1745P - Why do adult patients with cancer abandon treatment in India? A nationwide qualitative study to understand the perspectives of healthcare workers

Background

Treatment abandonment (TA) is a major challenge in cancer care leading to poor outcomes and wastage of resources. Reasons for TA are multi-factorial and country specific. Understanding these complexities is the first step toward developing effective strategies for the prevention of TA. Insights and experiences of healthcare workers (HCWs) can provide valuable information about the factors contributing to TA; hence we conducted a qualitative study to understand the issues.

Methods

The participants were purposively selected, experienced HCWs (N=30) treating cancer patients from high-volume cancer centres nationwide. In-depth interviews (semi-structured, open-ended) were conducted by a person trained and experienced in qualitative interviews to understand the perspectives of HCWs on TA among adult cancer patients. We used the grounded theory approach to thematically analyze the data using inductive analysis.

Results

The HCWs (oncologists=17, nurses=6, psycho-oncologists=3, counselors=4) were selected from 9 states of India representing all geographical regions and working in both private (paid services, N= 14) and government (free services, N=16) sectors. The average duration of the interview was 30 minutes, and the reasons for TA perceived by the HCWs were classified under 6 themes: 1) Socio-demographic, 2) Patient-specific, 3) Clinical, 4) Psychological, 5) Health system related, and 6) Economic factors. Catastrophic health expenditure, direct medical and/or non-medical costs, indirect medical costs, poor socio-economic status, lack of specific knowledge about disease and treatment, poor patient-provider communication, accessibility, psychological distress, and toxicities of treatment were the common reasons for TA cited by the HCWs.

Conclusions

The study is one of the first studies reporting on HCWs’ perspective on TA among cancer patients in India. In addition to well-known socio-economic factors, this study identified important themes such as lacunae in communication and psychological issues (e.g., distress) causing TA. The results of this study will help plan quantitative research into the complex issues of TA and interventions to counter the problem.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

P. Ganesan.

Funding

Indian Council of Medical Research-ICMR, New Delhi, India.

Disclosure

All authors have declared no conflicts of interest.