The cost of weak cancer policies

India’s cancer crisis is not defined by a lack of science. The drugs, treatments and expertise exist. And yet, patients are dying—because the system refuses to let them access it. This is not a story about affordability alone. It is a story about denial.

Consider a 57-year-old woman diagnosed with gallbladder cancer. Her tumour mutation required a targeted therapy drug, Selumetinib, where conventional treatments had failed. But the drug was never administered because the government health insurance scheme did not cover it. The very treatment that could have helped her was kept beyond reach. She died waiting—not for science to catch up, but for policy to allow it.

Then there was a 50-year-old woman with lung cancer. Her doctors recommended Osimertinib, a breakthrough treatment that conventional chemotherapy fails to give. This drug was particularly promising because it has the ability to cross the blood-brain barrier and reach the brain tumour site. The approval never came at the right time.

At what point did we decide that survival should be subject to paperwork? Regulation is necessary, but if there is a weapon that could help a patient fight, who are we to withhold it?

The inequities run deeper still. A modest painter from Raichur—someone who spent his life bringing colour to other people’s homes—was diagnosed with rectal cancer. He began treatment in Bengaluru but eventually stopped coming because he ran out of the means. Each trip meant lost wages, travel, accommodation costs, and the slow erosion of his family’s financial stability. For him, cancer was not just a disease; it was an economic death sentence.

India prides itself on flagship health insurance schemes—the Central Government Health Scheme (CGHS), Employee State Insurance (ESI), and Ayushman Bharat. The system claims political victory, boasting about its coverage under the schemes. But what is the value of “coverage” if it excludes the very treatments that define modern cancer care? Immunotherapy, targeted therapy, genomic testing, PET-CT scans—these are no longer luxuries. They are the standard of care. And yet, for most Indians, they remain out of reach.

Every day, patients walk into hospitals believing they will receive the best possible care. What they do not see are the invisible barriers—policy restrictions, reimbursement ceilings, and bureaucratic approvals—that quietly determine their fate. So we must ask: Are we truly caring for our patients or hoodwinking them? Are we treating cancer, or are we merely managing it within administrative limits?

Because there is a difference between what patients deserve and what they receive. And that gap is costing lives.

The above examples are not isolated cases but a representation of several patients across hospitals. Patients trust the system to provide them with the best possible care. The doctors are well-trained and have the knowledge to deliver the right treatment, but their hands are tied. Between the two, an invisible hand called ‘policy’, ‘regulation’ and ‘financial constraints’ decide who receives what.

Personalised medicine is the future of cancer care, and denying it on bureaucratic grounds only stalls progress. We urge the authorities to reconsider their approach, to listen and to allow innovation to reach those who need it the most.

India needs to move beyond symbolic health coverage and commit to genuine universal healthcare—one that reflects the realities of modern medicine. Introducing co-payment models for high-cost therapies can expand access without overwhelming public finances.

We need to establish structured multidisciplinary bodies involving the treating oncologist/physician, the medical officer in charge, and relevant authorities. These discussions should integrate value-based medicine principles, healthcare cost-benefit analysis, and universal health coverage perspectives. Decisions should be made on a case-by-case basis, considering both the potential clinical benefit and the family’s emotional and financial considerations. There must be regular audits to ensure that approved treatments are delivered judiciously and align with clinical best practices.

The question is no longer whether India can afford to do this. It is whether it can afford not to. Because when a patient dies despite the existence of a viable treatment, it is not just a personal tragedy. It is a systemic failure.

(The writer is a doctorpreneur, oncologist, and chairman of a cancer hospital chain)