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Efficacy of a cashless scheme in rural India to improve outcomes in head and neck cancer patients

Purpose: Treatment of head and neck cancer is toxic, costly, and challenging in underserved population of India; adherence to treatment is the key predictor of the outcome. Objective: The aim of this work was to study compliance with radiotherapy (RT) in beneficiaries of a cashless scheme, namely Mahatma Jyotiba Phule Jan Arogya Yojna (MJPJAY), and factors associated. Materials and Methods: Head and neck cancer patients eligible for curative intent RT and beneficiaries of the cashless scheme registered at a rural tertiary cancer center were included in the study. Noncompliance was studied for association with age, sex, stage of disease, primary site, distance to travel, radical surgery, concurrent or neo-adjuvant chemotherapy, poverty level, and education. Results: Of the 228 patients, 128 (56.14%) defaulted to start RT after approval of the package and 55 (24.12%) have completed treatment without a gap. Conclusion: A large number of patients are defaulting even after approval of the cashless package to initiate RT. Patients with early-stage cancer, who are undergoing radical surgery, with lesser distance to travel, with higher education, who are above poverty level are more likely to start treatment. Whereas employed patients, patients with lesser distance to travel, with higher education are more likely to complete their prescribed RT.