For 45-year-old Sarita (name changed), the worry began with a lump in her breast. She had read online that it could be a sign of cancer, and the fear prompted her to confide in her husband. The couple decided not to wait and went to the nearby district hospital to get it checked.
But they were told the hospital did not have the diagnostic and treatment facilities needed for cancer. They could go to a private hospital, they were told, but that was beyond what the lower-middle-class family could afford.
The couple were left with little choice but to travel to a metro city for further evaluation and treatment.
What followed was not just a medical journey. Every visit meant spending on travel, food and accommodation, besides the possibility of losing wages.
More importantly, the family had to navigate an unfamiliar healthcare system far from home.
Sarita’s experience reflects the wider cancer-care gap in the country. Cancer treatment services are available in only about 5% of district hospitals, while around 70% of cancer patients are estimated to live in rural areas.
The challenge is likely to become even greater as the number of cancer cases rises. India is projected to see annual new cancer diagnoses increase from more than 1.5 million currently to nearly 2.5 million by 2045, a rise of about 67%.
Experts say prevention and early detection will have to go hand in hand with expanding treatment capacity.
The geographical divide, along with other challenges faced by cancer patients, was discussed threadbare at the Indian Cancer Society (ICS), Delhi’s annual seminar on “Bridging Innovation & Affordability in Cancer Care”, held recently.
Prominent oncologists, public health experts, insurers, hospital representatives and pharmaceutical industry professionals who attended the meeting agreed with the ICS call for strengthening cancer-care services in Tier 2, Tier 3 and Tier 4 cities and rural areas, with district hospitals taking a bigger role in screening, early diagnosis, initial care and referral to specialised centres. ICS has been working in the cancer care sector for the last 75 years.
Speaking on the occasion, Delhi Lieutenant Governor Sardar Taranjit Singh Sandhu emphasised the importance of detecting cancer early.
“The Prime Minister and the government believe that healthcare should be accessible, available and affordable to all. One of the most effective ways of making cancer care more affordable is to detect the disease early. Screening and early detection can make a fundamental difference,” Sandhu said.
He also stressed the need for a stronger referral network.
“A better referral system can ensure that patients enter the healthcare system early. The connection between primary healthcare, diagnostic services and specialised hospitals can make a significant difference,” he said.
Prof Ravi Mehrotra, former Director of ICMR-NICPR, said cancer care does not have to mean building a specialised centre in every district.
“What we need is to ensure that basic diagnostics and initial cancer care are available closer to the patient. Specialised centres can provide advanced care and expertise, with district-level facilities connected to them through a hub-and-spoke model,” Mehrotra said.
Such a system could allow district hospitals to undertake basic screening and diagnostic work, identify suspicious cases and refer patients quickly to specialised centres. It could also reduce unnecessary visits to distant hospitals.
Prof. Chintamani, senior consultant, surgery and chairperson, surgical oncology, Sir Ganga Ram Hospital, Delhi, said access was already improving in some smaller cities but more needed to be done.
“Cancer-care facilities are still limited when we look beyond the major cities. But the scenario is changing. With Ayushman Bharat PM-JAY, cancer-care facilities are increasingly becoming available in smaller cities as well. We should continue to take care closer to patients,” Dr Chintamani said.
For a lower-middle-class family, however, travelling to another city can turn cancer treatment into a prolonged financial strain. The direct cost of medicines, procedures and hospitalisation may be only one part of the bill. Repeated travel, food, accommodation and loss of income can continue throughout treatment.
Vinay Subramanian, Commercial Head (VP), Oncology, GSK Pharmaceutical Ltd., highlighted this hidden cost.
“For many families, around 60% of the overall expenditure can go towards commuting, food and other expenses, while only about 40% is the actual cost of treatment. If we can provide at least early care at the district level, it can change the situation,” he said.
Insurance can provide some protection, but experts at the seminar said coverage and awareness also need to improve so that families do not discover the limits of their financial protection only after a diagnosis.
While moderating the panel on “Insurance Coverage with Emphasis on High-Volume Outreach", Dr Abhitabh Gupta, Chief Business Executive, Ace Insurance Brokers Pvt. Ltd., said, "Insurance coverage and innovative models of outreach can play an important role in reducing the economic burden on families.”
At the same time, Dr PN Arora, Chairman and Managing Director, Yashoda Group of Hospitals, highlighted the need for greater transparency between insurers and healthcare providers, so patients can understand their coverage and navigate treatment more easily.
Jyotsna Govil, Chairperson, ICS, said the organisation’s focus has always been to ensure that cancer does not push families deeper into financial distress. “We have been working for cancer patients for the last 75 years, and our main concern has always been to make cancer care more and more affordable. Access to care should not become another burden for a patient who is already dealing with cancer,” Govil said.
The society’s Cancer Sahyog initiative also works with cancer survivors and carers to provide emotional and practical support and help families navigate available healthcare and financial-support systems, she added.
With India’s cancer burden projected to rise sharply over the next two decades, expanding treatment capacity alone will not be enough, the experts said, adding that early detection, basic diagnostics and initial care must also become accessible closer to where people live instead of concentrating in a handful of major cities.
Coming back to Sarita’s case, for people like her who seek answers and treatment soon after noticing a possible sign of cancer, every day should be about getting the right diagnosis and timely care. It should not be worrying about how far they have to travel to find it.
