Background
Hospital-Based Cancer Registries (HBCRs) play a critical role in cancer surveillance in low- and middle-income countries (LMICs), particularly where population-based cancer registries have limited coverage. Despite their importance, many HBCRs in LMICs face persistent challenges related to sustainability, data quality, workforce capacity, and digital integration. In India, HBCRs form the backbone of institutional cancer surveillance, yet their performance remains uneven due to structural and policy-level gaps. Translating empirical evidence into actionable policy guidance is therefore essential to strengthen HBCRs and align them with national cancer control and digital health initiatives.
Objectives
To document evidence-based policy and practice recommendations for strengthening and digitalizing hospital-based cancer registries in India, drawing on convergent evidence from a systematic review, qualitative empirical studies, and policy analysis.
Methods
This study synthesizes findings from three interrelated research components: (1) a systematic review examining the operational feasibility of HBCRs in LMICs; (2) a phenomenological qualitative study exploring stakeholder experiences and challenges in HBCR implementation in Eastern India; and (3) an ethnographic study of two active hospital-based cancer registries. Using a triangulation approach, evidence across these studies was integrated to identify recurring system-level constraints, enabling factors, and implementation practices. These findings were translated into policy-oriented recommendations using an evidence-informed health systems strengthening framework.
Results
The integrated analysis identified key policy-relevant domains influencing HBCR performance: workforce capacity and training, institutional governance and accountability, digital infrastructure and interoperability, data quality assurance mechanisms, and sustainable financing. Active and functional registries demonstrated strong clinical leadership, integration of registry activities within routine clinical workflows, and adaptive use of digital tools. In contrast, underperforming registries were characterized by fragmented responsibilities, limited policy prioritization, and inadequate institutional support. The findings highlight that digitalization alone is insufficient without parallel investments in human resources, governance structures, and continuous capacity building.
Conclusions/Implications
This study proposes a set of evidence-based policy and practice recommendations to strengthen HBCRs in India, emphasizing digital integration, protected financing, workforce development, and alignment with national initiatives such as the Ayushman Bharat Digital Mission. The recommendations are grounded in empirical evidence and stakeholder experiences, offering a scalable framework applicable to comparable LMIC settings. Strengthening HBCRs through context-sensitive policy action can enhance cancer surveillance, support evidence-based planning, and contribute to broader cancer control efforts in resource-constrained health systems.