According to the World Health Organization (WHO), cancer is the second leading cause of death globally, with approximately 70% occurring in Low- and Middle-Income Countries (LMIC). India’s cancer scenario is burdened with oral cavity cancer being the most common among men. In fact, India accounts for almost a third of the global incidence and mortality related to oral cancer.
While significant advances have been made in diagnosing and managing oral cancers, the increasing treatment costs have created a financial strain on healthcare providers and patients alike. The direct and indirect expenditures not only affect individuals but also their families and supporters, pushing the economically disadvantaged further into a debt-cycle and poverty. Moreover, these cancers are becoming increasingly common among the younger age groups, in contrast to the western world, which can put a significant strain on the productivity of the economy.
Tata Memorial Centre’s efforts can now provide in-depth information on the productivity loss resulting from premature mortality of oral cancer that can assist policy makers in planning disbursements more effectively. In a country where the affordability gap is wide, these results are important to deliver a disease-driven, objective strategy for oral cancer care.
To tackle these issues, Dr. Pankaj Chaturvedi, Director, ACTREC, and his team set out to conduct research that determine the economic lost due to premature mortality related to oral cancer in India based on a long follow up. This is the first such study in India and among a handful globally, whose estimates were calculated utilizing real time patient data that was collected prospectively for up to 3 years. This enormous data collection has resulted in determining the the total lost productivity due to premature mortality related to oral cancer, i.e., per patient loss to society due to non-participation directly attributable to oral cancer.
Dr Arjun Singh, Assistant Professor at Tata Memorial Hospital and the lead author of the study said that the 671 years were lost to early (29.8%) and advanced cancers (70.2%). Considering the retirement age in India being 62 years, 91% of the deaths or uncurable recurrence of caners were in the premature age groups, with a median age of 41.5 years. Both early (70%) and advanced (86%) stage cancers, were from a middle-class socioeconomic status, with 53% requiring some form of insurance schemes or financial support in order to complete treatment. The productivity lost due to premature mortality was calculated using a method known as human capital approach. In most economic studies, assumptions are considered for market wages and other indicators during calculations. This is one of the few studies where individual patient data (including market and non-market contribution, socioeconomic status, education level, etc.) was gathered prospectively and over a long time period. Their results were in line with the national labor force participation (48%) and unemployment rates (7%) as reported by the National Sample Survey Office (NSSO), India. Productivity lost due to premature mortality among females and males was INR 57,22,803 INR and INR 71,83,917, respectively per death.
The loss of productivity to society was 31,29,092 INR/per early-stage and INR 71,72,566 per advanced-stage cancer. Based on the death rates in the population, these results show that the total cost of lost productivity due to premature oral cancer mortality in India in 2022 was $5.6 billion, representing 0.18% of the combined gross domestic product. These results underestimate the impact of variability in treatments and its access that exists across the country. While population data has been derived from an internationally validated registry, the GLOBOCAN, the true burden might be much more as the population coverage in low- and middle-income countries is estimated to represent less than ten percent of the actual population.
Due to the younger age of initiation of tobacco and areca nut usage in India, oral cancers tends to develop in younger individuals as well. This leads to devastating consequences for individuals, families, society and the economy. Tailored prevention policies that target this young age group are needed to be implemented. Screening and early detection strategies among high-risk groups need to be prioritized. Such programs have been difficult to implement in many countries due to a lack of infrastructure and resources, including the availability of treatment for those identified with any suspicious lesions. These differences in access to treatment result in productivity losses.
Dr Sudeep Gupta, Director, Tata Memorial Centre said "As per the latest GLOBOCAN statistics, the proportion of deaths from oral cancer were 55% of the oral cancers diagnosed, making it a real public health crisis. The gross lack of awareness, fear, and misconceptions surrounding oral cancer lead to a large number of cases being diagnosed at a late-stage, contributing tothe high mortality rates. Even those who receive timely treatment in these advanced stages often face complex surgeries and reduced quality of life, impacting their ability to contribute to society." With oral cancer being the most common cancer among males in the country, accounting for one-third of the global burden, the impact on individuals, families, and the economy is staggering.
Dr R. A. Badwe, senior author and Ex-Director, Tata Memorial Centre, added that “Very few studies have focused on productivity losses of cancer in low resource settings and in particular in India to understand the broader economic impact. In order to inform policy-makers decisions around resource allocation we undertook at study and extrapolation to estimate the overall economic costs of oral cancer in India due to premature mortality.”
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