Financial burden due to distance traveled to access treatment from specialized cancer hospitals in public sector in India: a case study of patients treated for gastric and pancreatic cancer.

BACKGROUND

Cancer care offered in India and large part of the world is heterogenous with few regions having dedicated high volume centres with established referral patterns. Due to scarcity of the specialized units treating cancer, patients often have to travel for long distances for medical care. Our study examines the impact of additional financial burden (non-medical expenses) on cancer patients' families due to long distance travelled while seeking treatment for gastric and pancreatic cancer.

METHODS

The data (n = 244) were collected as part of a prospective, non-interventional cohort study, conducted at Tata Memorial Hospital (TMH), Mumbai, India. Consecutive patients with gastric and pancreatic cancers. The medical and non-medical expenditures were collected for each visit along with other cancer specific and treatment details. Distress financing defined as borrowing money or selling assets to meet treatment-related expenses.

FINDINGS: The mean distance travelled by patients was 1475 km. 63.1 % of patients travelled greater than 1500 km. The mean Non-Medical Health Expenditure (NMHE) for patients traveling more than 1500 km was ₹107,040 ($1278), nearly two times higher than the expenditure for patients traveling less than 500 km, ₹49,112 ($587). A total of 42.9 % of NMHE was spent on travel, 33.3 % on accommodation, and 17.2 % on food. The logistic regression results depict that patients traveling > 500 km are three times more likely to experience Catastrophic NMHE (CNMHE) compared to < 500 km. The distress health financing due to cancer treatment was 39.3 %. Distress health financing was higher with CNMHE at 25 % (52.8 %) compared to CNMHE at 10 % (45.8 %), and was two times higher in patients travelling > 500 km compared to < 500 km

CONCLUSION

A structured decentralization of cancer care is the need of the hour to negate the additional financial burden and CNMHE experienced by the cancer patients and their families. If adequate infrastructure is provided at the non-urban areas, well trained oncologists can be deployed in hospitals closer to patients homes to treat cancers at earlier stage.