Audit of Financial, Social and Logistic Concerns of Overseas Cancer Patients Treated at Tertiary Care Centers in New Delhi

Abstract

India has emerged as one of the leading medical tourism destination in the recent times. Patients come from sub-Saharan countries, pacific island nations, west Asia, and post-Soviet republics (CIS) .We analyzed the issues and concerns of overseas cancer patients who come to New Delhi for their cancer treatment. 2833 overseas patients from 42 countries were treated in two different institutions between September 2013 and February 2019. Out of these, 743 patients were interviewed as per the NCCN distress thermometer for their financial, social (food, language, and culture) and treatment related difficulties. These included countries with low income (per-capita gross national income <$995), countries with upper-middle income (<$12055) and 6 countries from high income group (World Bank 2018). Patients treated with curative intent constituted 43%, while the rest were considered for palliative treatment. Patients who expressed minimal or no financial burden were 13.5%; they were either sponsored by an organization/the government or wealthy enough to afford treatment. Nearly 35% of the patients had sold their land/house property; rest 51.4% patients received returnable/non-returnable financial help from friends and (or) relatives. In case patient happened to be the primary earning member of the family, the expected time to recover from the net financial loss due to disease was ≥6 years; in other instances, it was 3-4 years. When interviewed, median number of visits to New Delhi was 2 (range 1-6). Nearly 93% patients reported issues with language and food. 17% patients came alone, mainly to reduce financial burden; other reasons for travelling alone were proficiency in English, not having anyone else to travel with and not wanting to disclose their health status to others. The remaining 83% patients were accompanied by 1 to 5 persons (median = 1). Inflation adjusted mean medical expense was 10098±9497 $ (range 2684-38538 $). If high cost treatments (>14000 $) like bone marrow transplant were ignored, mean expense came down to 5884±3067 $ (range $ 2684-9700). Average travel expense for 2 persons was 2035±1567$ (range $ 597-4507), and accommodation and average food expense for 1 month was about 2600 $. Almost all (≈96%) patients were unsatisfied with the medical practice, available instruments or high cost in their home country; only a few (3-4%) chose overseas treatment to avoid social stigma. Our study sheds light on the issues related to patients coming for treatment to New Delhi from an overseas destination. This study further provides critical inputs related to expenses borne by these patients and the other logistical issues faced by them.