Access to timely cancer treatment initiation in India: extent, determinants and trendsResearch in context
Summary: Background: Treatment delays are significantly associated with advanced stage, poor response to treatment, increased mortality risk, poor health outcomes, increased healthcare expenditures among cancer patients. However, factors associated with these delays have not yet been robustly evalu...
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| Format: | Article |
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Elsevier
2025-01-01
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| Series: | The Lancet Regional Health - Southeast Asia |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772368224001641 |
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| author | Pritam Halder Jyoti Dixit Nidhi Gupta Nikita Mehra Ashish Singh Pankaj Malhotra Anisha Mathew Lalit Kumar Amal Chandra Kataki Sudeep Gupta Shankar Prinja |
| author_facet | Pritam Halder Jyoti Dixit Nidhi Gupta Nikita Mehra Ashish Singh Pankaj Malhotra Anisha Mathew Lalit Kumar Amal Chandra Kataki Sudeep Gupta Shankar Prinja |
| author_sort | Pritam Halder |
| collection | DOAJ |
| description | Summary: Background: Treatment delays are significantly associated with advanced stage, poor response to treatment, increased mortality risk, poor health outcomes, increased healthcare expenditures among cancer patients. However, factors associated with these delays have not yet been robustly evaluated. In order to bridge this gap, we determined the delayed time to treatment initiation (TTI) among cancer patients in India, ascertained its determinants, and assessed the trends of delayed TTI. Methods: We analysed data collected from 6695 cancer patients seeking outpatient/daycare treatment, recruited at purposively selected seven healthcare facilities across six states of India. Data on socio-demographic and clinical characteristics including date of cancer diagnosis, date of treatment initiation, cancer site, stage and type of treatment were collected to determine the median TTI and ascertain its determinants among cancer patients in India. Time to treatment initiation was calculated as the duration (days) between diagnosis of cancer (histologically/clinically) and date of initiation of treatment. Multi-variable logistic regression was employed to analyse the relationship between the outcome variable (TTI) and each explanatory variable. A Cox Proportional Hazard (CPH) model was used to conduct time-to-event analysis, and to assess the impact of government-funded health insurance on timely cancer treatment initiation. Findings: The median (IQR) overall TTI was 20 (7–39) days, with a mean of 53.7 days (SD, 192.9). The TTI was higher for those having head and neck cancer (median TTI: 29 days, IQR: 10.5–55.5) and those receiving radiotherapy as initial treatment (27.5 days, IQR: 10–49.5). Younger patients, those educated up to graduation level and males had significantly lower odds of delayed TTI. As compared to patients who were diagnosed between 1995 and 2017, those diagnosed after 2018 had a 36% (26–46%) higher odds of timely initiation of treatment within 30 days. Upon stratifying by enrolment under PMJAY, we found that while the access for timely treatment initiation increased by 33% for those who were not enrolled, vs. 90% among those enrolled under PM-JAY. Overall, this shows significant improvement in timely initiation of cancer treatment as a result of introduction of PM-JAY. Interpretation: The study highlights the positive impact of government-funded health insurance schemes on the timely access to cancer treatment in India. Our study recommends expanding AB PM-JAY cancer packages to include cost-effective treatments, increasing population coverage under screening programs and promoting e-RUPI to reduce financial constraints associated with diagnostic services to address delayed treatment initiation due to unknown cancer stages. Funding: Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India. |
| format | Article |
| id | doaj-art-6df7ca95039248108ba328ea9e0c871a |
| institution | DOAJ |
| issn | 2772-3682 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health - Southeast Asia |
| spelling | doaj-art-6df7ca95039248108ba328ea9e0c871a2025-08-20T02:52:25ZengElsevierThe Lancet Regional Health - Southeast Asia2772-36822025-01-013210051410.1016/j.lansea.2024.100514Access to timely cancer treatment initiation in India: extent, determinants and trendsResearch in contextPritam Halder0Jyoti Dixit1Nidhi Gupta2Nikita Mehra3Ashish Singh4Pankaj Malhotra5Anisha Mathew6Lalit Kumar7Amal Chandra Kataki8Sudeep Gupta9Shankar Prinja10Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Radiation Oncology, Government Medical College and Hospital, Chandigarh, IndiaDepartment of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, IndiaDepartment of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, IndiaDepartment of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, IndiaDepartment of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaDepartment of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India; Department of Medical Oncology, Artemis Hospitals, GurugramDepartment of Gynaecologic Oncology, Dr. B. Booroah Cancer Institute, Guwahati, Assam, IndiaDepartment of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, IndiaDepartment of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India; Corresponding author.Summary: Background: Treatment delays are significantly associated with advanced stage, poor response to treatment, increased mortality risk, poor health outcomes, increased healthcare expenditures among cancer patients. However, factors associated with these delays have not yet been robustly evaluated. In order to bridge this gap, we determined the delayed time to treatment initiation (TTI) among cancer patients in India, ascertained its determinants, and assessed the trends of delayed TTI. Methods: We analysed data collected from 6695 cancer patients seeking outpatient/daycare treatment, recruited at purposively selected seven healthcare facilities across six states of India. Data on socio-demographic and clinical characteristics including date of cancer diagnosis, date of treatment initiation, cancer site, stage and type of treatment were collected to determine the median TTI and ascertain its determinants among cancer patients in India. Time to treatment initiation was calculated as the duration (days) between diagnosis of cancer (histologically/clinically) and date of initiation of treatment. Multi-variable logistic regression was employed to analyse the relationship between the outcome variable (TTI) and each explanatory variable. A Cox Proportional Hazard (CPH) model was used to conduct time-to-event analysis, and to assess the impact of government-funded health insurance on timely cancer treatment initiation. Findings: The median (IQR) overall TTI was 20 (7–39) days, with a mean of 53.7 days (SD, 192.9). The TTI was higher for those having head and neck cancer (median TTI: 29 days, IQR: 10.5–55.5) and those receiving radiotherapy as initial treatment (27.5 days, IQR: 10–49.5). Younger patients, those educated up to graduation level and males had significantly lower odds of delayed TTI. As compared to patients who were diagnosed between 1995 and 2017, those diagnosed after 2018 had a 36% (26–46%) higher odds of timely initiation of treatment within 30 days. Upon stratifying by enrolment under PMJAY, we found that while the access for timely treatment initiation increased by 33% for those who were not enrolled, vs. 90% among those enrolled under PM-JAY. Overall, this shows significant improvement in timely initiation of cancer treatment as a result of introduction of PM-JAY. Interpretation: The study highlights the positive impact of government-funded health insurance schemes on the timely access to cancer treatment in India. Our study recommends expanding AB PM-JAY cancer packages to include cost-effective treatments, increasing population coverage under screening programs and promoting e-RUPI to reduce financial constraints associated with diagnostic services to address delayed treatment initiation due to unknown cancer stages. Funding: Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India.http://www.sciencedirect.com/science/article/pii/S2772368224001641CancerAccess to treatmentTime to treatment initiationDeterminantsBarriers to treatment |
| spellingShingle | Pritam Halder Jyoti Dixit Nidhi Gupta Nikita Mehra Ashish Singh Pankaj Malhotra Anisha Mathew Lalit Kumar Amal Chandra Kataki Sudeep Gupta Shankar Prinja Access to timely cancer treatment initiation in India: extent, determinants and trendsResearch in context The Lancet Regional Health - Southeast Asia Cancer Access to treatment Time to treatment initiation Determinants Barriers to treatment |
| title | Access to timely cancer treatment initiation in India: extent, determinants and trendsResearch in context |
| title_full | Access to timely cancer treatment initiation in India: extent, determinants and trendsResearch in context |
| title_fullStr | Access to timely cancer treatment initiation in India: extent, determinants and trendsResearch in context |
| title_full_unstemmed | Access to timely cancer treatment initiation in India: extent, determinants and trendsResearch in context |
| title_short | Access to timely cancer treatment initiation in India: extent, determinants and trendsResearch in context |
| title_sort | access to timely cancer treatment initiation in india extent determinants and trendsresearch in context |
| topic | Cancer Access to treatment Time to treatment initiation Determinants Barriers to treatment |
| url | http://www.sciencedirect.com/science/article/pii/S2772368224001641 |
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