Facilitating Timely Access to Highly Specialized Surgery for Children with Extremity Bone and Soft-Tissue Sarcomas in North and Central India
Original Article | Volume 6 | Issue 1 | JBST January-April 2020 | Page 2-4 | DOI: 10.13107/jbst.2020.v06i01.005
Author: Rashmi Kumari [1], Akshay Tiwari [2], Ishita Maji [1], Haresh Gupta [1], Poonam Bagai [1], Mohini
Daljeet Singh [3], Ramandeep Singh Arora [1]
1. Quality Care, Research and Impact Division, Cankids…Kidscan, New Delhi, India,
2. Max Institute of Cancer Care, , Max Super Speciality Hospital, Saket, Delhi, India,
3. Founder CEO, Max India Foundation, Delhi, India.
Address of Correspondence
Dr. Ramandeep Singh Arora,
Department of Musculoskeletal Oncology, Max Institute of Cancer Care, Max Super
Speciality Hospital, Saket, New Delhi – 110 017, India.
E-mail: childhoodcancer@gmail.com
Abstract
Background: Optimal management of bone and soft-tissue sarcomas (BSTSs) of the extremity in low- and middle-income countries like India remains a challenge due to the paucity of surgical expertise and other resource limitations. In this study, we aimed to develop a multiple stakeholder model where children with extremity BSTS in North and Central India can access specialized surgery without experiencing cost and delays.
Materials and Methods: The model brought together four stakeholders and developed a pathway of identifying eligible patients, facilitating timely referral, providing specialized surgery, and sharing the cost. Services were offered for 1 year (2018–2019) under this model.
Results: Sixteen non-metastatic patients (69% osteosarcoma, 18% soft-tissue sarcoma, and 13% Ewing sarcoma) from five hospitals received specialized extremity BSTS surgery under this model. About 69% had limb salvage surgeries, 19% rotationplasty, and 12% amputation. Surgery was done at a median interval of 16.9 weeks (range 7.3–33.6 weeks) from the date of diagnosis. None of the patients abandoned treatment. The total cost for the facilitation of the surgery, supportive care and social support for the entire cohort was INR 38.7 lakh (USD 54,180) with
an average of INR 2.8 lakh per patient (USD 3920). The patient had to bear no cost toward the surgery.
Conclusions: In this study, we developed a model systematically bringing together four stakeholders and identifying eligible patients, facilitating timely referral, providing specialized surgery at zero cost to the patient, and ensuring completion of treatment and follow-up. Our next goal is to increase the capacity of this model by amplifying its scope and replicating it in other parts of India.
Keywords: Child, Health services accessibility, India, Sarcoma.
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| How to Cite this article: Kumari R, Tiwari A, Maji I, Gupta H, Bagai P, Singh MD, Arora RS | Facilitating Timely Access to Highly Specialized Surgery for Children with Extremity Bone and Soft-Tissue Sarcomas in North and Central India | Journal of Bone and Soft Tissue Tumors | January-April 2020; 6(1): 2-4. |
