Denied, Delayed, Dead

By Dr. B.S. Ajaikumar

India’s cancer crisis is not defined by a lack of science. The drugs, treatments and expertise exist. And yet, patients are still dying — because the system refuses to let them access it. This is not a story about affordability alone. It is a story about denial.

Consider a 57-year-old woman diagnosed with gallbladder cancer. Her tumour mutation required a targeted therapy drug, Selumetinib, where conventional treatments had failed. But the drug was never administered because the government health insurance scheme did not cover it. She died waiting — not for science to catch up, but for policy to allow it.

Then there was a 50-year-old woman with lung cancer. Her doctors recommended Osimertinib, a breakthrough treatment that conventional chemotherapy fails to give. The approval never came at the right time.

At what point did we decide that survival should be subject to paperwork? Regulation is necessary but if there is a weapon that could help a patient fight, who are we to  withhold it?

The inequities run deeper still. A painter from Raichur — someone who spent his life bringing colour to other people’s homes — was diagnosed with rectal cancer. He began treatment in Bengaluru but eventually stopped coming because he ran out of the means. Each trip meant lost wages, travel, accommodation costs and the slow erosion of his family’s financial stability. For him, cancer was not just a disease; it was an economic death sentence.

India prides itself on flagship health insurance schemes — CGHS, ESI, Ayushman Bharat. But what is the value of “coverage” if it excludes the very treatments that define modern cancer care?

Immunotherapy, targeted therapy, genomic testing, PET-CT scans — these are no longer luxuries. They are the standard of care. Yet, for most Indians, they remain out of reach.

Every day, patients walk into hospitals believing they will receive best possible care. What they do not see are invisible barriers — policy restrictions, reimbursement ceilings, bureaucratic approvals — that quietly determine their fate.

So we must ask: Are we treating cancer or are we merely managing it within administrative limits? Because there is a difference between what patients deserve and what they receive. And that gap is costing lives.

India needs to move beyond symbolic health coverage and commit to genuine universal health care — one that reflects the realities of modern medicine. Introducing co-payment models for high-cost therapies can expand access without overwhelming public finances. Establishing structured, multidisciplinary decision-making bodies can ensure that treatment approvals are based on clinical benefit and the patients’ finances. There must be regular audits to ensure approved treatments are delivered judiciously.

The question is no longer whether India can afford to do this. It is whether it can afford not to. Because when a patient dies despite the existence of a viable treatment, it is not just a personal tragedy. It is a systemic failure.

Dr. B.S. Ajaikumar is the Chairman of Bharat Hospital and Institute of Oncology, Mysuru, Founder and Chairman of HCG Cancer Centres. He is the author of the book ‘Excellence Has No Borders: How A Doctorpreneur Created A World Class Cancer Hospital Chain.’