On World Cancer Day, February 4 when the focus globally is on unitedly fighting the disease, let us give a thought to the overall economic burden to a cancer patient who undergoes treatment in a public institution.
An average cancer patient bears an economic burden of Rs 36,812 for the entire cancer therapy at an institution like the All India Institute of Medical Sciences (AIIMS) that provides tertiary care for such patients.
Just to bring the overall burden into perspective, the average economic burden
to a cancer patient being treated at AIIMS amounted to Rs 14,031 (before start of radiotherapy) plus Rs 8,184 (for a seven week period of Radio Therapy course), adding up to Rs 22,215, where services are free or highly subsidised.
According to a paper published in the Economic and Political Weekly on ‘The Economic Burden of Cancer' by Bidhu Kalyan Mohanti, Abhiroop Mukhopadhyay, Sanghamitra Das, Kuldeep Sharma, and Soumitra Das, a patient also incurs an average expenditure of Rs 14,597 before coming to the AIIMS.
Cancer is one such disease, where the financial burden of treatment is a major source of stress for patients and families.
The out-of-pocket costs incurred because of the illness can consume a substantial part of income and the family budget. However, patients and their families do not have a good estimate of the expenses involved.
The healthcare delivery in India is going through a process of transition, more so the tertiary specialty care of chronic diseases like diabetes, hypertension, heart attack, kidney or liver failure, mental disorder, ageing and cancer. More than 80 per cent of these patients are now seeking medical interventions from a private doctor or private/corporate hospital sector and more than 90 per cent individuals end up paying the costs from their own pocket. New medical technologies and newer drugs cause increasing expenditure borne by patients and their family carers.
Approximately one million newly diagnosed cancer patients are seen in India each year and out of these nearly 50-60 per cent present themselves at a disease stage suitable for curative cancer-directed therapy (CDT), which consist of surgery, chemotherapy and radiotherapy. Depending upon the cancer type and stage of disease, the initial therapy course is the most expensive period. Hence, a cancer patient and family members can face the double dilemma of confronting the cancer diagnosis and meeting the financial burden of CDT.
Radiation therapy (RT) is a key treatment. Two-thirds of all major cancers require RT with or without the other two types of treatment, and approximately 40 per cent of all cancer cures are directly attributable to the benefits of RT. Delivered over a continuous period covering several weeks, a RT course lasts between five and seven weeks. It is often observed that patients may not receive this RT course, because it is of long duration, the need to stay near a cancer centre/away from their own home and the unaffordable economic cost of therapy duration. This non-compliance can have serious implications in terms of a curative disease progressing to an incurable stage and the subsequent loss of life.
The AIIMS survey was done when the patient started the radiotherapy course and continued till the last week, spread over the RT period. It captured the major out-of-pocket expenditure incurred by the patient/household during the course of cancer therapy including medicines, tests, transportation cost to and from hospital, accommodation, and food.
The baseline survey was carried out on 432 patients between October 2006 and December 2007 when they first came to the RT-OPD registration at the cancer centre. Native place wise, 37 per cent of the sampled patients were from Uttar Pradesh, 26 per cent were from Delhi, 14 from Haryana, 10 per cent from Bihar, 5 per cent from Uttarakhand, 3 per cent from Rajasthan and the rest 5 per cent from other parts of India.
Almost half of the surveyed patients had already spent more than Rs 5,000 before coming to the AIIMS. For some, the expenditure may be very high, sometimes as much as Rs 3,72,500. Thus, the mean expenditure at Rs 14,597 is almost three times the median expenditure. These expenditures depend to a large extent on the length of time and the kind of facility patients go to.
The paper reports the expenses undertaken after reaching AIIMS and before the start of radiotherapy. The cost calculations are based on weekly data of 284 patients. The RT course in these 284 patients was for five weeks in 6.7 per cent, six weeks in 12.3 per cent, and seven weeks in 81 per cent of the surveyed patients. During the second phase of the study, for an initial subset of 141 patients, the authors collected data on all the prescribed weeks of radiotherapy.
It was concluded that the average cost across all treatment plans was Rs 1,062 per week. This would imply an average cost of Rs 5,310 for a radiotherapy course treatment lasting five weeks. If we add Rs 750 that has to be paid at the beginning as the RT course fee, the patients end up paying around Rs 6,060 for a five week RT course (in case of seven weeks, this cost is higher at Rs 8,184).
As much as 59 per cent of this cost is spent on transportation and food and lodging. These direct, indirect and total weekly costs are borne by patients during their RT course, depending upon treatment. There are significant differences between the expenditures of various treatment plans but patients are largely unaware about financial requirements for cancer diagnosis and its treatment, which can consist of direct medical, non-medical, and other indirect costs. Even the medical fraternity has little knowledge about the costs of cancer treatment borne by patients and their families.
India has a population of approximately 1,100 million with a requirement of 1,200 radiotherapy machines, whereas presently 400 RT machines are available for cancer treatment. The modern radiotherapy facilities are concentrated in private hospitals where the cost of the RT course appears to be prohibitively high and beyond the reach of common Indians, the paper points out.
