JMIR Publications

ABSTRACT

Background:

Cancer is a significant public health challenge in India, contributing to 8.3% of deaths and 5.0% of DALYs in 2016—nearly double its burden in 1990. Fragmented service delivery, limited specialist availability, late presentation, and significant financial hardship continue to hinder access to timely and effective cancer care, particularly in rural and underserved regions. National initiatives such as the NP-NCD and Ayushman Bharat have expanded diagnostic and treatment coverage; however, critical gaps remain in infrastructure, human resources, and quality of care. A comprehensive, system-level assessment is essential to inform evidence-based planning and strengthen cancer services nationwide.

Objective:

This study aimed to assess the availability, readiness, accessibility, and quality of cancer care services across primary, secondary, and tertiary healthcare facilities in India. Specifically, it evaluated infrastructure, human resources, diagnostic and treatment capacity, referral pathways, and service delivery across the six Institute of Medicine quality domains (equitable, effective, patient-centred, safe, efficient, and timely), compared rural–urban and public–private disparities, and used these findings to develop an evidence-informed framework for strengthening cancer care services and informing national policy and programme planning.

Methods:

A three-year cross-sectional descriptive study was conducted across 32 States and Union Territories using proportionate district sampling based on rural–urban population distribution. Nodal hospitals, preferably those hosting Hospital-Based Cancer Registries, coordinated data collection from primary, secondary, and tertiary healthcare facilities. Facility-level data were collected using standardised electronic questionnaires covering infrastructure, workforce, diagnostic and treatment services, referral systems, service utilisation, and quality-of-care indicators across the six Institute of Medicine domains. Data were entered through a secure web-based portal with centralised quality monitoring. Descriptive statistics were used to summarise service availability and readiness, while Chi-square tests were performed to compare rural–urban, public–private, and facility-level differences. The findings were synthesised to identify service gaps and develop recommendations for strengthening cancer care delivery and informing national policy.

Results:

A total of 6,896 health facilities (4,353 primary, 1,979 secondary, and 564 tertiary) from 352 districts across 31 States/Union Territories were assessed. The West and South consistently demonstrated greater availability of prevention, screening, diagnostic, treatment, multidisciplinary, survivorship, and patient safety services, while the North-East had the lowest availability across most domains. Urban facilities generally had better diagnostic and imaging capacity than rural facilities, and private tertiary hospitals reported greater availability of advanced diagnostics and specialised treatment services than public hospitals.

Conclusions:

This country-level assessment demonstrates substantial regional inequities in cancer care preparedness across India. Strengthening infrastructure, human resources, diagnostic and treatment capacity, particularly in underserved regions, is essential to ensure equitable access to comprehensive cancer care and to support progress towards universal health coverage.