India fight against cancer and Cancer care

By 2040, according to one estimate 20 lakh people a year will be diagnosed with cancer in India. In the coming years, it is expected to take over heart disease and infections as well.

Cancer in India- A Look at numbers

• By 2040, according to one estimate 20 lakh people a year will be diagnosed with cancer in India. Cancer is already the third leading cause of death in India.
• The projected cancer burden in India for 2021 was 26.7 million Disability Adjusted Life Years (DALYs).
• More than 40% of the total cancer burden was contributed by the seven leading cancer sites — lung (10.6%), breast (10.5%), oesophagus (5.8%), mouth (5.7%), stomach (5.2%), liver (4.6%), and cervix uteri (4.3%).

Cancer care in India- A socio-economic burden

• The money spent by a patient on an ailment is the highest for cancer. People are financially destroyed by cancer and its treatment.
• Cancer treatment rendered catastrophic health expenses in more than 80% and impoverishment in more than 60% of people.
• The government provides free cancer care. These devastating costs arise in the private sector due to the sheer burden of disease plus an underfunded public health
• The financial burden worsens by adding to the direct and/or indirect out-of-pocket expenditure (OOPE).
• Direct includes doctor’s consultation fees, cost of medicines, and medical tests, and direct non-medical OOPE includes costs of transport, accommodation, and food for people travelling to larger cities for treatment. Indirect OOPE accounts for loss of productive hours and/or income.

What makes the financial fallout worse?

• Though government provides free care and treatments but at times, due to the pendency’s and delay people not only lost their precious time but also the timely treatment which worsens the health.
• The financial fallout of cancer is worse when it affects the breadwinner of the family. 
• Compared to the general population, people with cancer are at seven time’s greater risk of unemployment within five years after diagnosis.
• Cancer diagnosis has a similar impact on caregivers.They also lose their working hours and productivity. Further the effect is compounded by mental and physical burden.
• The cost of accommodation and travel costs causes a huge burden Since cancer care is concentrated in major cities, most people from rural India, where 60-70% of the country’s population lives.
• Borrowing money and selling assets has been identified to be a common strategy that disproportionately affects people from rural areas.

What are the possible solutions?

• There are two way out- Public Funded and subsidised treatment costs including indirect out of the pocket expenditure.
• The Pradhan Mantri Jan Arogya Yojana (PMJAY) has offered some respite by providing health insurance of Rs 5 lakh per family per year.
• In 2012, the Haryana government made transport for patients with cancer and one caregiver in public buses from their places of residence to their places of treatment
• In Kerala where patients with cancer are eligible for 50% concession on public bus tickets.
• To improve compliance with care, patients travelling to seek care in Cachar Cancer Hospital and Research Centre in Assam are given financial support for travel as well as free accommodation and food.
• Delhi government’s Arogya Kosh schemeto reduce the burden on public health centres and avoid treatment delays. It is for residents of Delhi making less than Rs 3 lakh a year are eligible to get certain tests, like ultrasound and CT scans, in private health centres for free.
• However, 93% of people seeking care in government hospitals in Delhi were found to be unaware of the scheme, thus pointing towards lack of awareness.
• Haryana, Tripura, and Kerala have also floated a ‘cancer pension’ to financially assist patients with advanced-stage cancer: Rs 2,500 per month in Haryana and Rs 1,000 in Tripura and Kerala.
• The most obvious solution to such post-cancer problems is to open publicly funded cancer care centres in every nook and corner of India. This may take time but it is required.

Until cancer care becomes as accessible as diabetes or hypertension care, government need to continue to provide financial support to those who are suffering, either directly or indirectly, and their families. Free cancer care alone won’t save our people from poverty and suffering.