Cancer care medical tourism in the national capital region of India - Challenges for overseas patients treated in two private hospitals.

Objectives The purpose of this study is to analyze the challenges that overseas cancer patients face while receiving treatment in a Tier 1 city in India. Methods A total of 2835 overseas patients from 55 countries received cancer treatment in two hospitals in Delhi, India between November 2013 and April 2019. Of these, 937 patients participated in a 30-point questionnaire on patient reported outcomes. The questionnaire included clinical information, difficulties, expenditure, financial toxicity (FT), education, profession/earning, family/emotional issues, and the reason for the choice of Delhi. Results Patient population consisted of 1149 and 1686 males and females with a mean age of 46.8 ± 18.7 years. Patients came from countries spread across four geographical regions, namely Asia (19 countries), Europe (4), Oceania (8), and Africa (23). The two most prominent reasons for overseas treatment were (1) unreliable medical service at home or in nearby countries and (2) non-availability of the medical services in the home country. 14.9% of the patients had metastatic disease. Of the 55 countries in total, 15 did not have any inland radiotherapy facility. The average number of caregivers was 1.3. The average treatment cost, travel cost, and one month accommodation cost for 2.3 people were 10.1 ± 9 thousand, 4.3 ± 2.9 thousand, and 1.6 thousand United States dollars, respectively. While 116 (13.4%) patients reported an ignorable financial burden, the rest (86.4%) reported moderate to extreme financial distress. Among the financially distressed patients, 35% had exhausted their lifetime savings. All patients in this category reported compromised lifestyle in terms of food and treatment of other chronic diseases for themselves and family. Conclusion Patients from other countries coming to Delhi for cancer management travel long distances in search of reliable medical services. In the process, many patients and their families exhaust their finances, leading to lifetime financial distress. Lay Summary Traveling of cancer patients to another country for treatment (migration) is a worldwide problem. This is due to the lack of reliable medical facilities in the home and nearby countries, or the desire for better treatment. Cancer patient migration often produces several problems, which include family and emotional issues, financial difficulties, profession/earning and problems associated with travel to other countries. A total of 937 cancer patients from 55 countries belonging to four continents (Africa, Asia, Europe, and Oceania) were interviewed on a 30-point questionnaire about these difficulties and the reason for their choice of an overseas destination for cancer treatment. It was found that the most significant problems contributing to cancer patient migration were the lack of comprehensive cancer care facilities and reliability of the existing facilities.  Around 15% of migrated patients had terminal diseases with limited life expectancy. This study, first of its kind, identifies problems associated with overseas cancer patients and quantify them.