One of the significant objectives of the Indore Cancer Foundation is the setting up of a research institute devoted to head and neck cancers, a state of the art, national centre of excellence, working on preventive strategies, diagnostic programmes and clinical & basic research on head & neck cancers.

Our decision was influenced by the high incidence of head & neck cancer in India (33% of all cancers) coupled with the fact that this type of cancer can be effectively prevented with health education and has a better chance of cure if detected in early stages.

The Indian Institute of Head & Neck Oncology, the first of its kind anywhere in the world, was not visualized to be like an ordinary general cancer hospital but a multi-institutional, multi-disciplinary institute of head & neck oncology; with a multi-pronged strategy: creating awareness amongst people on how to improve their chances of preventing head & neck cancers, detecting such cancers in the early stages when there are better chances of cure, establishing more effective treatment protocols through international collaboration, and offering palliative support to patients who are beyond curative treatment.

The development of the institute was visualized in the following 4 phases. However, the process took on its own dynamic and evolved not entirely as visualized, although the basic objective and planned scope of services/facility has not been changed.

Phase I

Radiation Oncology, ambulatory care unit (OPD block), with its infrastructure of emergency unit, endoscopy unit, diagnostic X-ray unit, minor surgery and other necessary facilities to work initially as a day hospital. Supportive laboratory facilities particularly for histopathology and hematology. This phase to also have subsidized accommodation, a 'dharamshala' for patients and their attendants, a rehabilitation area for in-house capacity enhancement including facilities for physiotherapy, a minimum residential campus and also a community centre. A mortuary for 2 bodies has also been visualized in this phase.

Phase II

An in-patient's facility and all clinical facilities required for the institute like operation theatres, post operative intensive care unit, a step-down ICU, blood bank, laboratory services, central sterile supply department, intensive care unit, pharmacy, imaging services like ultrasound, cat scan MRI, Nuclear Medicine department, PET scan and a Cath lab to enable state of the art facilities such as Digital Subtraction angiography, tumor embolization, intra-arterial chemotherapy .Further development of radiotherapy services like inclusion of linear accelerator complex, a Brachytherapy facility, completion of residential campus. The other services that need to be added are house keeping, security, kitchen, medico-administrative services like medial record keeping including cancer registry, medico-social services, transport services, fire and estate management.

Phase III

Development of a training and research.

Phase IV

Expansion and addition on the basis of experience gained in running the institute in the earlier phases and strengthening the infra structural facilities.

Radiotherapy Facility

The Bhabhatron II machine acquired through a grant from the Department of Atomic Energy, Government of India started treating patients from 23.08.2008.

The Department of Information Technology, Ministry of Communication & Information Technology, Government of India, has promised to give us a linear accelerator that has been indigenously developed by SAMEER, DIT, by the end of 2010. The Padma-Keshav Trust has agreed to support the cost of constructing the centre that will house the linear accelerator. And the Nargis Dutt Memorial Foundation, New York Chapter, has agreed to support the purchase of equipment required without which the linear accelerator cannot be operationalised. This support is to the tune of $ 150 000/-.

We are hoping to find the means to install a brachytherapy unit, treatment planning systems, a CT simulator. If we are able to realize this dream, our institute would then be in a position to offer the entire spectrum of radiotherapy treatment to cancer patients.

Rehabilitation Centre

It often happens that a cancer patient requires physical and/or financial rehabilitation.

We have already mentioned elsewhere the physical rehabilitation work we do with laryngectomy and mastectomy patients.

Very often a cancer patient may also require support for financial rehabilitation. The cost of treatment, the need to do less demanding or no work during treatment and/or thereafter, at times the treatment causes a physical debilitation (like voice box removal) that impinges on the person's ability to work, are some of the factors that place a strain on the patient's financial resources.

Appreciating this problem, the Industrial Development Bank of India (IDBI), under its community development project gave a grant for the construction of the necessary building. The grant did not cover the purchase of the required equipment and the recurring cost of running the centre. Today, the construction is complete. Small donations, in the form of sewing and knitting machines have been received. The Institute's computer is also used for training. In addition, we counsel patients and/or families and help them identify government-aided institutes that offer free or subsidized vocational training. As detailed elsewhere, Honorable Union Minister of State, Mrs. Vasundhara Raje, inaugurated this phase of our rehabilitation center.

We are now working on evolving an employment cell. This cell will comprise of volunteers. The patients and/or families who require support in finding employment will be interviewed and the volunteers will try and contact potential employers. We have to create a database of companies who are sympathetic to the plight of cancer patients and are willing recruit such candidates.

Gradually, finances permitting, we will expand our rehabilitation work.

Cancer Prevention Center

Creating awareness about the dangers of tobacco chewing and reducing tobacco consumption, can prevent cancers of the head and neck. It is also possible to detect and treat oral pre-cancerous lesions. A pre-cancerous lesion is not cancer but has the potential of one day developing into cancer. One also needs to create a database of oral pre-cancerous lesions so that appropriate interventional strategies can be developed.

The Government of Japan gave a grant for the construction of a cancer prevention center. However, it did not cover the recurring costs involved.

The construction of the prevention center is complete and once the required funds are generated this center will start functioning.The dental OPD that has been started is a step in this direction.

Given the socio-economic conditions prevailing in India, the basic philosophy of the Indore Cancer Foundation is that no patient should be denied treatment because of lack of funds. We, therefore , offer completely free treatment or charge highly subsidized fees. As such, we face a perennial shortage of funds. The only solution to this problem is to set up a corpus that would take care of the recurring and administrative costs and ensure that our activities run unhindered.

The estimated attributable risk associated with tobacco chewing habits is 61% for oral cancer and 79% for pharynx and larynx (Notani et al 1989). With the rapid rise in tobacco consumption in younger population, the pre-cancerous conditions like sub-mucous fibrosis and leucoplakia are quite prevalent in young people. The total cancer burden in younger patient is likely to achieve epidemic proportion in a decade or so.

There is a marked variation in the incidence of lip, oral cavity and pharynx cancers in different countries. Indian cancer registries have noted much higher age adjusted and truncated rates than those reported by other registries. (Cancer incidence in five continents volume V, 1987) The global picture is dominated by the incidence of oral cancers in southern Asia and of oral cavity plus nasopharynx in southeastern Asia. Malignant tumors of lip, oral cavity and Pharynx are the most common cancers in Indian cancer registries (NCRP1988-89). The tongue, mouth, oropharynx and hypopharynx are the predominant sites in this group.

Oral cancer is the 6 th most common cancer in the world. But it is the most common cancer in India, and it forms 30-35 % of all cancers. More than 200 000 new cases occur every year with a poor prospect of survival in south and south East Asia.

There is a need for a specialized center to deal with the problem of head and neck cancers because it is assuming epidemic proportion, is becoming common in the younger population and its aggressive behavior calls for research in clinical practice as well as research at molecular biology level. There is tremendous research potential in various aspects of head and neck cancers. These cancers can be prevented through proper intervention .If detected early they are curable. There was not a single institute that dealt exclusively and comprehensively with head and neck cancers.

It was to fulfill this need that the Indore Cancer Foundation decided that one of it main objects would be to set up a “state-of-the-art” comprehensive head and neck cancer research institute. Our Institute is the “first of its kind anywhere in the world”.

We visualize that our institute will eventual grow into a center that would be instrumental in designing various clinical research trials, would function as a model in research at cellular level. It would be a collaborative and need based center that would offer comprehensive treatment to all head and neck cancer patients irrespective of their socioeconomic status. Further more it would chalk out various preventive strategies based on field research.

Like other professionals, the medical personnel also need to continuously update their knowledge and skills. We, therefore, plan to organise continuing medical education activities with the proposed auditorium providing the necessary infra-structural support.