Cancer care in India stands at a critical inflection point. Over the past decade, we have witnessed remarkable advances in diagnostics, molecular profiling, immunotherapy and targeted treatments. Survival outcomes in several cancers, including lung cancer, have improved meaningfully. Yet, one uncomfortable truth remains: access to these advances is still uneven. For too many patients, the quality of cancer care continues to be determined by geography.
India accounts for over 1.4 million new cancer cases annually and this number is projected to rise steadily by 57.4%. A significant proportion of patients present from semi-urban and rural districts, often travelling long distances to tertiary cancer centres in metropolitan cities. The journey is not merely physical, it is financial, emotional and social. Families relocate temporarily, incomes are disrupted and the burden on caregivers is immense. In many cases, treatment adherence suffers because the system is not aligned with the realities of patients’ lives.
Recognising this challenge, the recent Union Budget 2025–26 emphasised strengthening decentralised cancer care and announced the establishment of Day Care Cancer Centres in district hospitals. This is a forward-looking step. It signals an understanding that cancer care cannot remain concentrated only in apex institutes and big cities. For India to truly improve outcomes at scale, we must take care closer to patients.
Decentralisation is not simply about infrastructure. It is about rethinking delivery models. Traditionally, systemic cancer therapies have required prolonged intravenous infusions administered in well-equipped centres. While these remain essential in many scenarios, they can create bottlenecks in high-volume hospitals and require patients to spend several hours in infusion chairs. For patients travelling from smaller towns, each visit can mean a full day lost, if not more.
If district hospitals are to play a meaningful role in oncology, treatments must be adaptable to those settings. We need therapies that maintain clinical efficacy while being simpler and more efficient to administer. Innovations in drug delivery such as shorter administration formats and subcutaneous options, hold promise in this context. By reducing chair time and simplifying procedures, such approaches can ease hospital congestion, optimise staff utilisation and make it feasible for more centres to safely deliver advanced therapies.
From a patient perspective, multiple long hospital visits over months can erode quality of life. When treatment formats evolve to minimise this burden, the benefits extend beyond convenience; they improve adherence, reduce caregiver strain and allow patients to retain a sense of normalcy.
This is particularly important in cancers like lung cancer, where immunotherapy has transformed outcomes. As survival improves, our responsibility expands. We must ensure that life-prolonging treatments are not accessible only to those living within a short drive of tertiary centres. Decentralised delivery models can help bridge this gap.
Capacity-building will be key. Day Care Cancer Centres must be equipped not only with infrastructure but also with trained oncology nurses, pharmacists and physicians. When local teams are empowered, patients benefit from continuity of care within their communities.
However, decentralisation should not be misconstrued as dilution. The goal is not to fragment care but to extend its reach. Complex cases will continue to require specialised centres. What must change is the assumption that every component of cancer treatment requires metro-based infrastructure. With thoughtful integration of innovation particularly in treatment delivery formats, we can create a hybrid model that combines excellence with accessibility.
As oncologists, we are witnessing a paradigm shift. Scientific breakthroughs have extended survival and redefined hope for many patients. The next frontier lies in delivery innovation. By aligning therapeutic advances with system-level reforms, India has the opportunity to set a global example in equitable oncology care.
This article is authored by Dr. Vashishth Maniar, director, co-founder and cancer physician, M|O|C Cancer Care & Research Centre, Mumbai.
