LAUSR

Abstract Background : Patients living below the poverty line in India have limited access to oncology services. Services at state run cancer hospitals are available exclusively in designated centers. Patients attending these nodal cancer centers have to travel long distances to avail treatment and follow up. Poverty, lack of social security and independence has a bearing on psychosocial wellbeing, which is already adversely affected by the diagnosis of cancer. Our study aimed to assess and compare the level of difficulty faced by those below as opposed to those above poverty line. Methods : Between September 2014 and February 2016, 1081 patients receiving chemotherapy at the daycare unit at this institute were assessed for distress during ongoing chemotherapy. Among these patients 648 patients were from below poverty line by national standards and 433 patients were above poverty line. The screening tool on distress management available from the NCCN guidelines on distress management was adopted for this study. Results : Among the patients below poverty line the modal distress score on a scale of 0–10, was 8, as opposed to the modal score of 6 among those above poverty line. Overall, 531 (81.94%) patients from the former group responded in the affirmative to questions related to practical problems, family problems and emotional problems. In this group 279 (90.87%) women reported the same. In contrast, 320 (73.90%) patients of the latter group responded affirmatively to these questions, with 175 (77.78%) women reporting the same. Conclusions : Patient Distress Score was higher in patients living below poverty line who had to travel far from their families for treatment. Overall, inconvenience was higher among women reflecting poorer social security and lower economic independence. Clearly, indices of psychosocial wellbeing need to be urgently added to existing measures of efficacy in national oncology programs. The absence of community based services, oncology nurses and accessible healthcare requires immediate attention.