Critical Roadblocks Along the Cancer Care Pathway in India: A e-Delphi Study

Abstract Background: Cancer is a major global public health concern and a leading cause of mortality. High mortality rates are often attributed to delays in seeking treatment and low participation in screening programs. While cancer care pathways are designed to reduce discontinuities in care, studies identifying critical roadblocks along these pathways are limited. This study aims to identify the most significant barriers to effective cancer care in India. Methods: An e-Delphi study was conducted. Following an international systematic literature review and expert consultation, 27 barriers across six domains were identified. These barriers were sent to experts for evaluation, and the top 10 highest-ranked barriers from Round 1 were evaluated for consensus in Round 2. The proportion of experts prioritizing each barrier within their top 10 choices was calculated and expressed as percentages, with consensus defined as agreement by more than 66% of experts. Results: Of the 495 invited experts, 27 completed Round 1, and 20 of these completed Round 2 (74% retention). Financial barriers were identified as the most critical roadblock, followed by geographical barriers, lack of information, and spiritual beliefs affecting the cancer care pathway. Conclusion: This study identified financial constraints as the primary barrier to the cancer care pathway, followed by geographical challenges, including distance from cancer centers and limited transport availability. Lack of information about cancer symptoms, signs, and treatment options also emerged as a significant barrier.