The Burden of Cancer Survivors in India: A Comprehensive Overview

Introduction:

Currently, over two million adults aged 45 and above in India live as cancer survivors, an unequivocal marker of progress in early diagnosis and treatment [1]. However, survivorship care remains nascent, leaving these individuals to grapple with a complex array of challenges. These include persistent physical aftereffects, psychological distress, economic hardship, comorbidities, and pervasive social stigma [2]. As India’s population continues to age and the number of survivors steadily grows, cancer survivorship is poised to become a critical public health priority, demanding a robust and integrated response from the healthcare system [3].

Furthermore, survivors are disproportionately drawn from wealthier, upper-caste, and urban groups, highlighting deep-seated disparities in access to timely diagnosis and treatment across the country. Interestingly, while more women survive cancer, men often face worse outcomes due to the typically late detection of lung and oral cancers [6]. A crucial factor influencing survival is a family history of cancer, which is associated with better outcomes, likely due to earlier screening and intervention efforts [7].

2. Physical Wellbeing and Pain Management:

In 2022, India recorded 1.41 million new cancer cases and a staggering 910,000 cancer-related deaths [8]. With a growing number of individuals surviving cancer, the focus has rightfully shifted to managing long-term physical complications that significantly impact their quality of life. Common issues include debilitating fatigue, chronic post-mastectomy pain, restrictive radiation fibrosis, and painful chemotherapy-induced neuropathy, particularly pronounced in low-resource settings where access to specialised care is limited [9-11].

The aftermath of surgery and radiation often brings side effects such as lymphedema and reduced mobility, necessitating extended and specialised rehabilitation [12]. The prevalence of comorbidities like diabetes, hypertension, and cardiovascular disease among survivors is also frequently observed, underscoring the critical importance of developing integrated chronic care models that address the full spectrum of a survivor’s health needs [13].

Effective survivorship care demands a truly multidisciplinary approach, involving oncologists, psychologists, physiotherapists, nutritionists, and social workers working in tandem [14]. Pain management, a cornerstone of physical well-being, should meticulously follow the WHO’s analgesic ladder, complemented by integrated therapies like yoga, acupuncture, and mindfulness practices [15, 16]. Despite these advancements, significant barriers persist, including high costs of care, limited accessibility in rural areas, and the enduring stigma associated with cancer, all of which hinder equitable access to essential services [15].

3. Psychological Wellbeing in Survivorship:

Beyond structured therapies, physical activity, particularly regular walking and yoga, offers profound physical and emotional benefits, acting as a powerful antidote to distress [23]. Holistic approaches like music and art therapy are also gaining traction, recognising the therapeutic power of creative expression [24]. To ensure comprehensive follow-up care, the adoption of standardised psychosocial screening tools like the Patient Health Questionnaire-9 (PHQ-9) and the Distress Thermometer is becoming increasingly vital, helping institutions identify and address psychological needs more systematically [25].

4. Global Models vs. Indian Practices:

Globally, many countries have established institutionalised survivorship frameworks that offer valuable lessons for India. In the United States, Survivorship Care Plans (SCPs) and dedicated survivorship clinics, epitomised by centres like the MD Anderson Cancer Centre, have become standard practice, providing structured long-term care [26]. The UK has notably implemented the NHS “Living With and Beyond Cancer” framework, a comprehensive strategy to support survivors throughout their journey. Meanwhile, Australia emphasises digital monitoring, vocational reintegration, and robust community-based care, showcasing diverse approaches to survivorship support [27, 28].

India, too, has initiated several commendable innovations. The Tata Memorial ACT Clinic stands out, offering long-term follow-up and crucial patient education. The PICASSO Project by the Indian Cancer Society provides invaluable psychosocial and vocational support, demonstrating a commitment to holistic care. Numerous Non-Governmental Organisations (NGOs) such as CanSupport, Yoddhas, and Sanjeevani also offer vital services, though their reach is often limited to urban centres and is heavily reliant on donor funding, highlighting a need for broader governmental integration.

To truly improve outcomes, India must strategically integrate survivorship care into the National Programme for Non-Communicable Diseases (NP-NCD). Leveraging the vast network of ASHA workers for rural outreach, providing comprehensive training to frontline healthcare staff in psychosocial care, and scaling up telehealth and AI-driven follow-up mechanisms are crucial steps. Equally important is dedicated funding for survivorship-focused research, especially among marginalised populations, to ensure tailored and equitable interventions.

5. Media’s Role in Cancer Survivorship:

However, the digital landscape is also rife with misinformation. Studies have shown that most cancer-related YouTube videos contain inaccuracies [30]. Unregulated content promoting “miracle cures” or pseudoscientific treatments, often termed ‘cancer quackery’, can dangerously delay effective medical care [31]. Compounding this issue, some celebrities continue to endorse carcinogenic products like pan masala, despite repeated warnings from health authorities, further muddying public understanding [32]. Moving forward, digital health literacy campaigns, stricter advertising laws, robust platform accountability, and authentic survivor-led storytelling are essential to reshape narratives and effectively counter misinformation, guiding the public toward reliable information and legitimate care.

 6. Challenges and Policy Gaps:

Despite commendable progress in cancer treatment, India currently lacks a formal, structured national policy dedicated to survivorship care. This absence manifests in several critical gaps: the lack of comprehensive national guidelines, a severe shortage of dedicated survivorship clinics, insufficient integration of mental health services into oncology care, fragmented data collection (often excluding crucial rural populations), and inadequate training of healthcare professionals in the nuances of survivorship care. These systemic challenges disproportionately affect rural and low-income survivors, who already contend with prohibitive costs, limited access to specialized services, and deeply entrenched societal stigma [1]. Addressing these gaps is paramount to ensuring equitable and effective long-term care for all cancer survivors in India.

7. Recommendations:

To address these multifaceted challenges, India must adopt a truly comprehensive approach to survivorship. Firstly, national guidelines must be developed, drawing inspiration from established international frameworks such as those provided by the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) [33, 34]. A crucial step will be making Survivorship Care Plans (SCPs) mandatory upon a patient’s discharge, ensuring a clear roadmap for post-treatment life. Furthermore, national health programs like the National Cancer Registry Programme (NCRP) and the National Programme for Non-Communicable Diseases (NP-NCD), along with expanding telemedicine networks, must explicitly include survivorship metrics to monitor progress and identify areas for improvement.

Oncology centres, nationwide, should significantly invest in integrated mental health services, recognising that psychological well-being is as crucial as physical recovery. Training curricula for healthcare professionals must be updated to comprehensively address survivorship care, equipping them with the necessary skills and knowledge. Critically, special funding should be allocated to research and support programs specifically targeting rural and marginalised survivor populations, ensuring that interventions are culturally sensitive and accessible. Finally, digital platforms can play an increasingly pivotal role in outreach, patient education, and fostering vital community-building among survivors, connecting them to resources and peer support regardless of their geographical location.

8. Conclusion:

India’s growing population of cancer survivors represents not just a pressing challenge but also a profound opportunity to redefine the nation’s healthcare priorities. A fundamental shift from merely “treatment to thriving” necessitates strategic investment in long-term care infrastructure, seamless integration of mental health services, innovative utilisation of digital tools, and comprehensive policy reforms. With the right frameworks in place and concerted, community-driven efforts, cancer survivorship can genuinely evolve into a central pillar of India’s healthcare system, ultimately offering a significantly better quality of life for millions.

References:

1. Guntupalli AM, Selvamani Y, Maclennan SJ, Dilip TR. Health status and associated factors of middle-aged and older adult cancer survivors in India: results from the Longitudinal Ageing Study in India. BMC Cancer 2022; 22(1): 1087.
2. Prasad M, Goswami S, Kurkure PA. The Care of Childhood Cancer Survivors in India: Challenges and Solutions. Indian J Med Paediatr Oncol 2024; 45(02): 167-172
3. Mathur P, Sathishkumar K, Chaturvedi M, Das P, Sudarshan KL, Santhappan S, Nallasamy V, John A, Narasimhan S, Roselind FS; ICMR-NCDIR-NCRP Investigator Group. Cancer Statistics, 2020: Report From National Cancer Registry Programme, India. JCO Glob Oncol 2020; 6: 1063-1075
4. Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 & projection for 2025: Result from National Cancer Registry Programme, India. Indian J Med Res. 2022 Oct-Nov;156(4&5):598-607
5. Raut J, Joshi A, Mudey A. Systems delay in women with breast cancer – A sequential explanatory mixed-methods study from central rural India. J Family Med Prim Care. 2024 Nov;13(11):5325-5333.
6. Pandey M, Anand A. Health and disability status among middle-aged and older adult cancer survivors: a case-control study. J Cancer Surviv. 2025 Feb;19(1):35-44
7. GBD 2019 India Collaborators. Cancer Burden in India, 1990–2019: Findings from the Global Burden of Disease Study. The Lancet Oncology 2020; 21(7): 885–900.
8. International Agency for Research on Cancer. (2021). India: GLOBOCAN 2020 fact sheet. Global Cancer Observatory. Retrieved from https://gco.iarc.who.int/media/globocan/factsheets/populations/356-india-fact-sheet.pdf
9. Choudhary S, Saxena AK, Bajaj M, Thakur A, Sonkar M. Persistent Chronic Pain in Cancer Survivors: An Update and Future Directions. Oncology Journal of India 2022: 6(3): 59-65
10. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US); 2011. PMID: 22553896
11. Mukherjee A, Sheth H, Ghosh S. Cancer and comorbidities in low- and middle-income countries: Need for integration of care. Cancer Research, Statistics, and Treatment 2024; 7(1): 135-136
12. Dhamija D, Chatterjee S, Goyal M. Exploring the Long-Term Consequences of Lymphedema on Functional Capacity and Daily Activities in Cancer Survivors. Int J Phys Med Rehabil 2024; 12: 719.
13. Wadasadawala T, Datta D, Puchali N, et al. Prospective Study of Incidence and Impact of Comorbidities on Breast Cancer Survival from India. Asian Pac J Cancer Prev 2023; 24(11): 3805-3814.
14. Alfano CM, Oeffinger K, Sanft T, Tortorella B. Engaging TEAM Medicine in Patient Care: Redefining Cancer Survivorship From Diagnosis. Am Soc Clin Oncol Educ Book 2022; 42: 1-11
15. Ramanjulu R, Thota RS, Ahmed A, et al. Indian Society for Study of Pain, Cancer Pain Special Interest Group Guidelines on Pharmacological Management of Cancer Pain (Part I). Indian J Palliat Care 2020; 26(2): 173-179.
16. Deng G. Integrative Medicine Therapies for Pain Management in Cancer Patients. Cancer J 2019; 25(5): 343-348.
17. Voskanyan V, Marzorati C, Sala D, et al. Psychosocial factors associated with quality of life in cancer survivors: umbrella review. J Cancer Res Clin Oncol 2024; 150(5): 249.
18. Mason A, Khan A, Nath D, Choudhury M, Sharma P. Prevalence and correlates of psychological distress among cancer patients in Northern India. Int J Community Med Public Health. 2019;6(5):2223–8.
19. Xu L, Guan A, Huang Y. Effects of online mindfulness-based interventions on mental and physical health outcomes in cancer patients: a systematic review and meta-analysis of randomised controlled trials. Medicine (Baltimore). 2025;104(12):e41870.
20. Goh CC, Gan XM, Klainin-Yobas P. Effectiveness of digital-based interventions on physical and psychological outcomes among cancer patients: a systematic review and meta-analysis. Semin Oncol Nurs. 2025;41(1):151796.
21. Zachariae R, O’Toole MS. The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients—a systematic review and meta-analysis. Psychooncology. 2015;24(11):1349–59.
22. Casellas-Grau A, Font A, Vives J. Positive psychology interventions in breast cancer. A systematic review. Psychooncology. 2014;23(1):9–19.
23. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–90.
24. Jethva DD, Manjunath KG, Lakshmi VA, Patil M. Music therapy in palliative care: a prospective study. Indian J Palliat Care. 2025;31:21–6.
25. Normen M, Sahaya FE, Kulkarni K, Vidhubala E, Shewade HD, Kathiresan J. Patients with cancer are distressed! Indian healthcare provider perspectives on distress screening and referrals to psycho-oncology services: a mixed methods study. Indian J Palliat Care. 2021;27(4):561–70.
26. Birken SA, Raskin S, Zhang Y, Lane G, Zizzi A, Pratt-Chapman M. Survivorship Care Plan Implementation in US Cancer Programs: a National Survey of Cancer Care Providers. J Cancer Educ 2019; 34(3): 614-622.
27. Jefford M, Rowland J, Grunfeld E, Richards M, Maher J, Glaser A. Implementing improved post-treatment care for cancer survivors in England, with reflections from Australia, Canada and the USA. Br J Cancer 2013; 108(1): 14-20.
28. Obeid LA, Dhillon HM, Tan SY, Vardy JL. Is there a need for change in cancer survivorship care? A qualitative exploration of survivor experiences and needs at the Sydney Cancer Survivorship Centre Clinic. Support Care Cancer 2023; 31(12): 642.
29. Lazard AJ, Meernik C, Collins MKR, et al. Social Media Use for Cancer Support Among Young Adults with Cancer. J Adolesc Young Adult Oncol 2023; 12(5): 674-684.
30. Loeb S, Sengupta S, Butaney M, et al. Dissemination of Misinformative and Biased Information about Prostate Cancer on YouTube. Eur Urol 2019;75(4):564-567
31. Delgado-López PD, Corrales-García EM. Influence of Internet and Social Media in the Promotion of Alternative Oncology, Cancer Quackery, and the Predatory Publishing Phenomenon. Cureus 201; 10(5): e2617.
32. Sushma C, Sharang C. Pan masala advertisements are surrogate for tobacco products. Indian J Cancer 2005; 42(2): 94-8.
33. National Comprehensive Cancer Network. 2018; https://www.nccn.org/
34. Smith TJ, Somerfield MR. The ASCO experience with evidence-based clinical practice guidelines. Oncology (Williston Park). 1997; 11(11A): 223-7.