Projected Cancer Burden, Challenges, and Barriers to Cancer Prevention and Control Activities in the State of Telangana

Background and Aim The Telangana cancer care program is a proactive, comprehensive initiative encompassing infrastructure development, human resource skilling and ensuring financial protection to those below poverty line. The broad aim of this exercise was to identify modalities to augment the Telangana State Cancer control Plan to implement a sustainable comprehensive cancer care model for Telangana. Methods We conducted in-depth interviews of stakeholders (17 patients and 25 providers) to identify barriers and challenges to access existing cancer care system; calculated the estimated magnitude of cancer and commensurate workload (in terms of visits to tertiary cancer care system for chemotherapy, radiotherapy, and surgery and human and equipment requirement) for the next 15 years (from 2021 to 2036). Using the anecdotal evidence and information from stakeholders’ interviews, we developed patient-journey funnels for cancer patients, which helped us to appreciate at what levels of care leakages occur. Results We estimated a 28% increase in the number of new cancer cases per year and the resultant workload: number of visits, chemotherapy, radiotherapy, surgeries, specialized human resources and equipment, from 2021 to 2036. Stakeholders mentioned delayed access to healthcare system as the main reason for the poor prognosis of patients. The common reasons cited for delayed access were: poor cancer-literacy including prevailing myths and misconception, financial barriers, and rural residence. Patient journey funnel for cancer care revealed major leakage from screened positive to diagnosis confirmation step. Patient leakage varies from ∼70% to 90% from screened positive till treatment completion. Conclusion Govt. of Telangana has initiated several measures to strengthen the healthcare system and to promote the uptake of cancer care services to manage the rising burden of cancer and resultant increasing workload. However, there is ample scope for further improvement (such as improved healthcare access, reduced patient leakage, commensurate human skills and infrastructure development etc.) to deliver comprehensive cancer care services in the state. Highlights ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement GVSM Funder: Roche India Health Institute, India NO - The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The project was approved by the Institutional Ethics Committee of the Indian Institute of Public Health – Hyderabad. Ethics no. IIPHH/TRCIEC/228/2020 December 11, 2020 I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable Data cannot be shared publicly because of Institutional Data Privacy Policies. Data are available from the Indian Institute of Public Health, Hyderabad Institutional Data Access / Ethics Committee (contact via email: nandu.k{at}iiphh.org) for researchers who meet the criteria for access to confidential data.