The extent of indebtedness among breast cancer survivors in India: A prospective longitudinal study from a tertiary cancer hospital.

BACKGROUND

The study examines the extent of loans and debts for patients with breast cancer across different phases of their treatment in India.

METHODS

This study used primary data of 500 breast cancer patients who sought treatment during 2019-2023 at Tata Memorial Hospital, Mumbai, India. This study is registered on the clinical trial registry of India (CTRI/2019/07/020142) on 10/07/2019. Data on economic burden was collected at three phases: baseline or at the time of registration to the hospital, endline or after completion of the treatment, and follow-up or after six months of post-treatment period. The outcome variables were the proportion of patients taken loan, loan sources, loan amount. Bivariate and two-part model were used to explore the determinants and estimate the amount of loan.

FINDINGS: The proportion of patients taking loans increased from 37.8% at baseline to 64.6% at endline and 68.9% at follow-up. Mean loan amount rose from ₹20,399 (9.2% of annual income) at baseline to ₹115,340 (47.4% of annual income) at follow-up. Younger patients, those with lower education, lower income quintiles, and rural residence were more likely to take loans. Loan sources shifted from friends and relatives at baseline to moneylenders at endline and follow-up. Significant factors influencing loan amount included income quintile, distance to the treatment center, marital status, and stage of cancer.

CONCLUSION

As the treatment progresses, increase in loan amount and the shifts towards informal, high-interest lending sources are alarming concerns. These findings highlight the need for improved financial protection mechanisms and targeted support for vulnerable cancer patients to prevent medical impoverishment.