{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T02:58:55Z","timestamp":1781060335199,"version":"3.54.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Support Care Cancer"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    This study examined the influence of socioeconomic status (SES) on physical, psychological, and wellbeing symptom burden among palliative cancer patients in New Delhi, India, to identify manifestations of inequity across the cancer care continuum. A secondary analysis of a prospective cohort dataset of 240 cancer patients receiving palliative care was conducted. Participants completed a baseline survey (T1); 120 were followed up after 1 month (T2). Symptom burden was measured using Likert scales for physical, psychological, and wellbeing outcomes. Chi-square tests assessed associations between SES and symptom severity. Ordinal logistic regressions examined the predictive effects of education, income, and slum residence, adjusting for age, sex, and cancer stage. Low education and financial insecurity were associated with higher symptom burden. At T1, patients with no formal education reported more severe weakness than those with tertiary education (OR\u2009=\u20092.84, 95% CI 1.25\u20136.42,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.012). Not coping on income was associated with greater weakness (OR\u2009=\u20092.67, 95% CI 1.48\u20134.82,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001) and depression (OR\u2009=\u20091.94, 95% CI 1.10\u20133.40,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.021). At T2, this was also associated with more pain (OR\u2009=\u20092.44, 95% CI 1.02\u20135.81,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.044) and feeling less informed (OR\u2009=\u20092.58, 95% CI 1.03\u20136.44,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.043). Slum residence was associated with higher odds of depression (OR\u2009=\u20090.25, 95% CI 0.09\u20130.70,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008). SES strongly shaped symptom burden, with low-income, less-educated, and slum-resident patients disproportionately affected. Findings highlight the need for cancer care strategies integrating financial protection, patient education, and mental health services to mitigate inequities in LMICs.\n                  <\/jats:p>","DOI":"10.1007\/s00520-026-10734-7","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T02:50:24Z","timestamp":1778122224000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of socioeconomic status on physical and psychological wellbeing during the cancer care continuum: a longitudinal and logistic regression analysis of cancer patients in New Delhi, India"],"prefix":"10.1007","volume":"34","author":[{"given":"Ishaan","family":"Rahman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mevhibe","family":"Hocaoglu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"issue":"4&5","key":"10734_CR1","doi-asserted-by":"publisher","first-page":"598","DOI":"10.4103\/ijmr.ijmr_1821_22","volume":"156","author":"K Sathishkumar","year":"2022","unstructured":"Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P (2022) Cancer incidence estimates for 2022 & projection for 2025: result from National Cancer Registry Programme, India. Indian J Med Res 156(4&5):598\u2013607","journal-title":"Indian J Med Res"},{"issue":"8","key":"10734_CR2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.27805","volume":"8","author":"P Mathur","year":"2025","unstructured":"National Cancer Registry Programme Investigator G, Mathur P, Sathishkumar K, Das P, Santhappan S, Sankarapillai J, National Cancer Registry Programme Investigator Group et al (2025) Cancer incidence and mortality across 43 cancer registries in India. JAMA Netw Open 8(8):e2527805","journal-title":"JAMA Netw Open"},{"issue":"4","key":"10734_CR3","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.31557\/APJCP.2024.25.4.1213","volume":"25","author":"RK Malhotra","year":"2024","unstructured":"Malhotra RK, Manoharan N, Deo SS, Bhatnagar S (2024) Demographical and epidemiological contribution to cancer incidence in Delhi and its trends from 1991-2015. Asian Pac J Cancer Prev 25(4):1213\u20131222","journal-title":"Asian Pac J Cancer Prev"},{"issue":"6","key":"10734_CR4","doi-asserted-by":"publisher","first-page":"e205","DOI":"10.1016\/S1470-2045(14)70115-9","volume":"15","author":"MK Mallath","year":"2014","unstructured":"Mallath MK, Taylor DG, Badwe RA, Rath GK, Shanta V, Pramesh CS et al (2014) The growing burden of cancer in India: epidemiology and social context. Lancet Oncol 15(6):e205\u2013e212","journal-title":"Lancet Oncol"},{"issue":"1","key":"10734_CR5","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1186\/s12905-023-02504-y","volume":"23","author":"MR Muthuramalingam","year":"2023","unstructured":"Muthuramalingam MR, Muraleedharan VR (2023) Patterns in the prevalence and wealth-based inequality of cervical cancer screening in India. BMC Womens Health 23(1):337 https:\/\/doi.org\/10.1186\/s12905-023-02504-y","journal-title":"BMC Womens Health"},{"issue":"12","key":"10734_CR6","doi-asserted-by":"publisher","first-page":"3639","DOI":"10.31557\/APJCP.2020.21.12.3639","volume":"21","author":"S Biswas","year":"2020","unstructured":"Biswas S, Syiemlieh J, Nongrum R, Sharma S, Siddiqi M (2020) Impact of educational level and family income on breast cancer awareness among college-going girls in Shillong (Meghalaya), India. Asian Pac J Cancer Prev 21(12):3639\u20133646","journal-title":"Asian Pac J Cancer Prev"},{"issue":"2","key":"10734_CR7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.puhe.2004.05.013","volume":"119","author":"T Seth","year":"2005","unstructured":"Seth T, Kotwal A, Thakur R, Singh P, Kochupillai V (2005) Common cancers in India: knowledge, attitudes and behaviours of urban slum dwellers in New Delhi. Public Health 119(2):87\u201396","journal-title":"Public Health"},{"key":"10734_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/j.cegh.2023.101259","author":"R Goyanka","year":"2023","unstructured":"Goyanka R, Yadav J, Sharma P (2023) Financial burden and coping strategies for cancer care in India. Clin Epidemiol Glob Health. https:\/\/doi.org\/10.1016\/j.cegh.2023.101259","journal-title":"Clin Epidemiol Glob Health"},{"issue":"2","key":"10734_CR9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0193320","volume":"13","author":"S Rajpal","year":"2018","unstructured":"Rajpal S, Kumar A, Joe W (2018) Economic burden of cancer in India: evidence from cross-sectional nationally representative household survey, 2014. PLoS One 13(2):e0193320","journal-title":"PLoS One"},{"issue":"9","key":"10734_CR10","doi-asserted-by":"publisher","first-page":"5049","DOI":"10.7314\/APJCP.2013.14.9.5049","volume":"14","author":"KS Nair","year":"2013","unstructured":"Nair KS, Raj S, Tiwari VK, Piang LK (2013) Cost of treatment for cancer: experiences of patients in public hospitals in India. Asian Pac J Cancer Prev 14(9):5049\u201354","journal-title":"Asian Pac J Cancer Prev"},{"key":"10734_CR11","first-page":"1","volume":"5","author":"A Mathew","year":"2019","unstructured":"Mathew A, George PS, Ramadas K, Mathew BS, Kumar A, Roshni S et al (2019) Sociodemographic factors and stage of cancer at diagnosis: a population-based study in South India. J Glob Oncol 5:1\u201310","journal-title":"J Glob Oncol"},{"issue":"1","key":"10734_CR12","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/s12905-023-02275-6","volume":"23","author":"SK Mohanty","year":"2023","unstructured":"Mohanty SK, Wadasadawala T, Sen S, Khan PK (2023) Socio-economic variations of breast cancer treatment and discontinuation: a study from a public tertiary cancer hospital in Mumbai, India. BMC Womens Health 23(1):113https:\/\/doi.org\/10.1186\/s12905-023-02275-6","journal-title":"BMC Womens Health"},{"issue":"1","key":"10734_CR13","first-page":"9","volume":"58","author":"E Ward","year":"2008","unstructured":"Ward E, Halpern M, Schrag N, Cokkinides V, DeSantis C, Bandi P et al (2008) Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin 58(1):9\u201331","journal-title":"CA Cancer J Clin"},{"issue":"4","key":"10734_CR14","doi-asserted-by":"publisher","first-page":"496","DOI":"10.4103\/IJPC.IJPC_72_18","volume":"24","author":"G Kumar","year":"2018","unstructured":"Kumar G, Panda N, Roy R, Bhattacharjee G (2018) An observational study to assess the socioeconomic status and demographic profile of advanced cancer patients receiving palliative care in a tertiary-level cancer hospital of Eastern India. Indian J Palliat Care 24(4):496\u2013499","journal-title":"Indian J Palliat Care"},{"issue":"17","key":"10734_CR15","first-page":"291","volume":"118","author":"M Tewes","year":"2021","unstructured":"Tewes M, Baumann F, Teufel M, Ostgathe C (2021) Symptoms during outpatient cancer treatment and options for their management. Dtsch Arztebl Int 118(17):291\u2013297","journal-title":"Dtsch Arztebl Int"},{"issue":"4","key":"10734_CR16","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1177\/02692163221137106","volume":"37","author":"X Meng","year":"2023","unstructured":"Meng X, An Z, Xu Y, Du J, Tan L, Yu H et al (2023) Living experiences of people with advance cancer with low socioeconomic status: a systematic review of qualitative evidence. Palliat Med 37(4):444\u2013459","journal-title":"Palliat Med"},{"issue":"2","key":"10734_CR17","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/NNR.0000000000000636","volume":"72","author":"TA Badger","year":"2023","unstructured":"Badger TA, Segrin C, Crane TE, Chalasani P, Arslan W, Hadeed M et al (2023) Social determinants of health and symptom burden during cancer treatment. Nurs Res 72(2):103\u2013113","journal-title":"Nurs Res"},{"key":"10734_CR18","first-page":"76","volume-title":"A conceptual framework for action on the social determinants of health","author":"(WHO) WHO","year":"2010","unstructured":"(WHO) WHO (2010) A conceptual framework for action on the social determinants of health. World Health Organisation, Geneva, Switzerland, p 76"},{"issue":"3","key":"10734_CR19","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/j.jpainsymman.2010.06.011","volume":"41","author":"TA Badger","year":"2011","unstructured":"Badger TA, Segrin C, Meek P (2011) Development and validation of an instrument for rapidly assessing symptoms: the general symptom distress scale. J Pain Symptom Manage 41(3):535\u2013548","journal-title":"J Pain Symptom Manage"},{"key":"10734_CR20","volume-title":"New Delhi District","author":"Delhi GoNCTo","year":"2011","unstructured":"Delhi GoNCTo (2011) New Delhi District. Government of National Capital Territory of Delhi, New Delhi, India"},{"issue":"9","key":"10734_CR21","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011699","volume":"6","author":"J Chen","year":"2016","unstructured":"Chen J, Chu S, Chungbaek Y, Khan M, Kuhlman C, Marathe A et al (2016) Effect of modelling slum populations on influenza spread in Delhi. BMJ Open 6(9):e011699","journal-title":"BMJ Open"},{"key":"10734_CR22","unstructured":"Group WB (2025) India: trends in poverty, 2011\u201312 to 2022\u201323. Geneva, Switzerland: World Bank Group, Team PE"},{"issue":"12","key":"10734_CR23","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1177\/0193945916672663","volume":"39","author":"OK Ham","year":"2017","unstructured":"Ham OK, Chee W, Im EO (2017) The influence of social structure on cancer pain and quality of life. West J Nurs Res 39(12):1547\u20131566","journal-title":"West J Nurs Res"},{"issue":"19","key":"10734_CR24","doi-asserted-by":"publisher","first-page":"20150","DOI":"10.1002\/cam4.6596","volume":"12","author":"AKG Levinsen","year":"2023","unstructured":"Levinsen AKG, Kjaer TK, Thygesen LC, Maltesen T, Jakobsen E, Gogenur I et al (2023) Social inequality in cancer survivorship: educational differences in health-related quality of life among 27,857 cancer survivors in Denmark. Cancer Med 12(19):20150\u201320162","journal-title":"Cancer Med"},{"issue":"1","key":"10734_CR25","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-020-01274-5","volume":"19","author":"C Malhotra","year":"2020","unstructured":"Malhotra C, Krishnan A, Yong JR, Teo I, Ozdemir S, Ning XH et al (2020) Socio-economic inequalities in suffering at the end of life among advanced cancer patients: results from the APPROACH study in five Asian countries. Int J Equity Health 19(1):158","journal-title":"Int J Equity Health"},{"key":"10734_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2024.117535","volume":"364","author":"SK Mohanty","year":"2025","unstructured":"Mohanty SK, Khan J, Maiti S, Kampfen F, Maurer J, O\u2019Donnell O (2025) Healthcare inequity arising from unequal response to need in the older (45+ years) population of India: analysis of nationally representative data. Soc Sci Med 364:117535","journal-title":"Soc Sci Med"},{"issue":"5","key":"10734_CR27","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1093\/heapol\/czaa008","volume":"35","author":"A Landrian","year":"2020","unstructured":"Landrian A, Phillips BS, Singhal S, Mishra S, Kajal F, Sudhinaraset M (2020) Do you need to pay for quality care? Associations between bribes and out-of-pocket expenditures on quality of care during childbirth in India. Health Policy Plan 35(5):600\u2013608","journal-title":"Health Policy Plan"},{"issue":"10","key":"10734_CR28","doi-asserted-by":"publisher","first-page":"1820","DOI":"10.1016\/j.worlddev.2011.04.026","volume":"39","author":"A Zacharias","year":"2011","unstructured":"Zacharias A, Vakulabharanam V (2011) Caste stratification and wealth inequality in India. World Dev 39(10):1820\u20131833","journal-title":"World Dev"},{"issue":"8","key":"10734_CR29","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1177\/10105395211014648","volume":"33","author":"R Thapa","year":"2021","unstructured":"Thapa R, van Teijlingen E, Regmi PR, Heaslip V (2021) Caste exclusion and health discrimination in South Asia: a systematic review. Asia Pac J Public Health 33(8):828\u2013838","journal-title":"Asia Pac J Public Health"},{"issue":"5","key":"10734_CR30","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2021-055415","volume":"12","author":"JE Park","year":"2022","unstructured":"Park JE, Kibe P, Yeboah G, Oyebode O, Harris B, Ajisola MM et al (2022) Factors associated with accessing and utilisation of healthcare and provision of health services for residents of slums in low and middle-income countries: a scoping review of recent literature. BMJ Open 12(5):e055415","journal-title":"BMJ Open"},{"issue":"3","key":"10734_CR31","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1016\/0304-3959(92)90032-7","volume":"50","author":"CW Whitney","year":"1992","unstructured":"Whitney CW, Von Korff M (1992) Regression to the mean in treated versus untreated chronic pain. Pain 50(3):281\u20135","journal-title":"Pain"},{"key":"10734_CR32","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-8-65","volume":"8","author":"S McPhail","year":"2010","unstructured":"McPhail S, Haines T (2010) Response shift, recall bias and their effect on measuring change in health-related quality of life amongst older hospital patients. Health Qual Life Outcomes 8:65","journal-title":"Health Qual Life Outcomes"},{"key":"10734_CR33","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2019.00783","volume":"9","author":"G Ilie","year":"2019","unstructured":"Ilie G, Bradfield J, Moodie L, Lawen T, Ilie A, Lawen Z et al (2019) The role of response-shift in studies assessing quality of life outcomes among cancer patients: a systematic review. Front Oncol 9:783","journal-title":"Front Oncol"},{"key":"10734_CR34","doi-asserted-by":"publisher","DOI":"10.3389\/frhs.2024.1385370","volume":"4","author":"AY Armiya\u2019u","year":"2024","unstructured":"Armiya\u2019u AY, Akande Y (2024) Role of a mental health physician in the management of oncology patients: a case vignette and the need for collaboration. Front Health Serv 4:1385370","journal-title":"Front Health Serv"},{"key":"10734_CR35","doi-asserted-by":"publisher","DOI":"10.1016\/j.lansea.2024.100514","volume":"32","author":"P Halder","year":"2025","unstructured":"Halder P, Dixit J, Gupta N, Mehra N, Singh A, Malhotra P et al (2025) Access to timely cancer treatment initiation in India: extent, determinants and trends. The Lancet Regional Health 32:100514","journal-title":"The Lancet Regional Health"},{"issue":"1","key":"10734_CR36","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/oncolo\/oyac206","volume":"28","author":"K Christiansen","year":"2023","unstructured":"Christiansen K, Buswell L, Fadelu T (2023) A systematic review of patient education strategies for oncology patients in low- and middle-income countries. Oncologist 28(1):2\u201311","journal-title":"Oncologist"},{"issue":"4","key":"10734_CR37","doi-asserted-by":"publisher","first-page":"1074","DOI":"10.4143\/crt.2017.401","volume":"50","author":"HS Min","year":"2018","unstructured":"Min HS, Yang HK, Park K (2018) Supporting low-income cancer patients: recommendations for the public financial aid program in the Republic of Korea. Cancer Res Treat 50(4):1074\u20131083","journal-title":"Cancer Res Treat"}],"container-title":["Supportive Care in Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-10734-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00520-026-10734-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00520-026-10734-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T02:29:09Z","timestamp":1781058549000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00520-026-10734-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":37,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10734"],"URL":"https:\/\/doi.org\/10.1007\/s00520-026-10734-7","relation":{},"ISSN":["0941-4355","1433-7339"],"issn-type":[{"value":"0941-4355","type":"print"},{"value":"1433-7339","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]},"assertion":[{"value":"26 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval for the original IPOS Hindi survey, of which this study is a secondary analysis of, was obtained from the Institutional Ethics Committee for Human Research of CanSupport Charity (IEC-CanSupport-1\/2021 dated 5th Feb 2021), in accordance with institutional ethical standards and the principles of the Declaration of Helsinki. The original developer of IPOS provided permission for cultural adaptation and validation of the measurement instrument.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"507"}}