Cancer Treatment

Advances in Medical Technology

Dr. A K. Dewan, MS, MCh (Surgical Oncology) Consultant Surgical Oncologist Rajiv Gandhi Cancer Institute, Delhi Medical Director Ganga Prem Hospice

Dr A K Dewan at RGCI

‘Medical Technology’ means the procedures, equipments and processes by which medical care is delivered. Examples of advanced medical technology in oncology include Minimally invasive surgery, Robotics, HIFU (High Intensity Focused Ultrasound), Tomotherapy, IGRT, Targeted therapies, PET scan and Telemedicine etc.

Some innovations such as new drug molecules may cost more immediately but save more lives and have effect on survival. Any innovation saving meaningful human life is a worthy innovation. A few other examples are newer anaesthetic agents and newer machines and monitoring devices. These have reduced patient recovery time, shortened hospital stay and lead to fewer medical errors. These changes have reduced the overall costs although the technology may have been expensive. At the same time, these innovations have made it possible to perform surgeries on high-risk patients. Newer technology in radiotherapy is precision based aiming to reduce the morbidity associated with radiation. In the history of surgery, laparoscopic cholecystectomy remained unchallenged from the time it was introduced and soon became the gold standard. Cost of laparoscopic cholecystectomy has reduced dramatically with good innovative instrumentation and increasing expertise.

Robotic surgery, single port minimally invasive surgeries have become popular in the last decade. HIFU is being used for fibroid uterus and prostate cancer. Newer techniques are quite expensive but if a patient of localized prostate cancer has a hospital stay of 7 days for open surgery vs. 3 days for Robotic surgery vs. one day for HIFU. There is cost saving in terms of hospital stay, faster recovery and minimal morbidity. Who knows HIFU may replace Robotic surgery in prostate cancer in the near future. Another mind-blowing question is what influences the growth of these innovations? Is it industry or doctor or consumer? The answer is consumer demand for better health. As people become wealthier, they provide a fertile market of new medical innovations. Advances in medical technology are perceived as a way to promote the goal of achieving and maintaining good health. Consumer demand is also affected by increasing public awareness of medical technology through the media, the Internet and advertisement from industry. Professionals also try to find better ways to treat their patients with the ‘’latest and best’’. They may also be motivated by professional goals like peer recognition, prestige and improvement in practice. Industry driven innovations may find consumer interest and major financial reimbursements.

My humble appeal is to the clinicians, oncologists, researchers and industrialists. India has a huge medical market potential. Let us invest in basic science that is not motivated by an interest in creating new products but by the desire to increase human understanding. Clinicians should join hands with researchers and spend some time of their life in bringing technology from the lab to the bedside of the patients. Secondly, as a clinician we are becoming high tech but low touch. No young doctor wants to touch the patient. Doctors don’t clinically examine the patient. They only see and treat latest X-rays and scans. Remember ‘X-rays and scans are only as good as doctors who request them and the radiologist who reports them’. High-end technology can never replace clinical skill. Let us be high tech and high touch.