Situational Analysis of Cancer Care Services in India: Protocol for a Nationwide Cross-Sectional Health Systems Study.

Abstract

Background: Cancer is a significant public health challenge in India, contributing to 8.3% of deaths and 5.0% of disability-adjusted life years in 2016-nearly twice its contribution 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. A comprehensive, system-level assessment is essential to inform evidence-based planning and strengthen cancer services nationwide.

Objective: This study aims to assess the availability, readiness, accessibility, and quality of cancer care services across primary, secondary, and tertiary health care facilities in India. Specifically, it will evaluate infrastructure, human resources, diagnostic and treatment capacity, referral pathways, and service delivery across the 6 Institute of Medicine quality domains (equitable, effective, patient-centered, safe, efficient, and timely); compare rural-urban and public-private disparities; and use these findings to develop an evidence-informed framework for strengthening cancer care services and informing national policy and program planning.

Methods: A 3-year cross-sectional descriptive study was conducted across 31 states and union territories using proportionate district sampling based on rural-urban population distribution. Nodal hospitals coordinated data collection from primary, secondary, and tertiary health care facilities. Facility-level data were collected using 3 standardized electronic forms-developed separately for primary, secondary, and tertiary levels of care-covering infrastructure, workforce, diagnostic and treatment services, referral systems, and service. Descriptive statistics will be used to summarize service availability and readiness, and chi-square tests to compare rural-urban, public-private, and facility-level differences.

Results: The study received funding in October 2023. Facility-level data collection took place between July 2024 and March 2026. We enrolled 6896 health facilities (4353 primary, 1979 secondary, and 564 tertiary) from 352 districts across 31 states and union territories, with participation rates of 64.6% (4353/6735) for primary health centers, 75.7% (1979/2612) for secondary-level facilities, and 63.9% (564/902) for tertiary hospitals. Data cleaning and quality checks are complete, and analysis is complete but unpublished; we will report results on service availability, readiness, and regional variation separately.

Conclusions: This nationwide assessment is expected to provide one of the most comprehensive evaluations of cancer care preparedness undertaken in India. Findings are anticipated to inform national policy and program planning, including investment priorities under the NP-NCD, Ayushman Bharat, and related initiatives to support progress toward equitable, comprehensive cancer care and universal health coverage.