Background
India faces a severe cancer burden, with over 70% of patients diagnosed at advanced stages. While structural and socioeconomic barriers to timely care are known, the influence of information asymmetry—disparities in health knowledge between patients and providers—remains understudied. This research examines how gaps in awareness, reliance on informal healthcare, and systemic communication failures delay diagnosis among patients with oral, breast, cervical, and lung cancers at Tata Memorial Hospital, Mumbai.
Objectives
This paper outlines a study protocol with the primary objective: To trace and typologize care-seeking pathways from symptom recognition to diagnosis, and assess how information asymmetry shapes these trajectories.
Methods
A mixed-methods study will be conducted at TMH. A sample of 400 patients (100 per cancer type: oral, breast, cervical, lung) and their caregivers will be enrolled. Structured surveys will capture symptom timelines, provider sequences, health literacy, trust in informal care, and communication experiences. In-depth interviews with a purposive sub-sample will explore decision-making, uncertainty, and reliance on non-formal providers. Data will be analyzed through pathway mapping, sequence analysis, and thematic coding.
Results
Based on existing literature, the study anticipates:
- Significant reliance on informal providers (traditional healers, chemists, unqualified practitioners) before accessing formal care.
- Extended care-seeking pathways involving 3–5 provider visits prior to diagnosis.
- Common misdiagnoses due to low suspicion and limited referral at primary levels.
- High out-of-pocket expenditure on non-curative treatments and repeated diagnostics.
- Delays influenced by low health literacy, cultural beliefs, and trust in traditional systems.
- Findings will inform targeted interventions to reduce delays:
- Community awareness campaigns tailored to local health beliefs and literacy levels.
- Training and sensitization of informal providers to recognize warning signs and refer appropriately.
- Strengthening primary care capacity for early suspicion and timely referral.
- Policy measures to streamline referral pathways and reduce financial toxicity in diagnostic journeys.
Pathways to cancer care in India