Non-financial barriers drive oral cancer treatment deferral despite free care in rural Northeast India

This is the authors' abstract. We don't add key points for this paper.

Community-based screening programs for oral precancerous lesions and cancer in low- and middle-income countries frequently encounter high rates of treatment deferral, even when treatment costs are covered. This study examined sociodemographic characteristics and patient-reported reasons for deferral among screen-positive individuals in rural Assam, India, to examine the reasons for treatment deferral which persisted following the provision of financial support for care. A comparative cross-sectional study was conducted in the Katlicherra Health Block of Hailakandi District of Assam, a remote region in the northeastern part of India. Simple random sampling was done to select 107 individuals who deferred treatment and 107 who completed the treatment within the same period. Trained investigators administered a structured questionnaire via telephone or in-person interviews to collect sociodemographic data and, for the deferred group, reasons for non-completion. Data were analysed using chi-square tests and Mann-Whitney U tests (significance at p < 0.05). No significant sociodemographic differences were observed between the deferred and completed-treatment groups in age, sex, annual income, or literacy ( p > 0.05). A higher proportion of confirmed cancers (versus precancerous lesions) was noted in the deferred group (22.6% vs. 10.3%, p = 0.073). Among deferrers, patients who dropped out at the tertiary center were significantly older than those deferring at the subcenter level (29.6% vs. 7.5%, p = 0.003). The most frequently cited reason for deferral in both groups was denial of symptoms (58.5% subcenter; 40.7% tertiary), followed by seeking treatment elsewhere (28.3% vs. 38.9%), preference for alternative medicine (15.1% vs. 29.1%), and family resistance (5.7% vs. 24.1%). Logistical and purely financial barriers (travel costs, documents for support schemes) were reported by < 2% of participants. Perceptual, cultural, and psychosocial factors, particularly the denial of initial symptoms, predominate as reasons for treatment deferral, even when financial support is available. Older patients face heightened barriers at the tertiary level. Strengthening patient navigation, family-inclusive counselling, and targeted health literacy interventions is essential to convert early detection into timely treatment and improved survival in high-burden rural settings.