Oncology in India: Rising Challenges and Emerging Business Opportunities

Rise of cancer burden in India

The cancer burden in India is on a steady and concerning rise, demanding urgent attention and action. In 2022, India saw an estimated 1,461,427 new cancer cases, with a crude incidence rate of 100.4 per 100,000 individuals.

Approximately 1 in 9 Indians is expected to face a cancer diagnosis during their lifetime.

This increase outpaces global averages, with cases rising from 1.39 million in 2020 to an estimated 1.57 million by 2025. Among women, the most common cancers are breast, cervical, and ovarian, while men are predominantly affected by lung, oral, and prostate cancers.

India faces Low Survival Rates Compared to Global peers

5-year survival rates for cancer

Key reasons for lower cancer survival rates in India can be attributed to :

• Late Diagnosis: Many cancers are diagnosed at advanced stages (III or IV), reducing treatment effectiveness.
• Limited Access to Healthcare: Rural areas often lack specialized cancer treatment facilities, delaying diagnosis and care.
• Concentration of Specialists: Oncology specialists are mainly found in urban centers, making access difficult for rural patients.
• Socioeconomic Barriers: High treatment costs and lack of health insurance deter timely medical intervention.

Transformative Opportunities in Oncology: Diagnosis, Treatment, and Post-Care

The field of oncology presents a pressing opportunity to address the growing cancer burden in India. Advancements in diagnosis, treatment, and post-care offer avenues to improve patient outcomes and reshape cancer care in the country.

Diagnosis

Early and accurate diagnosis is pivotal in oncology, as it significantly improves survival rates. Current challenges in India include limited access to diagnostic tools in rural areas and a lack of awareness about routine screenings.

Treatment

Cancer treatment has evolved with advances in precision medicine, immunotherapy, and minimally invasive surgeries. However, affordability and accessibility remain key challenges in India. Addressing these gaps could involve:

Post-Care

Post-treatment care is a critical yet often overlooked aspect of oncology. With advancements in cancer treatments, survivorship care is becoming increasingly important to manage the long-term health of patients. Key areas of focus include:

Analysis of Business opportunities in these fields

A > Diagnostic Oncology

Problem statement —

1. Limited Access to Advanced Diagnostics: A significant portion of India’s population, particularly in rural areas, lacks access to diagnostic facilities. Over 65% of cancer diagnostic centers are concentrated in urban areas, leaving rural populations underserved.
2. Low Awareness Levels: Many individuals are unaware of the importance of regular cancer screenings, contributing to late detection. For instance, breast cancer screening rates in India are 1.9%, which is much lower than the rates in the USA (82%), UK (70%), and even China (23%).
3. Technological Gaps: While advanced screening technologies exist globally, their adoption in India is slow due to cost barriers and limited infrastructure.

Attractive Business Opportunities—

(a) Innovative Screening Techniques:

• AI-Driven Imaging: Artificial intelligence can significantly enhance the accuracy of imaging techniques like mammography, enabling early and reliable detection.
• Liquid Biopsies: Non-invasive methods like liquid biopsies offer a cost-effective and efficient way to detect cancers through biomarkers in the blood.
• Genetic Testing: Expanding access to genetic profiling can help identify individuals at high risk, allowing for targeted interventions.

(b) Expansion of Diagnostic Infrastructure:

• Establishing accessible diagnostic centers in underserved areas can decentralize cancer detection.
• Mobile diagnostic units and telemedicine services could bridge the urban-rural divide, reaching populations with limited access to healthcare facilities.

(c) Public Awareness Campaigns:

• Community outreach programs focusing on the importance of regular screenings for breast, cervical, and oral cancers are vital.
• Collaborating with NGOs, government agencies, and local influencers can increase the reach and impact of these campaigns.

Key unconventional players in the segment

1. Karkinos: Karkinos Healthcare provides technology-driven solutions for the early detection, diagnosis, and management of cancer. The company focuses on offering end-to-end services at lower costs while maintaining profitability. Reliance recently acquired Karkinos for Rs 375 crore, recognizing its potential in transforming cancer care.
2. OncoStem Diagnostics: Specializing in personalized cancer treatment, OncoStem offers genomic tests that predict the risk of recurrence in breast cancer patients, enabling tailored therapies for better outcomes.
3. PredOmix: PredOmix leverages next-generation sequencing technologies to provide advanced diagnostic tools that enhance cancer detection and improve early diagnosis.
4. Niramai Health Analytix: Niramai uses thermal imaging for non-invasive breast cancer screening, offering an alternative to traditional mammography and making screenings more accessible.

B > Treatment Oncology

Problem statement —

1. Infrastructure Gaps: Limited cancer care infrastructure, especially in rural and tier-2/3 cities, restricts access to treatment and specialized care.
2. Need for Single-Specialty Hospitals: The growing demand for hospitals dedicated solely to oncology to provide focused expertise and comprehensive cancer care.
3. Cost Barriers: High capital expenditure (capex) for advanced medical equipment limits the affordability of cancer treatment.
4. Opportunity for Local Manufacturing: Developing “Make in India” medical equipment to reduce capex costs and improve access to quality cancer care across the nation.

Attractive Business Opportunities—

1. Single-Specialty Cancer Hospitals:
   Global case studies highlight the need for single-specialty hospitals dedicated to cancer care. For instance, the Dana Farber Cancer Institute’s collaboration with Beth Israel Deaconess Medical Center (BIDMC) reflects a shift towards independent cancer-focused institutions, as opposed to operating within large, multi-specialty health systems. This approach enhances specialized care and operational efficiency, presenting a promising opportunity to establish single-specialty cancer hospitals in India.
2. Hub-and-Spoke Model for Comprehensive Care:
   The hub-and-spoke model offers an efficient way to optimize cancer care resources. The “hub” should be a state-of-the-art comprehensive cancer care facility, incorporating radiology, medical, surgical, and diagnostic oncology services, and equipped with high-end diagnostic tools like PET CT, mammogram, gamma cameras, and LINAC machines. The “spokes” can be smaller, district-based daycare centers offering screenings, lab tests, biopsies, and basic diagnostic services, equipped with MRI, CT, ultrasound, etc. This model allows for extensive reach, making cancer care more accessible while ensuring effective resource utilization.
3. “Make in India” Medical Equipment and PLI Incentives:
   The Make in India initiative, supported by the government’s Production-Linked Incentive (PLI) scheme, presents an attractive business opportunity in the oncology space. Manufacturing medical equipment locally can significantly reduce capital expenditure (capex) costs for cancer centers. The production of high-end diagnostic tools and treatment equipment within India will not only make cancer care more affordable but also foster self-reliance in the healthcare sector.

Key players in the segment —

1. HCG (HealthCare Global Enterprises) — A specialized chain of hospitals dedicated to cancer care with multiple centers across India, offering advanced technologies like CyberKnife and TrueBeam, providing multidisciplinary cancer care..
2. Medicover Cancer Institute : A leading single-specialty oncology facility equipped to handle all aspects of cancer treatment, including prevention and rehabilitation.
3. Onco-Life Hospitals : The largest chain of oncology hospitals in Maharashtra, providing personalized cancer diagnostics and treatments.

C > Post care Oncology

1. Rehabilitation Services: Providing physical, psychological, and occupational rehabilitation to improve quality of life.
2. Palliative Care: Expanding access to pain management and holistic care for patients in advanced stages of cancer.
3. Mental Health Support: Addressing the emotional and psychological challenges faced by cancer survivors through counseling and peer support groups.
4. Follow-Up Programs: Establishing structured follow-up care plans to monitor recurrence and manage chronic conditions resulting from treatment.

Recent M&A Transactions in the space

1. HCG’s Acquisition of Mahatma Gandhi Cancer Hospital & Research Institute (Jun24)

• Details: Healthcare Global Enterprises (HCG) announced the acquisition of Mahatma Gandhi Cancer Hospital & Research Institute (MGCHRI) in Visakhapatnam for ₹414 crore (approximately $50 million). HCG will initially hold a 51% stake, with plans to acquire an additional 34% over the next 18 months. This acquisition aims to enhance cancer care delivery and data collection across India

2. Merger of M | O | C Cancer Care & HOC Vedanta (Jul24)

• Details: The M | O | C Cancer Care & Research Centre merged with Hemato Oncology Clinic-Vedanta (HOC), forming a new entity named HOC-Vedanta — M | O | C. This merger combines resources to provide comprehensive cancer care across Western India, aiming to serve over 22,000 patients annually through a network of 22 community cancer care locations

3. Healthcare Global Enterprises Acquires HCG NCHRI Oncology LLP (Nov24)

• Details: HCG executed a Business Transfer Agreement to acquire the oncology business of HCG NCHRI Oncology LLP located in Nagpur on a slump sale basis for up to ₹25 crore

4. Reliance Industries Acquires Karkinos Healthcare (Dec24)

• Details: Reliance Industries completed the acquisition of Karkinos Healthcare, a technology-driven oncology platform, for ₹375 crore. This acquisition is part of Reliance’s strategy to expand its footprint in the healthcare sector, particularly in oncology.

Recent Fundraise in the space

1. Morgan Stanley Private Equity Asia invests in Omega Hospitals

Omega Hospitals, India’s second-largest oncology chain, raised ₹500 crore (approximately $65 million) in Series A funding from Morgan Stanley Private Equity Asia. This investment will help the company expand its presence across multiple states, enhance existing facilities, and establish new hospitals.

2. Oncare received $1 million in seed funding round led by Huddle Ventures

Oncare is addressing critical gaps in India’s oncology landscape by offering comprehensive patient education, Transparent treatment plans and costs, On-call nursing support, Partnerships with hospitals.

Key Budget Announcement 2025

1. 36 life-saving drugs and medicines are proposed to be added to the list of medicines fully exempted from basic customs duty (BCD)
2. The government will facilitate the setting up of daycare cancer centres in all district hospitals in the next three years. 200 will be established in 2025–26 itself.

LoEstro Advisors is an investment banking firm specializing in sell-side fundraising and M&A advisory, along with a strong consulting arm. Recognized as the #1 financial advisor in education in India, we are the advisor of choice to India’s blue-chip education businesses.

Over the last four years, we have grown to be one of India’s largest (in terms of M&A transactions) homegrown boutique investment banks, with $1.2bn+ worth of combined deals closed across education, healthcare, consumer, and technology sectors.