The Extent of Indebtedness among Breast Cancer survivors in India: A Prospective Longitudinal Study from a Tertiary Cancer Hospital

The study examines the extent of loans and debts by patients with breast cancer across different phases of their treatment in India. This study used primary data of 500 breast cancer patients who sought treatment during 2019 to 2023 at Tata Memorial Hospital, Mumbai, India. This study is registered on the clinical trial registry of India (CTRI/2019/07/020142) on 10/07/2019. Data on economic burden was collected at three phases: baseline or at the time of registration to the hospital, endline or after completion of treatment, and follow-up or after six months of post-treatment period. The outcome variables were the proportion of patients taken loan, loan sources, loan amount. Bivariate and two-part model was used to explore the determinants and estimate the amount of loan. The proportion of patients taking loans increased from 34.3% at baseline to 62.7% at endline and 67.9% at follow-up. Mean loan amount rose from ₹20,399 (9.2% of annual income) at baseline to ₹115,340 (47.4% of annual income) at follow-up. Younger patients, those with lower education, lower income quintiles, and rural residence were more likely to take loans. Loan sources shifted from friends and relatives at baseline to moneylenders at endline and follow-up. Significant factors influencing loan amount included income quintile, distance to the treatment center, marital status, and stage of cancer. As the treatment progresses, increase in loan amount and the shifts towards informal, high-interest lending sources are alarming concerns. These findings highlight the need for improved financial protection mechanisms and targeted support for vulnerable cancer patients to prevent medical impoverishment. • This study highlights one of the most important but often neglected measures of economic burden among cancer patients, loan and debt accumulation. • The proportion of patients taken loan has increased from 38% in baseline to 65% in endline and 69% in follow-up period. • The mean amount of loan has increased from 9% of annual income to almost 50% of annual income in subsequent treatment period. • Family and friends were the main source of loan in baseline while it got repla