Evidence supporting innovative cancer care delivery model for overcoming health disparity.

Dinesh Pendharkar Sarvodaya Hospital, Faridabad, Delhi, India info_outline Dinesh Pendharkar, Chandramauli Tripathi, Kalpana Srivastav, Uttam Kumar, Ashok Kumar Nagar

Authors Dinesh Pendharkar Sarvodaya Hospital, Faridabad, Delhi, India info_outline Dinesh Pendharkar, Chandramauli Tripathi, Kalpana Srivastav, Uttam Kumar, Ashok Kumar Nagar Organizations Sarvodaya Hospital, Faridabad, Delhi, India, District Hospital, Ujjain, India, Mahatma Gandhi Government Hospital, Bhilwara, Rajasthan, India, Govt District D B Hospital, Churu, India, District Hospital, Jhalawar, India Abstract Disclosures Research Funding No funding received None. Background: Disparity in cancer care is the biggest challenge faced by the health systems. The solution could be brought out by new models of service delivery. To mitigate the challenge, an innovative district cancer care model was launched across 6 states of India. A cancer care unit has been established in government district hospitals, which constitute pivot of health systems in all low- and middle-income countries of the world . It assists cancer patients in complete care continuum from diagnosis to end of life care. Here, we report how a district cancer care model (Pendharkar model) proved its validity during the covid pandemic, by providing relentless cancer care, when specialized cancer services were paralyzed in the country. Methods: Patient data were collected from four government district hospitals of Ujjain (Madhya Pradesh) Bhilwara, Jhalawar and Churu (Rajasthan), over three years, including period of Covid pandemic and lockdown. The numbers were analyzed for attendance in outpatient and inpatient services, numbers of chemotherapy sessions administered, from January 2019 to December 2021. Standard statistical calculations were done. Results: A total of 4873 new patients were registered in the cancer units (1614,1678,1581 per year), over the period of three years: 2019, 2020, 2021. Annually, there were 695,643 and 609, new patients registered in the Ujjain district, 190,252 and 204 in Churu, 349. 276.and 276 in Jhalawar, and 380,507 and 442 in Bhilwara. Over a three-year period, there were 37183 outpatient visits in total (11416, 13665, and 12102 in 2019, 2020, and 2021 respectively). The number of inpatient admissions were 18593 (5047,7077,6469 respectively). A total of 17639 sessions of chemotherapy were performed during this period (5133,6361,8745 in 2019, 2020, and 2021 respectively). The data showed no change despite pandemic lockdown. Conclusions: Utilization of outpatient and inpatient services, as well procedures rendered, did not change despite covid and lockdown in caner units of government district hospitals. The data clearly demonstrates the robustness and resilience of this health care model of system strengthening, using alternate oncology workforce, task sharing and capacity building. It worked equally efficiently in different parts of India and maintained its effectiveness even during pandemic, when complete collapse of healthcare was noticed around the world. The oncology societies and international organizations could take more interest in analyzing and improving this delivery model, which has immense capability of reducing health disparities. Activity level of district hospitals in the year 2019, 2020, 2021. Activity District 2019 2020 2021 New Patients Registered Ujjain 695 643 609 Churu 190 252 204 Jhalawar 349 276 276 Bhilwara 380 507 492 Number of Outpatient visits Ujjain 4255 5336 4214 Churu 1982 1979 1700 Jhalawar 1993 1259 1779 Bhilwara 3186 5091 4409