Out-of-Pocket Expenditure for HNF Palliative Care Among Cancer Patients in the Urban Centre of Hyderabad: A Cross-Sectional Study

A BSTRACT Background: Out-of-pocket expenditure (OOPE) remains a major barrier to accessing timely and quality palliative care services in India, particularly among low-income urban populations. Limited public funding for home-based palliative care further exacerbates the financial burden on families. Objective: To estimate the OOPE for home–nursing–family palliative care among cancer patients and examine the association of expenditure patterns with sociodemographic factors. Materials and Methods: A hospital based cross-sectional study was conducted among 400 cancer patients receiving palliative care from a governmental tertiary care center in Hyderabad. Data on direct medical, non-medical, and indirect costs were collected using a semi-structured questionnaire. Results: The median total monthly OOPE was ₹4240, with direct non-medical expenses (transportation and caregiver wage loss) forming the bulk of the costs. Higher expenditure was significantly associated with advanced-stage cancer and the absence of government financial assistance ( P < 0.05). Female patients and lower socioeconomic strata were more likely to experience catastrophic health spending. Conclusion: Cancer patients receiving palliative care in Hyderabad face substantial OOPE, mainly driven by non-medical costs. Strengthening financial protection mechanisms and expanding public funding for community palliative services is crucial.