What Does It Take to Be at the Cutting-Edge of Radiation Oncology?
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What Does It Take to Be at the Cutting-Edge of Radiation Oncology?

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Manikandan Bala, Senior Vice President, ElektaThe incidence of cancer in India is flaring high. According to the Indian Council of Medical Research-National Cancer Registry Program, the number of cancer cases in the country is projected to go up from 14.6 lakh in 2022 to 15.7 lakh in 2025. When it comes to cancer, positive news is often generated only through advancements in diagnostics and radiation oncology. A critical part of cancer management, radiation oncology is driven by rapid progress in applying advanced imaging techniques and the availability of data and actionable information to create more precise and effective cancer therapies. It also implies building personalized, patient-centric treatments and improving the patient experience. To explore the latest radiation oncology trends, we recently engaged in an exclusive interview with Manikandan Bala, Senior Vice President, Elekta. With more than three decades of experience, Mani is a trusted industry thought leader driving best-in-class business growth for Elekta. He boasts exceptional cross-business functional skills and vast Healthcare industry experience gained through working for companies including GE, Siemens, Johnson & Johnson and Elekta.

In conversations with Manikandan Bala, Senior Vice President, Elekta

The global radiotherapy market is projected to reach $11.9 billion by 2031. What are the factors catalyzing this growth?
The global market is expected to host significant growth going forward. In fact, it might clock a much higher figure than what you mentioned. The radiation oncology market is estimated to reach 12.8 billion by 2028. The 8.5 percent growth is staggering; not good for the patients, but for the industry. Several factors are driving this growth. One of them is an aging population. Elderly patients are more prone to cancer.

The second factor is increased awareness among people and simultaneous advancements in diagnostics. It means that a lot more cases are being diagnosed as we move forward. Many cases today are diagnosed in the early stages because of this. This is a highly positive aspect of the growth.

The third factor, of course, is the increase in cancer incidences due to lifestyle changes and various biological factors, among others. This is an unfortunate scenario, as cancer incidences are clearly on an upward swing in most countries, including India. So, all of these factors contribute to the market growth. Additionally, radiation oncology constitutes a substantial portion of the oncology market today.

How do you perceive the current demand-supply gap in the oncology care segment? What are the prevailing challenges?
Unfortunately, India is witnessing significant growth in the number of cancer patients. Our country is quickly becoming the global capital of non-communicable diseases, wherein cancer tops the index of diseases. India registers almost 2.2 million every year. Given the massive number of people undergoing treatment, it’s a huge requirement.

As per the WHO guidelines, every country needs one linear accelerator (LINAC) per one million of population, and it’s a conservative estimate too. Developed countries often have four or five LINACs per million. In India, which has a population of 1.4 billion, we should have at least 1400 LINACs. But the present count is hovering around 650—not even half of what is required. So, that’s the kind of gap we are looking at in the radiation oncology segment. 

How does Elekta approach these challenges?
Elekta is taking on this challenge with our broad vision and futuristic thinking. Let me put it this way. Of the 2.2 million yearly cases, around 70 percent are diagnosed in tier-two, tier-three, and tier-four cities, which means only 30 percent of the cases are registered in Tier-one cities. But unfortunately, 80 percent of the cancer care infrastructure—both in terms of the hospitals and the radiation oncology—is located in Tier-one cities. Most of the patients travel all the way to the metros of the country to get treated. They are forced to stay there for months due to the longevity of treatment and often must come back even after treatment. This points the finger at a painful gap in the accessibility of quality.

We are a 1.4 billion strong population, and there is a considerable gap in terms of what the government can do and what the public wants. Hence, we are stepping more into this space with the help of other private players to figure out how we democratize this service


Elekta is on a mission to reduce this gap by taking world-class healthcare technology to where the patients are--tier-two and tier-three cities. It is a predominant part of Elekta’s vision, Access 2025, which aims at providing world-class healthcare technology and access to patients in tier-two and tier-three cities. We take input from the market requirements in the country and manufacture India-centric customized equipment. For example, the space requirement in tier-two and tier-three cities will be different, and there could be more frequent power downtime. Hence, we have developed equipment consuming less power and space. In a nutshell, we enable access to cutting-edge technology.

Another dimension of our intervention is our partnership with the government (PPP). As you know, the government renders several healthcare programs to provide healthcare to the public. But we are a 1.4 billion strong population, and there is a considerable gap in terms of what the government can do and what the public wants. Hence, we are stepping more into this space with the help of other private players to figure out how we democratize this service. 

The third aspect is enabling digital technology while connecting tier-two and tier-three cities. For instance, we have remote monitoring facilities. When a patient in a tier-two or tier-three city gets into the treatment cycle, we can monitor him/her continuously so that in case of any healthcare emergency, we can perform life-saving measures like immediately rushing the patient to a healthcare facility. The patient becomes a part of the healthcare. Elekta has a lot of solutions-oriented around the software that enables such facilities across the country. From an offering standpoint, we go beyond providing just technology to offer solutions by partnering with large corporate chains that take the infrastructure to tier-two and tier-three cities.  

We also address an essential aspect of the abovementioned gap—the people behind the machine. Equipment alone is not sufficient. We need skilled manpower behind this equipment, and right now, there is a massive shortage of skilled manpower in the segment. On the other hand, technology is advancing at an overwhelming pace, and the available skilled manpower gets obsolete in no time. Hence, we constantly train them. This is also in line with the government’s skill development initiatives. We constantly impart training & upskilling programs to physicists, clinical oncologists, and radiation oncologists to ensure that they have knowledge about using the latest technologies.

Tell us about your leadership approach. What are the guidelines or methodologies you follow to lead your team? 
A leader has to be himself. I believe in authentic leadership firmly rooted in transparency, genuineness, and honesty. In layman’s terms, you don’t need to necessarily follow the theoretical model of a great leader. If you’re comfortable with the way you want to operate, it’s perfectly fine. You don’t have to roam around with a Mont Blanc to be a leader. I have half a dozen of them, but I love using the ballpoint pen. 

You also have to be a team person with a long-term and short vision and convey that vision to your team. That’s where communication becomes a vital trait of a leader. Remember, it’s not a one-way street. You have to listen, not to answer, but to understand and give genuine feedback. Good communication skills will get you through many challenges not only in your professional life but also in your personal life. Above all, you need to have trust in your team. Your confidence in your team automatically tends to empower them with much more authority and responsibility. Furthermore, I believe changing and adapting to the latest trends in business and technology is another key aspect of successful leadership.

What are the skills you look for in a fresh candidate?
People often immediately say that it’s all about the knowledge about the industry. Make no mistake; for any candidate, knowledge is an excellent trait to have. But what I look for in a candidate is attitude and aptitude. Attitude to learn and adapt is crucial. I am generally advocating cross-industry working if you have the right attitude. I have got people from the automobile and banking industries to work for the medical sector. 

On the other hand, the zest for continuous learning is also vital. It’s beyond any reasonable doubt that you will become obsolete in no time if you don’t constantly learn and adapt to the changes. Additionally, great communication skill is something I always look for in a candidate because good communication helps establish trust and good relationships with all the stakeholders, including clients. 

In light of your leadership experience, what advice would you give budding leaders? 
Somebody asked a famous speaker once, “What is the secret to not making any mistakes?” The answer was that “Don’t do anything.” It implies the importance of making mistakes and learning from them. I believe it is essential to take risks in your career. Entrepreneurship is also about finding new opportunities and businesses, even within the organization that you work for.

It is also important to have both long-term and short-term visions. You also need to master communication skills to be a good leader. On the other hand, you must build networks within the business realm and constantly endeavor to widen that network. It is also imperative that you adapt to changes. You need to maintain an engaging social media account as well. 

Favorite Hobbies: “I love driving. I hit the road quite often. I love to explore new places, cultures, and roads.”

Favorite Travel Destination: “Outside India, I fell in love with the beautiful rivers, mountains and bridges of Interlaken in Switzerland. In India, my favorite destination is Leh-Ladakh.”

Favorite Cuisine: “Indian, preferably South Indian. I also love Italian.”

Favorite Movies: Gandhi, The Shawshank Redemption, 3 Idiots, and The Devil Wears Prada