Telemedicine and Cancer Care in India: Promises, Opportunities and Caveats

Figures & data

Table 1. SWOT analysis of use of telemedicine in India.

Strengths 1. India is a populous country where TM in the field of cancer could enhance reach of the healthcare professional to grass root level, i.e., rural pockets, which do not have easy access to tertiary level healthcare 2. TM can enhance virtual availability of oncologists of various streams, i.e., medical, surgical and histopathologists to a larger set of population in a developing country like India (where doctor patient ratios are lower than many countries) 3. Advanced cancer is a multisystemic disease which can give rise to emergency medical situations. Accelerated communications with the help of TM has the potential to save lives with the right prescription of the treating doctor within time 4. Wide application of TM can play a major role in prioritizing patient care

Weakness 1. There is an advancement in technologies every day, so TM usage needs to be updated with advancement of technology. This may be a challenge in India due to capital expenditure involved and recurring costs 2. Training and capacity building for correct usage of TM in India would be a challenge especially for a disease like cancer which needs specialised training 3. Connectivity with high speed internet at all times is a pre-requisite which is still a challenge faced in Indian rural set-ups 4. A tele medical consultation in the presence of an unknown technician who is facilitating the consultation may cause apprehensions regarding the authenticity of treatment offered/advised, especially in a conservative society with several languages and dialects 5. Sub-site-specific guidelines would be required for leading sites of cancer in India to enable diagnosis of correct anatomical site of cancer, e.g., head and neck cancers

Opportunities 1. Most of the cancers in India are diagnosed at locally advanced stage. TM provides a huge opportunity for early diagnosis, improve the quality of life and chances of survival of such advanced stage cancers 2. TMis the most economically viable option with wide usage of mobile devices & internet connectivity. Factors which can bring down cost are – travel costs by the patient and relatives to hospitals, infrastructure costs of hospitals i.e. disposables, bed linen usage, personal protection equipment (PPE), waiting spaces 3. Widespread use of TM gives an opportunity to downstage cancer in India. Earlier stages at detection and early initiation of treatment gives an opportunity to potentially cure cancer 4. In rural parts of the country, effectiveness of health system response maybe improved by linking TM with other modes of care delivery (e.g., supplies of medicines, involving Accredited Social Health Activists -ASHA)

Threats 1. There are situations where lack of clinical examination may miss out several important findings for a disease like cancer, i.e., pleural effusion which maybe elicited clinically can be missed out in a case of cancer lung 2. The linguistic disparities and firm socio-cultural beliefs followed in India may hinder wider implementation of telemedicine 3. Ethical issues may arise where prescription of certain analgesics is involved for advance stages of cancer through tele medical consultation 4. Patient consent needs to be ensured, electronic data protected and credentials of healthcare provider need to be verified for all teleconsultations