CatastROphic expenditure among COlorectal cancer patients in InDIa and barriers for treatment compLiancE (CROCODILE)

Research topic and its relevance:

Little is known about colorectal cancer treatment delivery in India and the associated costs. The aim of this study is to identify financial and non-financial barriers for colorectal cancer treatment compliance in India.

Financial protection is one of the global health priorities defined by the WHO (Sustainable Development Goal 3.8) and mitigating against catastrophic expenditure has also been prioritised by the Lancet Commission on Global Surgery.

Study Design:

CROCODILE is a mixed-methods study including

  • 1. A quantitative workstream: prospective cohort feasibility study to assess catastrophic expenditure and treatment compliance rates among colorectal cancer patients in four hospitals in India.

  • 2. a qualitative workstream: to explore patients and professionals perspectives on barriers and facilitators for treatment compliance.

Methodological details:

Quantitative workstream: Catastrophic expenditure will be defined as treatment cost being higher than 40% of non-subsistence household income. Treatment costs will include medical, non-medical and indirect expenses. Income assessment will be compared between three methods: patient-reported income, through the International Wealth Index and through the Gapminder tool.

Qualitative workstream: individual semi-structured interviews will be performed with colorectal cancer patients and cancer care professionals. A framework analysis will be performed from the raised categories.

The results will be triangulated with the quantitative workstream for mutual knowledge enrichment.

CROCODILE within the NIHR Global Health Research Unit on Global Surgery:

The feasibility of catastrophic expenditure data collection will be tested in this study, to inform future larger scale studies on the topic. It will also generate pilot work in the India setting, to be used in policy informing studies through modelling or other methodologies.