{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T19:35:22Z","timestamp":1794598522004,"version":"4.9.1"},"reference-count":39,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"unspecified","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009530","name":"Jawaharlal Institute Of Postgraduate Medical Education and Research","doi-asserted-by":"publisher","award":["JIP\/Res\/Intramural\/phs-1\/2023-24"],"award-info":[{"award-number":["JIP\/Res\/Intramural\/phs-1\/2023-24"]}],"id":[{"id":"10.13039\/501100009530","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,12,26]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to assess travel time, associated costs, challenges and factors influencing healthcare facility choices among persons with cancer in Southern India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An explanatory sequential mixed methods study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was conducted in the cancer care outpatient department at a tertiary care centre in Puducherry, Southern India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 192 persons with cancer aged 18 to 65 years, diagnosed with breast, lip and oral cavity, cervical, lung or upper gastrointestinal cancers, and attending the cancer care centre between 2023 and 2024, were enrolled in the study through systematic random sampling. Additionally, 10 in-depth interviews were conducted using purposive sampling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 192 participants, 89 (46.4%) belonged to a lower socioeconomic group, and 178 (92.7%) reported experiencing financial hardship while undergoing cancer treatment. The median travel time to a tertiary care centre was 4.3\u2009hours (IQR: 2.07\u20137.3), with a median direct non-medical cost of Indian Rupees (INR) 453 (IQR: 200\u2013987). Median expenditures for travel, food and accommodation were INR 200 (IQR: 123\u2013400), INR 360 (IQR: 150\u2013613) and INR 30 (IQR: 20\u201360), respectively, per single visit. A significant proportion of participants (n=146, 76%) were unaware of nearby cancer treatment centres and relied on peer recommendations when choosing their place of treatment. Key challenges identified included long-distance travel, financial burden due to high food and transportation costs and limited affordability for accommodation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study highlights that prolonged travel time and associated costs pose substantial financial strain on cancer-affected families. Enhancing awareness of available healthcare facilities, implementing patient-friendly travel and accommodation support systems and decentralising cancer care services can improve accessibility and mitigate both travel and financial burdens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104210","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T15:50:10Z","timestamp":1768319410000},"page":"e104210","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["The journey to healing: exploring travel challenges and associated costs for cancer care at a tertiary care centre in Puducherry, Southern India \u2013 a mixed methods study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3400-0722","authenticated-orcid":false,"given":"Loganathan","family":"Devaraj","sequence":"first","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2417-6639","authenticated-orcid":false,"given":"Reshma","family":"Ayiraveetil","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalaiselvy","family":"Arikrishnan","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swaroop Kumar","family":"Sahu","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasanth","family":"Ganesan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunaseelan","family":"Karunanithi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sona Priyanka","family":"Auroprem","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamil Selvan","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8326-2855","authenticated-orcid":false,"given":"Mahalakshmy","family":"Thulasingam","sequence":"additional","affiliation":[{"name":"Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"2026011307452619000_16.1.e104210.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(12)70211-5"},{"key":"2026011307452619000_16.1.e104210.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026011307452619000_16.1.e104210.3","doi-asserted-by":"crossref","first-page":"102339","DOI":"10.1016\/j.ctrv.2022.102339","article-title":"Global challenges and policy solutions in breast cancer control","volume":"104","author":"Trapani","year":"2022","journal-title":"Cancer Treat Rev"},{"key":"2026011307452619000_16.1.e104210.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2020.08.023"},{"key":"2026011307452619000_16.1.e104210.5","first-page":"2973","article-title":"On the road and away from home: a systematic review of the travel experiences of cancer patients and their families","volume":"26","author":"Vindrola-Padros","year":"2018","journal-title":"Support Care Cancer"},{"key":"2026011307452619000_16.1.e104210.6","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph18052422","article-title":"Australian Experiences of Out-of-Pocket Costs and Financial Burden Following a Cancer Diagnosis: A Systematic Review","volume":"18","author":"Bygrave","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2026011307452619000_16.1.e104210.7","doi-asserted-by":"crossref","DOI":"10.1093\/jncics\/pkae093","article-title":"The intersection of travel burdens and financial hardship in cancer care: a scoping review","volume":"8","author":"Planey","year":"2024","journal-title":"JNCI Cancer Spectr"},{"key":"2026011307452619000_16.1.e104210.8","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0110"},{"key":"2026011307452619000_16.1.e104210.9","doi-asserted-by":"crossref","first-page":"362","DOI":"10.4103\/ijmr.IJMR_1711_18","article-title":"Cancer research in India: Challenges & opportunities","volume":"148","author":"Singh","year":"2018","journal-title":"Indian J Med Res"},{"key":"2026011307452619000_16.1.e104210.10","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4103\/0971-5851.158848","article-title":"Delivery of cancer care in rural India: Experiences of establishing a rural comprehensive cancer care facility","volume":"36","author":"Banavali","year":"2015","journal-title":"Indian J Med Paediatr Oncol"},{"key":"2026011307452619000_16.1.e104210.11","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s40258-021-00641-9","article-title":"Disease-Specific Out-of-Pocket Payments, Catastrophic Health Expenditure and Impoverishment Effects in India: An Analysis of National Health Survey Data","volume":"19","author":"Yadav","year":"2021","journal-title":"Appl Health Econ Health Policy"},{"key":"2026011307452619000_16.1.e104210.12","unstructured":"JCO Global Oncology . Time Distance and Economics Influencing Cancer Care: Experience From a Regional Cancer Center in India, Available: https:\/\/ascopubs.org\/doi\/10.1200\/jgo.18.76900 [Accessed 12 Feb 2025]."},{"key":"2026011307452619000_16.1.e104210.13","doi-asserted-by":"crossref","first-page":"323","DOI":"10.55489\/njcm.140520232907","article-title":"Out of Pocket Expenditure among Cancer Patients Availing Treatment at A Tertiary Care Centre in Hyderabad, India","volume":"14","author":"Ahmed Mohiuddin","year":"2023","journal-title":"Natl J Community Med"},{"key":"2026011307452619000_16.1.e104210.14","unstructured":"National Health Systems Resource Centre . Ministry of health and family welfare, government of india 2020\u201321. Ministry of Health and Family Welfare, Government of India; 2024. Available: https:\/\/mohfw.gov.in\/sites\/default\/files\/NHA%202020-21_up.pdf [Accessed 13 Feb 2025]."},{"key":"2026011307452619000_16.1.e104210.15","unstructured":"Government of India . Ayushman bharat for new india-2022. Ministry of Finance. Available: https:\/\/pib.gov.in\/PressReleaseIframePage.aspx?PRID=1518544 [Accessed 28 Oct 2024]."},{"key":"2026011307452619000_16.1.e104210.16","unstructured":"NP NCD Operational guidelines . Ministry of health and family welfare. operational guidelines for national programme for non communicable disease (2023-2030). 2023."},{"key":"2026011307452619000_16.1.e104210.17","unstructured":"Health and Family Welfare Department, Tamil Nadu . Tamil nadu state policy for cancer prevention and control. g.o (ms) no.228. Health and Family Welfare Department, Tamil Nadu."},{"key":"2026011307452619000_16.1.e104210.18","unstructured":"New Delhi: Indian Railways . Indian Railways Concession Rules, Available: https:\/\/www.indianrail.gov.in\/enquiry\/StaticPages\/StaticEnquiry.jsp?StaticPage=conc_Ru les.html&locale=en [Accessed 28 Oct 2024]."},{"key":"2026011307452619000_16.1.e104210.19","unstructured":"Tamil Nadu State Transport Corporation . TNSTC Terms and Conditions for Cancer Patient and their Escorts, Available: https:\/\/www.tnstc.in\/innerHtmls\/terms.html#:~:text=Incase%20Cancer%20Patient%20alone%20travelling,AC%20Sleeper%20class%20of%20Services [Accessed 28 Oct 2024]."},{"key":"2026011307452619000_16.1.e104210.20","doi-asserted-by":"crossref","DOI":"10.1016\/j.adro.2024.101652","article-title":"The Relationship Between Travel Distance for Treatment and Outcomes in Patients Undergoing Radiation Therapy: A Systematic Review","volume":"9","author":"Silverwood","year":"2024","journal-title":"Adv Radiat Oncol"},{"key":"2026011307452619000_16.1.e104210.21","doi-asserted-by":"crossref","first-page":"3211","DOI":"10.31557\/APJCP.2025.26.9.3211","article-title":"Spatial Analysis of Travel Distances for Persons with Common Cancers Seeking Care at a Tertiary Care Facility in South India: An Operational Research","volume":"26","author":"Devaraj","year":"2025","journal-title":"Asian Pac J Cancer Prev"},{"key":"2026011307452619000_16.1.e104210.22","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.4103\/jfmpc.jfmpc_1944_24","article-title":"Household healthcare expenditure: A cross-sectional analysis of urban and rural Puducherry, South India","volume":"14","author":"Paulraj","year":"2025","journal-title":"J Family Med Prim Care"},{"key":"2026011307452619000_16.1.e104210.23","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1080\/19475683.2021.1966504","article-title":"How far persons with diabetes travel for care? Spatial analysis from a tertiary care facility in Southern India","volume":"27","author":"Olickal","year":"2021","journal-title":"Ann GIS"},{"key":"2026011307452619000_16.1.e104210.24","unstructured":"ESRI . ArcGIS Pro. Redlands (CA): Environmental Systems Research Institute, Available: https:\/\/www.esri.com\/en-us\/arcgis\/products\/arcgis-pro\/trial [Accessed 2 Nov 2024]."},{"key":"2026011307452619000_16.1.e104210.25","doi-asserted-by":"crossref","first-page":"88","DOI":"10.4103\/ijamr.ijamr_149_22","article-title":"Out-of-Pocket Expenditure for the Diagnosis of Cervical, Breast, and Oral Cavity Cancer: A Cross-Sectional Study from a Tertiary Care Hospital in South India","volume":"9","author":"Singh","year":"2022","journal-title":"Int J Adv Med Health Res"},{"key":"2026011307452619000_16.1.e104210.26","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0158332","article-title":"Gender Difference in Health-Care Expenditure: Evidence from India Human Development Survey","volume":"11","author":"Saikia","year":"2016","journal-title":"PLoS ONE"},{"key":"2026011307452619000_16.1.e104210.27","doi-asserted-by":"crossref","first-page":"235","DOI":"10.4103\/ijph.ijph_1299_22","article-title":"Role of education and income on disparities of time-to-treatment initiation and its impact on cervical cancer survival","volume":"67","author":"Sivaranjini","year":"2023","journal-title":"Indian J Public Health"},{"key":"2026011307452619000_16.1.e104210.28","doi-asserted-by":"crossref","DOI":"10.1200\/GO-25-00304","article-title":"Knowledge, Attitudes, and Health-Seeking Behavior for Cervical, Breast, and Oral Cancers Among Women in Jashore, Bangladesh: A Cross-Sectional Study","volume":"11","author":"Azim","year":"2025","journal-title":"JCO Glob Oncol"},{"key":"2026011307452619000_16.1.e104210.29","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1097\/DCR.0000000000000924","article-title":"Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes","volume":"60","author":"Xu","year":"2017","journal-title":"Dis Colon Rectum"},{"key":"2026011307452619000_16.1.e104210.30","first-page":"5381","article-title":"Impact of travel burden on clinical outcomes in lung cancer","volume":"30","author":"Stoyanov","year":"2022","journal-title":"Support Care Cancer"},{"key":"2026011307452619000_16.1.e104210.31","doi-asserted-by":"crossref","first-page":"403","DOI":"10.31557\/APJCP.2019.20.2.403","article-title":"Economic Burden of Head and Neck Cancer Treatment in North India","volume":"20","author":"Chauhan","year":"2019","journal-title":"Asian Pac J Cancer Prev"},{"key":"2026011307452619000_16.1.e104210.32","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1002\/cam4.2672","article-title":"Evaluating the appropriateness of chemotherapy in a low-resource cancer centre in sub-Saharan Africa","volume":"9","author":"Serra","year":"2020","journal-title":"Cancer Med"},{"key":"2026011307452619000_16.1.e104210.33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002402","article-title":"Decentralizing cancer care in sub-Saharan Africa through an integrated regional cancer centre model: The case of Kenya","volume":"3","author":"Nyangasi","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"2026011307452619000_16.1.e104210.34","doi-asserted-by":"crossref","unstructured":"Gangopadhyay A . Radiotherapy travel times \u2013 is time running out in India? ecancer 2022;16. doi:10.3332\/ecancer.2022.ed122","DOI":"10.3332\/ecancer.2022.ed122"},{"key":"2026011307452619000_16.1.e104210.35","doi-asserted-by":"crossref","first-page":"359","DOI":"10.4103\/ijc.IJC_82_19","article-title":"Radiotherapy in India: History, current scenario and proposed solutions","volume":"56","author":"Munshi","year":"2019","journal-title":"Indian J Cancer"},{"key":"2026011307452619000_16.1.e104210.36","doi-asserted-by":"publisher","DOI":"10.4103\/0971-5851.142040"},{"key":"2026011307452619000_16.1.e104210.37","doi-asserted-by":"crossref","DOI":"10.1016\/j.gore.2021.100868","article-title":"A qualitative study on the impact of long-distance travel for gynecologic cancer care","volume":"38","author":"Mujumdar","year":"2021","journal-title":"Gynecol Oncol Rep"},{"key":"2026011307452619000_16.1.e104210.38","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1111\/tmi.13958","article-title":"The burden of travelling for cervical cancer treatment in Uganda: A mixed\u2010method study","volume":"29","author":"Dau","year":"2024","journal-title":"Tropical Med Int Health"},{"key":"2026011307452619000_16.1.e104210.39","unstructured":"Department of Health and Family Welfare, Government of Tamil Nadu . Policy note 2024-2025. 2024. Available: https:\/\/www.tn.gov.in\/documents\/dept\/11 [Accessed 28 Oct 2024]."}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-104210","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T15:50:15Z","timestamp":1768319415000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-104210"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,13]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjopen-2025-104210"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-104210","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2025-104210.supp1","asserted-by":"subject"},{"id-type":"doi","id":"https:\/\/doi.org\/10.1136\/bmjopen-2025-104210.supp2","asserted-by":"subject"}]},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}