Healthcare-seeking pathways and out-of-pocket expenditure amongst patients attending a tertiary care government medical college in Eastern India

Background: Cancer care imposes substantial financial burden on patients and their families, even when treatment is received at government-funded institutions. This study assessed healthcare-seeking pathways and Out-of-pocket expenditure (OOPE) among cancer patients attending a tertiary care government medical college in Eastern India. Methods: A hospital-based cross-sectional study was conducted among 200 patients with pathologically confirmed malignancies attending the Department of Radiation Oncology of a tertiary care government medical college in West Bengal between 1st August, 2024 and 31st July, 2026. Data were collected using a semi-structured, pre-validated questionnaire, supplemented by clinical and treatment records. Results: Of the 200 patients, 54% were female and the median age was 56 years. Most patients had a median monthly household income of ₹12,000. Breast cancer was the most common malignancy (30%). Overall, 76% patients reported a direct healthcare pathway. 64% percent of patients were referred outside the study centre, including 54% outside the city and 10% outside the state. The median total OOPE was ₹95,000. OOPE differed significantly according to referral status, with median expenditure increasing from ₹70,000 among non-referred patients to ₹1,00,000 among those referred outside the city and ₹3,00,000 among those referred outside the state (P<0.001). OOPE also different significantly across primary disease groups (P<0.001). Conclusion: Despite treatment at a tertiary government medical college, cancer patients experience substantial OOPE and financial distress. Strengthening comprehensive surgical, radiotherapy, diagnostic, and supportive cancer services at tertiary government institutions, together with effective financial-risk protection, may help reduce the economic burden on patients and their families.