven Khargekar (HBCH, Varanasi), Dr. Shaleen Kumar (SGPGI, Lucknow), Dr. Gaurav Gupta (RML, Lucknow), Dr. Swagnik Chakrabarti (HBCH, Varanasi) and Dr. Praveen Birur (Lead- Oral Cancer Program, Biocon Foundation, Bengaluru.
2. Head & Neck Cancer Training in collaboration with National Health Mission, Assam
To build the capacity to curb the high prevalence of oral cancer in Assam, two training workshops were carried out for the dentists and specialists on use of technology for early diagnosis, management and referral of head and neck cancer, on 18th August 2018 and 01st September 2018, in fellowship with National Health Mission at B. Borooah cancer institute, Guwahati, Assam. Training was imparted by Dr. Pankaj Chaturvedi (Head & Neck Surgeon, TMH, Mumbai) and Dr. Praveen Birur (Lead- Oral Cancer Program, Biocon Foundation, Bengaluru).
3. Oral Cancer Awareness on the occasion of Head and Neck Cancer Day at Rashtrapati Bhavan, New Delhi
An educative talk was organized to mark the Head and Neck Cancer Day at Rashtrapati Bhavan, New Delhi on 27th July 2018. Dr. Moni Abraham Kuriakose (Director, Cochin Cancer Research Centre) and Dr. Praveen Birur (Lead- Oral Cancer Screening, Biocon Foundation) addressed around 150 delegates about early detection and management of oral cancer, associated risk factors and oral cancer self-examination.
4. Workshop for 38 NCD coordinators of tobacco cessation cell, 18 Districts of Karnataka in association with NHM and NCD cell (31st October 2018).
5. Head & Neck Cancer Workshop at Cochin Cancer Research Centre (CCRC), Kochi for 150 medical oncologists, surgeons, dentists and specialists in association with NHM, NCD cell, conducted by Dr. Moni Abraham Kuriakose (Director, CCRC) and Dr. Praveen Birur. (16-17th November 2018)
6. Training Program for 20 PHC Medical Officers and 16 Staff Nurses, 6 Districts of Karnataka. Hands-on training for cervical, breast and oral cancer screening program as per NICPR guidelines. (5-6th December 2018)
7. State level training program for 66 doctors at Directorate of Health and Family Welfare, sec 34 A, Chandigarh, in association with National Program for Prevention and control of Cancer, Diabetes, Cardiovascular (NPCDCS) Punjab and Tata Memorial Centre. (11th January 2019)
8. Workshop at Prayagraj, UP in association with Tata trust, Tata memorial hospital, Indian dental association for 70 doctors, dental surgeons and dental hygienists. Deployment of mobile health (mHealth) technology for early diagnosis of oral cancer at Kumbhmela. (12th January 2019)
9. Training program for dentists in association with NCD cell, Karnataka in convergence with National Tobacco Control Programme (NTCP) and National Oral health Programme (NOHP). (25th January 2019)

Screen and Treat Programs

  • Rashtrapathi Bhawan, New Delhi
  • South Western Railway Hospital, Bengaluru
  • Group D employees, KLESIDS, Bengaluru
  • Screening for Breast, Cervical and Oral Cancer. Pourakarmikas (City Corporation SWM staff), West Zone, Bengaluru

Expert Committee Meeting – Indian Practice Guidelines on the management of Head & Neck Cancer, Bengaluru (19th January 2019)

Media Report :
Cancer Task Force recommends guidelines for Cancer Care
Bengaluru, 4th February 2019: The Oral Cancer Task Force, an expert committee comprising leading oncologists from all over India met to present their recommendations to create guidelines for the management of Head and Neck Cancer. The recommendations were arrived at to mark the occasion of World Cancer Day, on February 4th, 2019.
Head and Neck Cancer, which includes oral cancer has been a major public health issue in India for several decades. Speaking at the meeting, the Convenor of the task force and, Founder and Managing Trustee of Biocon Foundation, Dr. Kiran Mazumdar-Shaw said, “Given that a third of oral cancer cases in the world are reported in India, it is a huge opportunity for our country to be at the forefront, both in the areas of policy-making and therapeutic innovation. We should not be restricted to the low end of the spectrum but go beyond, to research in epidemiology, genetics and all that goes with diagnosis and treatment. We should aspire to achieve the best outcomes for Head & Neck cancer with new discoveries coming out of translational research, technologies and approaches like bio-specific antibodies and checkpoint inhibitors to drive best possible treatment. Our aim should be to move from cancer care to cancer cure.”
Although, there are global guidelines for the management of Head and Neck Cancer, India with its huge Head and Neck Cancer burden has several demographic and genetic peculiarities, which require focus and specific therapeutic guidelines. The objective of the meeting was to identify optimal treatment for head and neck cancer, based on existing evidence on best outcomes among Indian patients.
Dr. G K Rath, Head, National Cancer Institute, AIIMS, the Chair of the meeting said, “Every patient has the right to receive ideal and optimal care, and healthcare should be made accessible to all. We should be able to offer both the ideal and optimal approaches to our patients.”
This consortium of 24 eminent oncologists, also included Dr. Pankaj Chaturvedi and Dr. Kumar Prabhash, from the Tata Memorial Hospital, Mumbai, Dr. K Govind Babu, Kidwai Memorial Institute of Oncology, Bengaluru and, Dr. Munish Gairola and Dr. Manish Singhal from Delhi.
Dr. Kumar Prabhash, spoke about the need for having India specific guidelines. He said, “There are no India specific guidelines for the management of head and neck cancer, what we follow are western guidelines. There is a need for developing our own India specific guidelines.” His colleague from the Tata Memorial Hospital, Dr. Pankaj Chaturvedi added, “While addressing India specific needs, there are still many unanswered questions and research should be encouraged. We should pursue those research proposals actively and be at the forefront of research in the global space.”
Meanwhile, Dr. Govind Babu, spoke about tobacco use in India and stressed on the importance of creating awareness, early screening and diagnosis for optimal treatment. “While having the consensus on management of head and neck cancer is of utmost importance, it is equally demanding to focus on prevention and early detection. All stakeholders need to participate in spreading awareness and saying no to tobacco,” he said.
The Oral Cancer Task Force has laid down recommendations for the management of head and neck cancer to help physicians and patients in establishing the best healthcare solutions for patients in India.