Barriers in quest for cancer care access in two states of northeast India.

BACKGROUND: The cancer burden in northeast India is high, with low survival and low case detection. Despite the availability of cancer institutes in the region, existing literature remarks on the increasing travel outside the region for cancer care. However, research is sparse on identifying impediment factors to the access of state cancer institutes. OBJECTIVE: To examine the barriers to cancer care in five common cancer sites: oral, lungs, stomach, breast and cervix. METHOD: Following a descriptive multiple-embedded case study design integrating quantitative and qualitative approaches, 388 participants were selected in phase one by stratified random sampling. In phase two, by purposive sampling, 21 semi-structured interviews were conducted. RESULT: The result suggests that family decision is the central factor in cancer care access. Treatment initiation is delayed because the existing government health insurance scheme does not cover diagnostic tests. Adverse steps are taken to fund cancer treatment. Besides, opting for alternative medicines were due to fear of surgery, chemotherapy and recommendations by relatives. Arranging accommodation, transportation and infrastructure shortage was another hurdle. In contrast, the lack of awareness of the state cancer institutes was a barrier to its access. CONCLUSION: This paper identifies and describes factors that hinder access to state cancer institutes. The findings could enhance policy interventions for efficient cancer care access in the region. Integration with NGOs working at the state level for cancer services would support ease of access by providing funds for diagnostic tests, accommodation and transportation, especially for those who cannot afford it.

Mapping Choice of Healthcare Institutes for Cancer Care: A Study in Northeast India.

OBJECTIVE: To map and identify the sequence of visitation to institutes by patients with common cancers. METHODS: This paper used a mixed method to follow a descriptive multiple-embedded case study. Participants selected in phase one were 388 by stratified random sampling, and in phase two, by purposive sampling, a semi-structured interview was conducted for 21 participants (15 participants and six key informants-oncologists: radiation - 2, medical - 2, surgical - 1 and gynaecology - 1). Ethical clearances were received from the study institutes. Informed consent was obtained from the participants. RESULTS: Sparse research exists on mapping and choices of healthcare settings by cancer patients from northeast India. The main finding comprises a vivid overview of the decisions taken by cancer patients to get their necessary treatment based on all factors mitigating and inhibiting. Up to five hospitals for cancer treatment across the country. Private hospitals were preferred on the first visit by 74 percent (287), followed by the government by 26 percent (101); this, however, changes in subsequent hospital choices, with the latter preferred over the other, which could be due to the long duration of cancer treatment that is directly influenced by the paying capacity of the individual. Visitation was not limited to famous cancer hospitals, but few participants reported accessing herbal medicines, Ayurveda and Homoeopathy. CONCLUSION: Mapping patient choices of cancer institutes by patients from northeast India is essential as the challenges faced are unique to the region. By mapping patient choices of cancer institutes, insights into the preferred healthcare facilities can influence policies to improve the accessibility of cancer facilities. Findings from this study can support improving access to quality healthcare services, promoting cultural sensitivity, enhancing the quality of care, and informing policy planning and resource allocation.