One in nine people in India has a lifetime risk of developing cancer. As cancer cases are seeing a jump in India, the cost of treatment is imposing a high financial burden on families, often leading to debt, even abandonment of care, and, on occasion, patients opting to discontinue treatment.
According to a recent Lancet study, cancer is a leading driver of catastrophic health expenditure in India, where medicines constitute more than 60% of out-of-pocket expenditure. In low- and middle-income countries, including India, cancer not only contributes to significant morbidity and mortality, but also leads to financial burden, particularly on marginalised socioeconomically vulnerable populations.
Financial toxicity, a term used to describe the overwhelming economic strain that cancer treatment places on patients and their families, often compels patients to make life-altering decisions about whether to continue treatment or turn to less effective but more affordable alternatives, the study said.
Agreeing that financial toxicity is real and deeply distressing, Dr Bhawna Sirohi, medical director at BALCO Medical Centre, Raipur, said quite a few of her patients trust traditional medicine or healers, which makes patients with curable cancers become incurable and treatable cancers become untreatable.
“This is a sad reality. When patients discontinue evidence-based treatment and shift to unproven alternatives, it often leads to cancer progression to a higher stage, which means the cost of treatment becomes higher, and treatment duration is also prolonged. Eventually, they return with advanced complications, which are more difficult and expensive to manage,” she said.
This not only increases the medical burden but also the emotional and financial strain on families. “We must ensure that patients do not feel compelled to choose between survival and financial ruin. Affordable, accessible, and evidence-based care must remain our priority,” she added.
In India, among all the diseases, cancer caused the highest incidence of catastrophic health expenditure (79%) and the highest prevalence of distress financing, affecting 43% of households.
Healthcare spending in India is disproportionately reliant on private financing, with households bearing 39.4% of out-of-pocket health expenses.
While most health insurance packages cover cancer care, coverage is largely confined to inpatient care and hospitalisation. This leaves a substantial gap in the coverage of outpatient department services.
“This gap is especially evident in spending on drugs and diagnostic tests, which are financed almost exclusively through out-of-pocket expenditure,” the Lancet report said.
Chetali Rao, senior scientific researcher and legal advisor, Third World Network, an international non-profit policy research organization, also agrees. “In India, cancer medicines and supportive drugs are the main drivers of financial toxicity in cancer care, accounting for more than 60% of patients’ out-of-pocket expenditures,” she said.
Medicines alone account for close to half of the patient’s treatment bills, while diagnostics constitute more than a third of families spending.
“As a result, most of the cancer-affected families face catastrophic health expenditure, with a significant proportion being pushed below the poverty line. Most newer cancer therapies are priced in lakhs for a single year of treatment,” she said.
Recognising the rising cancer burden in India, the government, in the Union Budget 2026-27, announced exemption on basic customs duty on 17 cancer drugs from 10% to nil. Noting that the announcement is a positive step towards affordability and driving health equity, Dr Sirohi said, “This will make the medicines reach a larger population across income brackets.”
“Many cancer drugs, especially targeted therapies and immunotherapies, are imported. Lower duties directly reduce hospital expenses, which can translate into lower treatment costs for patients,” she said.
However, she said, while this measure improves affordability at the margins, it is not a complete solution. “To further help drive equity, the government can also implement GST exemption to reduce out-of-pocket expenditure for cancer patients.”
The way forward
Stressing that the government providing ₹5 lakh insurance coverage under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) has been transformational and a boon to cancer patients who come to the hospital in advanced stages, Dr Sirohi said, much more needs to be done to make treatment more affordable.
What is required is that the government should consider covering critical diagnostics, and therapies, without which patients cannot avail themselves of the treatment packages, and of course, quicker reimbursements. A special top-up package should also be considered for catastrophic illnesses like cancer, as the Rajasthan government has done, providing a ₹25 lakh package.
“The government should engage with all centres that treat cancer patients to implement the PMJAY scheme, so more patients can have access to it, especially with corporates who have received land at very discounted rates,” she said.
What is also needed is to create palliative care packages, as patients may spend up to 80% of their treatment costs towards the end of life.
Dr Parth Sharma, junior specialist in the department of preventive oncology and public health at the Cachar Cancer Hospital and Research Centre, Assam, said that while reducing the cost of medicines used in cancer care is important, it is high time policies looked beyond medication and hospital expenditure to provide support for food, accommodation, travel, and loss of wages as well.
According to Dr Pragya Shukla, HOD of clinical oncology at the Delhi State Cancer Institute, there is a need to develop population-specific guidelines for both cancer screening and treatment. Technology can also play a crucial role in cost optimisation and democratising the delivery of cancer care. “When used appropriately, technology will enhance both outcomes and affordability,” she added.