Kerala Cancer Conclave
DAY 1 - SESSION 1
State of Kerala: Cancer Landscape
Kerala leads the nation in both the Human Development Index and the Sustainable Development Index. The State is often a trailblazer in health-related advancements and policies. Documenting cancer trends and accurately quantifying the cancer burden are essential steps in planning and improving oncology services across the country.
COMMON ISSUES
1) Rising Incidence of Cancer
Kerala is witnessing an alarming rise in cancer cases, according to government data. As per the Population-Based Cancer Registry (PBCR) published by the Indian Council of Medical Research (ICMR), the incidence of cancer is increasing by approximately 5% each year, necessitating urgent and coordinated interventions. At the Regional Cancer Centre (RCC) in Thiruvananthapuram—one of India's premier cancer care institutions—the number of new cancer cases increased from 11,191 in 2020–21 to 15,324 in 2022–23, marking a 36% rise in just three years. Additionally, review cases at the RCC surged from 1,50,330 to 2,42,129 during the same period—a 61% increase.
2) Inadequate Cancer Treatment Infrastructure
While many hospitals in Kerala offer cancer care, only a few are equipped to provide comprehensive treatment, including essential modalities such as radiotherapy. Radiation therapy is critical for treating prevalent cancers like cervical, breast and rectal cancer. Unfortunately, several centers lack advanced radiotherapy equipment that can minimise treatment-related side effects, resulting in greater physical and emotional burdens for patients.
3) Limited Access to Government Schemes in Private Hospitals
Although the government provides several financial support schemes for cancer patients—such as KASP, Medisep, RSBY and Ayushman Bharat—their availability and reach in private hospitals remain limited. Moreover, many of these schemes offer inadequate coverage for modern, high-cost therapies, leaving patients with significant out-of-pocket expenses.
4) Public–Private Divide in Healthcare Resources
A large proportion of patients continue to seek treatment in government hospitals due to affordability, despite long waiting times, overcrowding and less personalised care. This contributes to an unfavorable doctor-to-patient ratio and strains existing public healthcare resources. Reducing the cost of cancer drugs and diagnostics could encourage a more balanced patient distribution and improve resource utilization.
5) Underutilisation of Emerging Technologies for Data Management
Artificial Intelligence (AI) has immense potential in healthcare, especially for improving the accuracy and representativeness of health data. Integrating AI tools into cancer registries and hospital systems could enhance data collection and program implementation. Additionally, the state must invest in upgrading data labs in terms of both capacity and quality to ensure reliable health analytics.
6) Gaps in Public Awareness
Despite Kerala's highest literacy rates in the country, many cancer patients still present at advanced stages, likely due to factors such as social stigma, the painless nature of early tumours and fear of diagnosis. For example, breast cancer often manifests as a painless lump that could be detected early through self-examination, yet many women delay seeking medical attention. Community-based awareness campaigns and education initiatives can help address these challenges.
7) Aging Population and Shortage of Caregivers
Kerala's success in improving life expectancy has resulted in a significant rise in its elderly population. However, this demographic shift is compounded by the emigration of younger generations, leaving many older individuals without adequate caregivers. Given that cancer disproportionately affects the elderly, Kerala must proactively strengthen its support systems, infrastructure and policies to care for its aging population—who once formed the backbone of the State's development.
In summary, though Kerala leads in health indices, the rising incidence of cancer warrants urgent attention towards improving strategies for early detection, and more accessible healthcare facilities across the state. Importance of data collection and that too high quality data collection cannot be understated in this regard and these would be the key issues addresses in the first session of the Kerala Cancer Conclave.
DAY 1 - SESSION 2
Delivering Cancer Care Services: Challenges and Scope for Improvement
Cancer is undoubtedly one of the leading causes of morbidity and mortality in India. In spite of the recent advances in therapeutics and technology, the cancer burden in India remains high and continues to rise. Moreover, there exist significant regional disparities throughout the country with respect to cancer incidence and access to essential medical resources. Kerala, despite its commendable health indicators and high human development index, faces a multifaceted array of unique barriers in delivering optimal cancer care services. These challenges are a blend of socioeconomic, geographical and infrastructural factors.
The key hurdles are as follows:
Financial Burden and Affordability
This is probably the most significant barrier to cancer care services. Innovative therapies, diagnostics and long-term care create a substantial financial burden for patients and healthcare systems alike. Kerala has a high Out-of-Pocket Expenditure despite the government spending on healthcare. While government hospitals offer some treatments at subsidised rates or for free for economically weaker sections, access to targeted therapies or immunotherapy and advanced diagnostic tools in private facilities remains prohibitively expensive for many. The available insurance coverages are usually not sufficient enough to cover the entire spectrum of cancer care costs for all patients, especially those requiring prolonged or complex treatments
Awareness and Early Detection Gaps
A large number of patients in Kerala present with advanced-stage cancer. Despite a generally high awareness of cancer symptoms, actual screening rates for common cancers remain low. This is often attributed to fear of diagnosis, financial worries or a lack of proactive health-seeking behaviour until symptoms become severe. Misconceptions about cancer, including beliefs that it is incurable or a form of divine punishment are not rare. The stigma associated with certain cancers can also cause delay in seeking medical attention.
Geographical Disparities and Access
While Kerala has well-established cancer centers, these are concentrated in specific regions. Lack of specialised treatment centres, particularly in rural or underserved regions, has led to disparities in cancer care. Patients from remote or rural areas often face significant challenges in traveling long distances for diagnosis, treatment and follow-up. Although efforts are being made to establish early cancer detection centres and offer screening in district and taluk hospitals, a consistent and comprehensive network reaching every corner of the state is still developing.
Healthcare Infrastructure and Workforce
While the public sector provides a vital lifeline for affordable and often high-quality care, it struggles with capacity and waiting times. The private sector offers speed, comfort and access to the latest advancements, but at a prohibitive cost. There is a persistent shortage of highly specialised oncology professionals, including medical oncologists, radiation oncologists, surgical oncologists and trained oncology nurses, particularly in the public sector and in more remote areas.
Lack of Research and Monitoring
Though national data exists, a deeper understanding of Kerala-specific cancer epidemiology is crucial for targeted prevention and early detection programs. Lack of granular local research means we might be missing specific drivers of cancer in the state. Evaluating the effectiveness of existing cancer control programs, screening initiatives and treatment protocols and development of affordable diagnostic tools, treatment regimens and care delivery models in the context of Kerala is vital but often limited. Limited participation in local and international clinical trials means that patients in Kerala may have less access to cutting-edge therapies and diagnostic advancements that are still in the research phase. It also limits the generation of evidence relevant to the Indian population. Information asymmetry, fragmented care pathways and a lack of standardised protocols across different institutions can also hinder optimal patient management. There is also a lack of uniformly accepted and routinely collected quality indicators across public and private cancer care facilities. This makes it difficult to compare performance, identify best practices and hold providers accountable. Without standardised quality measures, it is challenging for hospitals and care providers to benchmark their performance against national or international standards, or even against each other. This limits opportunities for continuous quality improvement through peer learning.
Late Integration of End-of-Life Care into the Cancer Journey
While Kerala has made remarkable strides in community-based palliative care, particularly in making basic pain relief accessible, the lack of widespread integration of specialised palliative care early in the cancer journey and the inconsistent end-of-life services across all care settings remain significant barriers to providing truly comprehensive and compassionate cancer care. Strengthening these aspects is crucial for improving patient and family quality of life throughout the entire cancer experience.
Addressing these barriers requires a multi-pronged approach, focusing on strengthening healthcare infrastructure, increasing the oncology workforce and implementing comprehensive financial protection mechanisms to ensure equitable access to high-quality care. Investing in improved public health awareness, robust training programs for healthcare professionals, fostering inter-institutional collaboration and prioritising preventative care and screening initiatives are also crucial steps toward a more effective and equitable cancer care landscape. A strong research ecosystem coupled with rigorous quality measurement is required to understand the burden of cancer and to allocate resources efficiently. Ultimately, this would help to improve the outcome and quality of life of those affected by cancer in Kerala.
DAY 1 - SESSION 3
Use and Misuse of Media in Cancer Control Efforts
This session will critically examine media's powerful, yet delicate, role in India's fight against cancer. It will explore how media acts as a vital catalyst, successfully raising awareness, destigmatising the disease and bridging the gap between science and society through national campaigns and celebrity disclosures.
However, the session will also confront the dangerous pitfalls: from TRP-driven sensationalism, 'media trials' undermining trust, and the promotion of unscientific 'cures' often fueled by political agendas, to unethical collaborations with industries producing carcinogens that contradict prevention efforts. It will define the crucial ethical boundaries media must not cross, such as disclosing patient identities without consent or speculating on outcomes.
Finally, the discussion will propose collaborative strategies including medical literacy training for journalists, joint regulatory guidelines, proactive health media cells, and real-time myth debunking by experts and NGOs. It will also address AI's double-edged sword—its potential for personalised awareness versus its misuse to amplify fear. The session will underscore that media, like medicine, holds the power to heal or harm, urging for ethical practices, trusted partnerships, and an unwavering prioritisation of public welfare over sensationalism and profit.
DAY 1 - SESSION 4
SWOT of Pharmaceuticals in Cancer Care
Relevance
India has a growing population and rising cancer incidences. Indian pharma companies are world-renowned for producing generic cancer drugs at lower costs, increasing access both domestically and globally.
Concerns
While India is a major player in the global generics industry, concerns have emerged in areas related to quality, regulation, ethics and global competitiveness. Though physicians use generic drugs, there are doubts over the bioequivalence standards. There are systemic challenges that raise questions about consistency, oversight and transparency, especially for drugs sold in the domestic market.
Unlike small-molecule generics, biosimilars are far more complex to manufacture and regulate due to their biological origin and inherent variability. India's regulatory framework for biosimilars is still developing. The current guideline is more aligned with global norms, but interpretation and enforcement vary. This is of specific significance for oncology since many of the new therapies are biologics and regulatory issues are directly affecting the entry of biosimilars, which can reduce costs for patients.
Biosimilars, unlike generic drugs, cannot be approved based on chemistry alone—they require robust clinical evidence to establish similarity in safety, efficacy, and immunogenicity to the reference biologic. India's regulatory body insists on comparative clinical trial data of Indian patients, however, clinical trials face a unique set of challenges that significantly affect the country's research ecosystem, innovation potential, and global participation in drug development.
Kerala Cancer Conclave – Discussing the Undiscussed
This session will explore the Strengths, Weaknesses, Opportunities and Threats (SWOT) of the cancer pharmaceutical landscape in India. It will highlight the critical role of the pharma industry in enhancing cancer care, while also addressing the challenges it faces, including regulatory hurdles, accessibility, affordability and innovation. This session opens up the legal aspects of drug regulation, licensing and drug patent rules in India.
DAY 1 - SESSION 5
Access and Affordability of Cancer Care: Payer, Payee and System Perspectives
Context and Rationale:
The landscape of oncology is undergoing rapid and exponential transformation. Breakthroughs in diagnostics, treatment modalities such as immunotherapy and targeted agents, and supportive care have significantly improved patient outcomes. However, the real- world translation of these advancements into improved population health remains a complex challenge, especially in resource-constrained settings like Kerala.
Ensuring that these innovations are accessible, affordable, and equitably distributed necessitates the integrated engagement of three critical pillars of healthcare delivery: payers (government agencies, insurance providers), payees (patients and their families) and the health system (providers, hospitals, public health infrastructure).
SESSION OBJECTIVES
This session aims to:
● Critically analyse the challenges each stakeholder—payer, payee, and health system—faces in providing and accessing cancer care.
● Highlight the systemic and structural barriers to affordability and accessibility in the Kerala context.
● Discuss policy-level solutions and multi-sectoral strategies to overcome these challenges in the future.
KEY THEMES
1) Affordability and Coverage Gaps
● Rising costs of cancer care driven by newer therapies, diagnostic technologies and prolonged survivorship.
● Inadequate insurance coverage for advanced therapies such as immunotherapies and precision medicine.
● Delayed reimbursements and limited inclusion of essential oncology drugs in public formularies.
● The burden of out-of-pocket expenditures on families, particularly in the absence of comprehensive health coverage.
2) Access Disparities and Resource Allocation
● Discrepancies in cancer care access between urban centers and rural or tribal regions due to infrastructure, manpower, and policy gaps.
● Underutilisation or overutilisation of limited healthcare resources due to low awareness, misinformation, or stigma surrounding cancer.
● Skewed resource distribution leading to bottlenecks in tertiary care centers and under-resourced primary health facilities.
3) Policy and System-Level Interventions
● Need for inclusive and flexible insurance schemes that accommodate emerging treatment modalities and technologies.
● Development of tiered reimbursement models to optimize use of high-cost drugs while ensuring patient benefit.
● Creation of dynamic and responsive cancer care pathways that integrate prevention, early detection, diagnosis, and treatment.
4) Public–Private Partnerships and Infrastructure Enhancement
● Encouraging collaboration between government bodies, private hospitals, non-profits, and pharmaceutical companies to co-fund and co-design innovative care models.
● Investing in digital health infrastructure, including telemedicine, AI-driven diagnostics, and remote monitoring tools to extend reach and efficiency.
● Expanding training programs to build a skilled oncology workforce, including community health workers and oncology nurses.
5) Awareness, Screening, and Prevention
● Addressing the psychological and social barriers such as fear, stigma and fatalism that prevent early presentation and compliance with treatment.
● Strengthening community-level cancer screening programs, particularly for cervical, breast and oral cancers.
● Promoting HPV vaccination and tobacco cessation through state-wide campaigns and school-based interventions.
● Incorporating health literacy initiatives to empower individuals to recognise early symptoms and seek timely care.
CONCLUSION
In a state like Kerala that boasts relatively high literacy and health indices, the challenge is not just about providing care but ensuring rightful, timely, and equitable access to it. This session will delve into actionable pathways to close the gap between innovation and implementation by aligning payer strategies, patient needs, and system capabilities. By integrating clinical advances with social equity and economic sensibility, Kerala can emerge as a model for equitable oncology care delivery in low- and middle-income settings.
DAY 1 - SESSION 6
Sensible Policies for Cancer Care
India achieving rapid strides in socioeconomic development has seen an increase in life expectancy over the past few decades and this has contributed to increasing incidence of non communicable diseases including cancer. Cancer incidence has increased by approximately 36% in the last decade and so is cancer mortality. With rising cancer incidences and need for long term care in patients with cancer, there is an urgent need for robust, well-defined policies. While individual efforts and healthcare advancements are crucial, it is the policymakers who hold the key to shaping the landscape of cancer control at a national and state level.
In India, policymakers play a multifaceted role, encompassing:
● Prevention: This includes formulating and enforcing policies on tobacco control, promoting healthy lifestyles, and ensuring food safety – all of which are vital in reducing risk factors for cancer. Through the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) the government of India has integrated cancer prevention along with other non-communicable diseases.
● Early Detection and Screening: Policymakers are instrumental in establishing and strengthening population-based screening programs, especially for common cancers like oral, breast, and cervical cancer. Initiatives under NPCDCS and the expansion of Ayushman Bharat-Health and Wellness Centres aim to bring these services closer to the community.
● Accessible and Affordable Treatment: Policies like the Ayushman Bharat Yojana (PM-JAY) and the Health Minister's Cancer Patient Fund (HMCPF) provide financial protection and make cancer treatment accessible, especially for economically vulnerable populations. However, policymakers need to address the geographical disparity in access to cancer care, particularly in rural areas, by strengthening tertiary care facilities and decentralizing diagnostic and treatment services.
● Infrastructure Development: Policymakers drive the establishment and strengthening of cancer care infrastructure, including State Cancer Institutes (SCIs), Tertiary Care Cancer Centres (TCCCs), and even Day Care Cancer Centres in district hospitals.
● Research and Innovation: Creating an enabling environment for cancer research, data collection through robust cancer registries, and fostering collaborations for innovative treatments are also within the purview of policymakers.
● Awareness and Education: Policies support mass media campaigns and community-level initiatives to raise public awareness about cancer prevention, symptoms, and the importance of early detection.
However, challenges persist. Disparities in access between rural and urban areas, the high out-of-pocket expenditure for many patients, low public awareness leading to late diagnosis, and the need for a stronger oncology workforce are areas that continually demand the attention and strategic intervention of policymakers.
To conclude, policymakers play a key role in developing a comprehensive and equitable cancer control strategy. Their decisions impact every stage of the cancer journey, from prevention to palliative care. The panel discussion on "Role of Policymakers in Cancer Care" hopes to elucidate key areas where policy makers can further refine existing infrastructure, strategies and policies for controlling the cancer epidemic in India.
DAY 2 - SESSION 1
Research in Kerala - What is the Missing Link?
The 'Kerala model' on health has gained national and international attention and the state has been consistently ranked among the best in the nation on various health indices. The public health infrastructure in the state is one of the best in the country. Despite this strong foundation, we lag behind in translational research and generating high impact data. This forms the crux of our panel discussion. It is expected to bring together eminent clinicians, scientists and policymakers who will give their valuable inputs on identifying the gaps in research and discuss possible solutions.
The discussion will explore key lacunae in Kerala’s research ecosystem from limited institutional support and fragmented data collection to lack of dedicated funding mechanisms. A major area of focus will be the need to form collaborative networks and generate and publish real-world data, where our patient profiles can offer globally relevant insights. This will help build sustainable, outcome-driven research networks and data generation. The panel will also delve into innovative models for funding research, such as leveraging Corporate Social Responsibility (CSR) initiatives and fostering public-private partnerships with local industry.
This session is expected to be not just a forum for problem finding, but one for solutions where policy becomes practice and vision ends in action. The road ahead may be difficult and filled with hurdles at multiple steps, but it is our hope that this conclave serves as a catalyst for humble beginnings on a new research culture rooted in our state’s strengths.
DAY 2 - SESSION 2
Genomics & Precision Medicine in Cancer Care: Unraveling Its Fullest Potential
1) Why Precision Oncology Matters?
Cancer is no longer defined only by the organ it starts in but by the genetic wiring that drives each tumour. Precision (personalised) oncology interrogates DNA, RNA, epigenetics and the immune micro-environment to match the right treatment to the right patient at the right time.
2) Why the Moment Is Now?
Next-generation sequencing (NGS) costs have fallen >100-fold, making broad genomic profiling routine.
Liquid biopsies (ctDNA) reveal minimal residual disease months before imaging, guiding adjuvant escalation / de-escalation.
AI-powered variant interpretation converts big-data noise into actionable insights in real time.
Pan-tumour approvals (e.g., pembrolizumab for MSI-H, larotrectinib for NTRK fusions) prove that biology trumps anatomy.
3) Implementation Essentials
Test broadly, early, wisely: Profile all advanced solid tumours—tissue first, plasma if tissue is scarce.
Molecular Tumour Boards (MTB): Multidisciplinary review (oncology, pathology, bio-informatics, genetics) ensures evidence-based action.
Equity & access: Tele-MTBs, state NGS reimbursement and sample-shipping networks can bridge the urban–rural divide in Kerala.
Data stewardship: Secure, de-identified registries aligned with the Indian DPDP Act will turn local experience into shared knowledge.
4) Kerala’s Opportunity:
Statewide Genomic Tumour Registry to map mutation frequencies in our population.
NGS-guided clinical trials embedded in routine care, offering early access to first-in-class therapies.
Precision Medicine Fellowship to upskill clinicians, nurses and pharmacists in genomics, bioethics and data analytics.
5) How a Panel Discussion Accelerates Progress
A well-curated panel discussion can propel precision oncology forward by rapidly distilling vast amounts of evidence into concise, actionable insights; adding essential contextual nuance that frames trial data within Kerala’s socioeconomic and resource realities; forging interdisciplinary consensus among oncologists, pathologists, geneticists, payers, and patient advocates; offering real-time problem-solving that turns audience cases into clear, frontline plans while demystifying complex ‘omics’ concepts; and creating policy traction through unified, evidence-based recommendations that administrators can confidently adopt.
6) Expected Outcomes from Our Conclave
Clear, Kerala-relevant algorithms for tissue and plasma genomic profiling.
Blueprint for a Kerala-wide MTB network leveraging telemedicine.
Priority list for public–private funding of NGS and ctDNA testing.
Training roadmap to achieve statewide genomic literacy by 2027.
