A recent study has revealed that 90.1 per cent of patients suffering from colorectal cancer incur catastrophic expenditure during treatment. And over 9 per cent change ongoing treatments to a different healthcare facility known as the treatment attrition rate. Catastrophic expenditure is the OOPE (out-of-pocket expenditure) incurred on the treatment which amounts to greater than 25 per cent of the patient’s annual household income. 

The study ‘Catastrophic expenditure and treatment attrition in patients seeking comprehensive colorectal cancer treatment in India’ was published in the Lancet journal by a group of authors with the likes of Bodhisattva Bose from All India Institute of Medical Sciences, Rishikesh, India, and Joanne Clarke from the Institute of Applied Health Research, University of Birmingham, United Kingdom. The study remains the first of its kind in India, which seeks to find out the cost burden and treatment attrition rate of colorectal cancers among patients in India. 

According to the study colorectal cancers in India are the 7th most common type of cancer with around 65,358 new cases added in 2021. The incidence of colorectal cancer is on the rise worldwide and it currently stands at 15.2 per 1,00,000 population in India and 19.5 per 1,00,000 globally. 

“In the year 2001, colorectal cancers were not even among the first 10 common cancers in the Indian population. But by 2021-22 almost 65,000 to 70,000 new cases of colorectal cancers are being seen in India. Approx 37,000 in males and 28,000 in females,” said Dr Vedant Kabra, Principal Director, Department of Surgical Oncology at Fortis Memorial Research Institute, Gurugram.

It has happened due to lifestyle changes, especially in diet, and a sedentary lifestyle. The mortality in India is also very high mainly because of diagnosis in advanced stages and also due to delayed and inadequate treatment. Mortality is to the tune of 80 per cent of all diagnosed patients in India, Dr Kabra added.

Colorectal cancers which are majorly of two types, colon and rectum are not included in the early detection programs of the country while they remain the 6th type of cancer contributing to the disability-adjusted life years lost in India. 

Colorectal cancer begins in the colon (large intestine) known as colon cancer or the rectum called rectum cancer when cells in these organs overgrow and become abnormal. There are various causes denoted to cancer such as genetics, diet, smoking, alcohol consumption, and inflammatory bowel disease.

The costs involved in the treatment of cancer are the highest among non-communicable diseases, leading to a higher rate of catastrophic expenditure and leaving patients financially vulnerable. 

As per a WHO report globally 996 million people underwent catastrophic expenditure in 2017 and 70 million were pushed into poverty. People living in low and middle-income economies are believed to be more at risk due to low government spending on healthcare, inadequate insurance coverage and high out-of-pocket payments.

According to the National Health Accounts 2018-19, the OOPE on healthcare in India stood at 48.21 per cent in comparison with the worldwide average of 18.1 per cent, meaning that almost half of the healthcare spend in India is out of pocket.

The study also notes India’s public health expenditure is less than 2 per cent of its GDP, which results in high out-of-pocket payments for the population with 6.53 per cent of people experiencing catastrophic health spending which is the 7th highest in the world.

It is estimated that government funds only cover a quarter to a third of cancer treatment costs, forcing patients to make out-of-pocket payments ranging from 19,494 to 295,679 Indian Rupees (INR) depending on the type of cancer, the study said.

“Most treatment costs for colorectal cancer were paid out-of-pocket by patients and catastrophic expenditure was common. Treatment attrition rates at tertiary centres were low, suggesting greater attrition at previous stages of care. Better financial protection may allow more patients to receive comprehensive cancer treatment while avoiding household financial catastrophe,” the study stated.

Talking about the treatment attrition rate Dr Sachin Almel, Section Co-ordinator of Medical Oncology, PD Hinduja Hospital & MRC said that treatment attrition rates for cancer, in general, are higher as compared to other diseases. Most commonly due to treatment-related side effects and sometimes prolonged treatment duration. However with proper guidance, and counselling, the majority of patients can successfully complete their treatment.

Speaking on solutions of colorectal cancers Dr Kabra said Lifestyle modification is needed to decrease the Incidence of colorectal cancer in India and screening programs should be advocated, for example, stool tests and colonoscopies, because colonoscopies can detect Polyps which are benign but have the potential to become cancer or show signs of early cancer.

He further said once the cancer is diagnosed, we have to have a mechanism of making it a fast-track cancer care in public hospitals because there is a lot of waiting there. For instance in NHS (National Health Service), if a patient is diagnosed with cancer, their treatment is fast-tracked, they are given an appointment within a couple of weeks and treatment also starts faster as compared to many other diseases where there is a waiting list of a couple of years. “In India, we need to devise some mechanism to fast-track cancer care,” Dr Kabra added.