Healthcare-seeking pathways and out-of-pocket expenditure amongst patients attending a tertiary care government medical college in Eastern India

Abhishek Basu; Rahul Mahawar; Saikat Sheet; Amitabha Chakrabarti; M. Mustakim Rahaman

doi:10.18203/2320-6012.ijrms20264190

Authors

Abhishek Basu Department of Radiation Oncology, Midnapore Medical College and Hospital, West Bengal, India, India
Rahul Mahawar Department of Radiation Oncology, Midnapore Medical College and Hospital, West Bengal, India, India https://orcid.org/0000-0003-4802-0193
Saikat Sheet Department of Radiation Oncology, Midnapore Medical College and Hospital, West Bengal, India, India
Amitabha Chakrabarti Department of Radiation Oncology, Midnapore Medical College and Hospital, West Bengal, India, India
M. Mustakim Rahaman Department of Radiation Oncology, Midnapore Medical College and Hospital, West Bengal, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20264190

Keywords:

Out of pocket expenditure, Cancer patients, Health care pathways, Financial risk in cancer

Abstract

Background: Cancer care imposes substantial financial burden on patients and their families, even when treatment is received at government-funded institutions. This study assessed healthcare-seeking pathways and Out-of-pocket expenditure (OOPE) among cancer patients attending a tertiary care government medical college in Eastern India.

Methods: A hospital-based cross-sectional study was conducted among 200 patients with pathologically confirmed malignancies attending the Department of Radiation Oncology of a tertiary care government medical college in West Bengal between 1^st August, 2024 and 31^st July, 2026. Data were collected using a semi-structured, pre-validated questionnaire, supplemented by clinical and treatment records.

Results: Of the 200 patients, 54% were female and the median age was 56 years. Most patients had a median monthly household income of ₹12,000. Breast cancer was the most common malignancy (30%). Overall, 76% patients reported a direct healthcare pathway. 64% percent of patients were referred outside the study centre, including 54% outside the city and 10% outside the state. The median total OOPE was ₹95,000. OOPE differed significantly according to referral status, with median expenditure increasing from ₹70,000 among non-referred patients to ₹1,00,000 among those referred outside the city and ₹3,00,000 among those referred outside the state (P<0.001). OOPE also different significantly across primary disease groups (P<0.001).

Conclusion: Despite treatment at a tertiary government medical college, cancer patients experience substantial OOPE and financial distress. Strengthening comprehensive surgical, radiotherapy, diagnostic, and supportive cancer services at tertiary government institutions, together with effective financial-risk protection, may help reduce the economic burden on patients and their families.

References

Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 and projection for 2025: results from National Cancer Registry Program, India. Indian J Med Res. 2022;156(4–5):598–607.

Dinesh TA, Nair P, Abhijath V, Jha V, Aarthy K. Economics of cancer care: a community-based cross-sectional study in Kerala, India. South Asian J Cancer. 2020;9(1):7–12.

Alexander A, Prabhu J, Korlimarla A, Manjunath S, Patil S, Kodaganur G. The impact of breast cancer on the patient and the family in Indian perspective. Indian J Palliat Care. 2019;25(1):66–72.

Kastor A, Mohanty SK. Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: do Indian households face distress health financing? PLoS One. 2018;13(5):e0196106.

Bagal S, Budukh A, Thakur JS, Dora TK, Qayyumi B, Khanna D, et al. Head and neck cancer burden in India: an analysis from published data of 37 population-based cancer registries. ecancermedicalscience. 2023;17:1603.

Brooks J, Wilson K, Amir Z. Additional financial costs borne by cancer patients: a narrative review. Eur J Oncol Nurs. 2011;15(4):302–10.

Ramalingam A, Rao UR, Naik BN, Pandey S, Nirala SK, Singh P, et al. Pathway of healthcare for breast cancer among women in an eastern state of India: a mixed method cross-sectional study. Asian Pac J Cancer Prev. 2025;26(2):505–13.

Mohiuddin SA, Vemulapalli M, Reddy SV. Out-of-pocket expenditure among cancer patients availing treatment at a tertiary care centre in Hyderabad, India. Natl J Community Med. 2023;14(5):323–328.

Khan MN, Hueniken K, Manojlovic-Kolarski M, et al. Out-of-pocket costs associated with head and neck cancer treatment. Cancer Rep (Hoboken). 2022;5(7):e1528.

Kumar MS, Mini M, Olickal JJ, Muttath G, Pavithran K, Thankappan KR. Pathways to care, out-of-pocket expenditure, and associated factors among breast cancer patients in Kerala, India: a hospital-based cross-sectional study. Asian Pac J Cancer Prev. 2026;27(4):1441–50.

Prinja S, Dixit J, Gupta N, Dhankhar A, Kataki AC, Roy PS, et al. Financial toxicity of cancer treatment in India: towards closing the cancer care gap. Front Public Health. 2023;11:1065737.

Rajpal S, Kumar A, Joe W. Economic burden of cancer in India: evidence from cross-sectional nationally representative household survey, 2014. PLoS One. 2018;13(2):e0193320.

Wadasadawala T, Mohanty SK, Sen S, Kanala TS, Maiti S, Puchali N, et al. Out-of-pocket payment and financial risk protection for breast cancer treatment: a prospective study from India. Lancet Reg Health Southeast Asia. 2024;24:100346.

Boby JM, Rajappa S, Mathew A. Financial toxicity in cancer care in India: a systematic review. Lancet Oncol. 2021;22(12):541–9.

Ranganathan S, Tomar V, Chino F, Jain B, Patel TA, Dee EC, et al. A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India. Support Care Cancer. 2023;31(7):420.

Prinja S, Chauhan AS, Karan A, Kaur G, Kumar R. Impact of publicly financed health insurance schemes on healthcare utilization and financial risk protection in India: a systematic review. PLoS One. 2017;12(2):e0170996.

Reshmi B, Unnikrishnan B, Rajwar E, Parsekar SS, Vijayamma R, Venkatesh BT. Impact of public-funded health insurances in India on health care utilisation and financial risk protection: a systematic review. BMJ Open. 2021;11(12):e050077.

Somu G, Mathew A, Lakshmi RV. Understanding the economic burden of cancer care and the utility of health insurance: an exploratory cross-sectional study in a tertiary care hospital in Karnataka, India. Indian J Public Health. 2023;67(3):357–63.

Nanda M, Sharma R. A comprehensive examination of the economic impact of out-of-pocket health expenditures in India. Health Policy Plan. 2023;38(8):926–38.

Muralidharan S, Gore M, Katkuri S. Cancer care and economic burden—a narrative review. J Family Med Prim Care. 2023;12(12):3042–47.

Muralidharan S, Gudgila RD, Chaudhari KP, Misal MU, Katkuri S. Out-of-pocket expenditure for HNF palliative care among cancer patients in the urban centre of Hyderabad: a cross-sectional study. J Pharm Bioallied Sci. 2025;17(Suppl 1):S2138–40.

Basu A, Ghosh D, Mandal B, Mukherjee P, Maji A. Barriers and explanatory mechanisms in diagnostic delay in four cancers—a health-care disparity? South Asian J Cancer. 2019;8:221–5.