Background: Treatment initiation and abandonment due to financial constraints remains a major yet under-recognized barrier to cancer control in low- and middle-income countries (LMICs). While hospital-based cancer registries (HBCRs) generate extensive real-world clinical data, they are rarely leveraged to identify and correct systemic failures in access to care. At tertiary cancer centres, the gap between diagnosis and treatment initiation often remains invisible without structured registry analysis.
RGCIRC, New Delhi a 500-bed tertiary cancer hospital and one of the largest in Asia, has maintained one of India’s longest-running HBCRs for over 26 years. Systematic analysis of this registry revealed that nearly 40% of diagnosed patients were unable to initiate or complete treatment, primarily due to financial constraints rather than medical ineligibility. Recognizing this as a measurable policy and health-system failure, RGCIRC transformed its HBCR from a passive surveillance tool into an operational driver of equity-oriented intervention.
Methods
A retrospective analysis of HBCR data from 1996 to December 2022 was conducted to evaluate demographic, geographic, and clinical characteristics of all registered patients.Registry evidence was integrated with institutional programmatic, governance, and financial datasets following the establishment of a dedicated Philanthropic Department in 2019, operating under a Public–Private–Philanthropy (PPP) model with a vision of the that no patient is denied cancer treatment due to lack of funds, and no patient abandons treatment because of financial hardship. Registry guided risk stratification informed eligibility, prioritization of vulnerable groups, partner engagement, and accountability mechanisms bridging clinical evidence with operational and policy decision-making.
Results
Over 26 years, 313,338 patients were registered, including 228,152 (72.8%) confirmed malignant cases. Patients originated predominantly from Delhi (41.7%), Uttar Pradesh (21.1%), and Haryana (12.8%), with a progressive shift toward extra-regional referrals, reflecting expanding institutional reach. Males constituted 56.1% of cases, and the highest cancer burden was observed in the 50–64-year age group.
 
Prior to 2019, treatment initiation and abandonment affected approximately 40% of patients due to financial and access barriers. Following integration of registry intelligence into a dedicated philanthropic PPP framework, treatment initiation and continuation improved substantially, with abandonment due to lack of funds reduced to minimal levels by 2024. Between 2019 and 2024, the number of funding partners increased from 4 to 16 (300% growth), including government Schemes (PMRF, CMRF), public sector undertakings , NGOs and crowd-funding platforms, with active collaboration across 22 partners. During this period, the number of patients financially supported rose from 913 to 1,669 (83% increase), while annual funds mobilized increased from INR 172.24 million to INR 541.45 million (214% growth). Pediatric oncology and other high-vulnerability cohorts were prioritized using registry-guided risk stratification.
Conclusions
This 26-year HBCR experience demonstrates how cancer registries can evolve into instruments of health system reform. By embedding registry data into financing decisions, governance, and accountability mechanisms, RGCIRC established a model where no patient is denied or abandons cancer treatment due to lack of funds. This registry-driven PPP philanthropic framework offers a scalable, WHO-aligned model for advancing equitable cancer care and reducing financial toxicity across LMICs.

Swarnima