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Cancer Care in India: The mental and financial burdens

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Cancer has both social and economic implications in India. The stigma associated with cancer is known to leave a psychosocial impact that alters the health seeking behavior of the patient. The prolonged treatment often impoverishes the household. The mortality rate due to cancer is high, at sixty eight percent of the annual incidence. Fewer than thirty percent of Indian patients with cancer survive five years or longer after diagnosis. This rate is much lower than many developed nations. Five year survival rates in South Korea and Japan are sixty eight percent and sixty percent, respectively. In a group of nations including U.S., Canada, Japan and sixteen European countries this rate is as high as eighty five percent. Leading factors for poor survival rate in India include delayed reporting due to lack of awareness, inadequate or incorrect diagnoses and suboptimum treatment often due to patients’ inability to access therapies. The absence of a convergent approach to address the multifactorial causality of cancer is also a concern for India (Mallath, et al., 2014). Public expenditure on cancer in India remains below ten dollars per person, compared with more than hundred dollars per person in high income countries (Pramesh, et al., 2014).

Psychological impact of cancer

Cancer therapy along with mere treatment also encompasses management of pain and psychological trauma. Hence it is often referred to as care beyond cure (Neron, 2009). A cancer patient is often undergoing extreme mental trauma and stress coupled with apprehension and uncertainty. The experience is worsened by the financial distress of the long term treatment and the disruption to normal life. Side effects of the radio and chemotherapy, and the associated physical pain, add to this already negative experience. In a study conducted by Public Health Foundation of India, Bhubaneswar on the patient satisfaction levels in cancer care elicits the trauma of the cancer patients in Indian public health.  This study considers the long waiting times for diagnosis and followup. Most of the cancer hospitals are located in large cities and warrant long travel for patients. Lacking diagnostic skills among primary healthcare doctors often worsen the situation (Mahapatra, et al., 2016). Social stigmas associated with cancer are attributed to changes in the body, cancer fatalism and a false belief that cancer is contagious (Kaur, 2015).

Financial impact of cancer

As per the National Institute of Cancer Prevention and Research, about around 2.5 million of Indians are living with cancer with seven hundred thousand being added each year.[1] Eighty seven percent of these are diagnosed with cancer at the final stages (Sharma, 2016).  As per an article published in the Times of India, the cost of the five most common cancers in India has risen by three to four times between 2000 and 2015. Insurance companies claim that one among the five cancer claims is by those between 36 and forty five years of age. Cancer may hence leads to the loss or disruption of household income. As per the latest National Sample Survey Healthcare round average out of pocket spending on cancer care is around INR thirty thousand and is the highest among all the inpatient episodes. The out of pocket spending for cancer care in private facilities is about three times that of public facilities (National Sample Survey Office, 2014). About forty percent of cancer hospitalization cases are financed mainly through borrowings, sale of assets and contributions from friends and relatives (Rajpal, et al., 2018).

Policy Implications

Literature referred in this blog suggests that primary care doctors need training for diagnosis as well as to provide counseling for patients in long term care. Nurses and community workers are well placed to act as focal points to fight cancer stigma. The government should give this serious consideration as they roll out the health and wellness clinics in India. The rates of cancer survivorship can be improved through “prevention, early detection, diagnosis and treatment.” The rate of early diagnosis in India is very low and about twenty or thirty percent of cases are diagnosed at stage one and two, respectively. Primary care centers can also work towards improving patient awareness on oral and cervical cancers which form the bulk of cancer cases in India (Rajpal, et al., 2018). The National Health Policy (2017) has emphasized stronger relation with the private sector to fill the strategic gaps in the public sector. This would enable quicker and financially practical last mile access of cancer care.

With the roll out of the National Health Protection Scheme, which aims to reduce financial catastrophe, it is all the more necessary to leverage the presence of the private sector and develop the capacity of the public sector to improve the quality of life and survival chances of those suffering from cancer. Cancer treatment needs empathy, patience and alleviation fear before alleviation of pain. India Against Cancer is one of the Ministry of Health’s serious attempts to provide information on the prevalent cancers in India with a major focus on awareness, prevention and treatment of these cancers. Few states have seriously taken the importance of early detection and treatment. A highly literate Kerala has forty percent of its cases are detected early, which ultimately leads to fewer deaths. Telangana is tying up with the Tata trusts to ensure that the medical colleges in the state act as hubs for detection and treatment of cancer.[2] The Government of India has set up Revolving Funds in twenty seven Regional Cancer Centers with funds upto INR five million at their disposal. Treatment for upto INR two hundred thousand is being provided free of cost to ensure that the financial duress is reduced.[3]

Yet the need of the hour would be to work on the awareness levels of the public as well the medical fraternity. With the 1300 Indians being diagnosed daily with the deadly disease, awareness on the tell tale signs, risk factors and treatment options need to be communicated better. This is important to ensure that the patient’s are well armed with the needed knowledge to fight their battle against cancer.

References

Kaur, R., 2015. Cultural Beliefs, Cancer and Stigma: Experiences of Patients from Punjab (India). Studies on Ethno Medicine, 9(2), pp. 247 254.

Mahapatra, S., Nayak, S. & Pati, S., 2016. Quality of care in cancer : An exploration of patient perspectives. Journal of Family Medicine and Primary Care, Volume 5, pp. 338 342.

Mallath, M., Taylor, D. & Badwe, R., 2014. The growing burden of cancer in India: Epidemiology and Social Context. Lancet, 7011(9), pp. 1470 2045.

National Sample Survey Office, 2014. NSSO Social Consumption   Health 71st round 25th Schedule. Ministry of Statistics and Program Implementation.

Neron, A., 2009. Care Beyond Cure: Management of Pain and Other Symptoms. Canadian Journal Hospital Pharmacists, 62(2), p. 178.

Pramesh, C., Badwe, R. & Borthakur, B., 2014. Delivery of aff ordable and equitable cancer care in India. Lancet, 70117(2), pp. 1470 2045.

Rajpal, S., Kumar, A. & Joe, W., 2018. Economic burden of cancer in India: Evidence from cross sectional nationally representative household survey, 2014. Plos One, 13(2).

Sharma, D., 2016. Cancer data in India show new patterns. Lancet, 2045(16).

[1] Cancer Statistics in India (link)

[2] Tata trust signs MoU with Telangana Government on cancer care (link)

[3] Central Health Ministry’s Cancer Programs (link)

Anuradha Katyal

Anuradha Katyal

Anuradha works is a lead researcher with ACCESS Health India.

4 Comments

  1. Priya on May 17, 2018 at 12:42 am

    A very important and touching subject, policy, nation and humanity

  2. Kailash Gupta on May 17, 2018 at 8:51 am

    Dear Ms. Katyal,

    My hearty congratulations for this article. I have recently lost my Granny to Lung cancer, she comes from a very small town. I have experienced everything you have mentioned right from the myth of this being contagious to the travelling and financial issues. It is really very well written article with actual ground realities, I only wish the state and central government take cognizance of this and incorporate your suggestions to empower the primary care centers in small towns to create awareness and provide the much needed care, detecting it at a early stage will make be big help. It is usually a fatal disease, patients suffering from it needs moral and social support more than anything else.

    Thank you very much for bringing this up. I wish you all the best.

    Best Regards,

    Kailash Gupta

  3. Sudhir Kumar rampal on May 17, 2018 at 10:27 am

    Absolutely true..
    very keen Abservation on this health issue….

  4. Sudhakar on August 11, 2018 at 10:02 pm

    Very touching, more it became the social problem among Indians facing financially dethroning the family economy, with such disease epidemics, there is a need to educate people about proactive coping strategies and make available affordable diagnostics and treatment procedures. It is a very broad field and also applies to Holistic Health Care for Indians.
    thanks

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