Financial toxicity in cancer palliative care in India: Addressing existence and beyond – Seeking remedies for a balanced financial journey

Financial toxicity (FT) places a significant burden on individuals undergoing cancer care, leading to emotional distress, social isolation and financial burnout. In India, the growing number of cancer cases and the ever-expanding population, combined with insufficient government investment in public healthcare, inadequate insurance coverage, poor financial literacy among medical and non-medical communities and the lack of comprehensive financial planning exacerbate the financial difficulties faced by patients. This article aims to address FT as a source of suffering and explores potential frameworks and solutions for preventing and managing FT in patients undergoing cancer treatment and seeking palliative and hospice care in India. We conducted a literature search to review the burden of FT, across diverse healthcare settings for cancer patients. The prevalence of FT in cancer care ranges from 30% to 90.1% and is influenced by various socio-demographic, disease and healthcare-related factors. The sources of distress financing include consumption of savings, asset sales and borrowing, which add to the financial suffering. This interdisciplinary collaborative research paper highlights the dearth of financial literacy in our population and emphasises the pressing need to enhance financial awareness for healthcare professionals, cancer patients and their families. More than 30% of the Indian population lacks any form of insurance coverage, and many of those who do have it mostly lack 'adequate' coverage. We explore essential financial strategies, such as budgeting, expense analysis, asset consolidation, liquidity management, understanding estate planning tools and banking operations, streamlining paperwork, ensuring smooth transactions, adopting methods like low-interest loans and crowdfunding platforms, advance care planning, early palliative care ntegration and timely transition to hospice care. We also highlight the importance of available community resources, non-profit organisations, cancer foundations, health insurance and government support. Overall, integrating financial planning into cancer palliative care seems essential for reducing FT and enhancing the quality of cancer care in India. Further research on the topic is needed.