Socio-economic variations of breast cancer treatment and discontinuation: a study from a public tertiary cancer hospital in Mumbai, India

Abstract

Background The study examined the socio-economic variation of breast cancer treatment and treatment discontinuation due to deaths and financial crisis. Methods We used primary data of 500 patients with breast cancer sought treatment at India’s one of the largest cancer hospital in Mumbai, between June 2019 and March 2022. This study is registered on the Clinical Trial Registry of India (CTRI/2019/07/020142). Kaplan–Meier method and Cox-hazard regression model were used to calculate the probability of treatment discontinuation. Results Of the 500 patients, three-fifths were under 50 years, with the median age being 46 years. More than half of the patients were from outside of the state and had travelled an average distance of 1,044 kms to get treatment. The majority of the patients were poor with an average household income of INR15,551. A total of 71 (14%) patients out of 500 had discontinued their treatment. About 5.2% of the patients died and 4.8% of them discontinued treatment due to financial crisis. Over one-fourth of all deaths were reported among stage IV patients (25%). Patients who did not have any health insurance, never attended school, cancer stage IV had a higher percentage of treatment discontinuation due to financial crisis. Hazard of discontinuation was lower for patients with secondary (HR:0.48; 95% CI: 0.27–0.84) and higher secondary education (HR: 0.42; 95% CI: 0.19–0.92), patients from rural area (HR: 0.79; 95% CI: 0.42–1.50), treated under general or non-chargeable category (HR: 0.60; 95% CI:0.22–1.60) while it was higher for the stage IV patients (HR: 3.61; 95% CI: 1.58–8.29). Conclusion Integrating breast cancer screening in maternal and child health programme can reduce delay in diagnosis and premature mortality. Provisioning of free treatment for poor patients may reduce discontinuation of treatment.

Out-of-pocket payment and financial risk protection for breast cancer treatment: a prospective study from India

“…A total of 71 patients did not complete the treatment due to death or financial and other reasons. 31 Supplementary Table S2 shows the summary characteristics of the 429 patients in the concluded sample. A majority of the patients were married and from rural areas.…”

“…Details of the study design and sample design, including inclusion and exclusion criteria, can be found elsewhere. 31 …”