Cancer care expands beyond metros as providers bet on tier-2, tier-3 India

Hospitals, diagnostics firms, and support groups are expanding cancer care into tier-2 and tier-3 cities as demand, screening and awareness rise beyond large metros

India’s cancer care ecosystem is moving beyond the country’s largest metros, as hospitals, diagnostics firms, and patient-support organisations expand into Tier-II and Tier-III cities to meet rising demand driven by increasing cancer incidence, greater awareness, and improved screening.

 

Healthcare providers say the shift is being driven by rising patient loads in smaller cities, the need to reduce migration to metros for treatment, and improving oncology infrastructure outside traditional hubs such as Mumbai, Delhi, and Bengaluru.

 

Diagnostics companies are also pushing beyond metros as demand for precision oncology grows. 4baseCare, a cancer genomics and diagnostics firm, is expanding into cities such as Srinagar, Guwahati, Coimbatore, and parts of Rajasthan after establishing facilities in places like Jammu and Kottayam. “We want to bring advanced genomic testing closer to patients in Tier-II and Tier-III cities, where access and awareness are still limited,” said Hitesh Goswami, cofounder and chief executive officer of 4baseCare. “Most of the cancer burden already exists there, but diagnosis and screening have historically been lower.”

 

4baseCare specialises in genomic profiling to help doctors personalise treatment plans. Goswami said the company is moving away from the traditional centralised diagnostics model by setting up testing infrastructure within hospital systems instead of relying solely on collection centres that send samples to metro hubs.

 

Industry executives said the economics of expansion into smaller cities are more complex than often perceived. While rentals and real estate costs are lower outside metros, equipment and compliance costs remain largely unchanged. “The machine cost does not change whether you are setting up in Bengaluru or a smaller city,” Goswami said, adding that logistics and skilled manpower remain major operational challenges outside metros. “In fact, personnel costs can sometimes increase because you have to incentivise trained professionals to relocate.”

 

Capital expenditure also remains significant. 4baseCare said setting up a genomics laboratory can cost between ₹3 crore and ₹10 crore, depending on scale and equipment.

 

Alongside hospitals and diagnostics firms, patient-support organisations are also decentralising services to reduce the financial and emotional burden on families forced to travel to metros for treatment.

 

Access Life Assistance Foundation, which provides accommodation and support services for children undergoing cancer treatment, is expanding into cities such as Tiruvannamalai, Raipur, and Puducherry after establishing centres in Pune, Silchar, and Manipal. “We realised that children were travelling from rural India to metros because they did not have access to specialised support infrastructure locally,” said Girish Nair, founder and chairman of Access Life Assistance Foundation. “Our strategy is to identify hospitals in Tier-II and Tier-III cities that already have strong treatment protocols and create support ecosystems around them.”

 

Nair said non-medical expenses such as accommodation, food, and transportation can account for nearly half the overall cost burden for families undergoing long-term cancer treatment. The foundation’s shelter homes, focused specifically on paediatric cancer care, aim to reduce these pressures by providing accommodation close to treatment centres.

 

Executives across the sector believe the next phase of oncology growth will increasingly come from smaller cities, where awareness levels and health-seeking behaviour have improved significantly since the Covid-19 pandemic. “With increasing screening and awareness, more cases that previously went undetected in smaller towns are now being diagnosed,” Goswami said. “The next frontier for cancer care expansion is clearly Tier-II and Tier-III India.”

 

Even so, industry players cautioned that challenges remain around affordability, specialist availability, and logistics. While government insurance schemes and state-funded programmes are improving access to treatment, private providers said a large section of patients still relies on out-of-pocket expenditure, making lower-cost, community-based models increasingly important.

 

MOC Cancer Care & Research Centre, which operates community cancer centres across western and northern India, plans to expand its network from about 28-29 centres currently to nearly 40 by the end of this financial year. The company recently launched a new facility in Navi Mumbai and is eyeing further expansion in the Delhi-National Capital Region and southern markets, including Bengaluru, Hyderabad, Chennai, and Kochi, over the next few years.

 

“We are looking at expanding our community cancer centres, which are registered hospitals and not daycare centres,” said Ashish Joshi, founder and director of MOC Cancer Care & Research Centre. “Cancer care was previously concentrated within a few tertiary hospitals, but given the burden of disease, community cancer centres offering proximity, access, and clinical excellence are becoming increasingly important.”

 

According to Joshi, metro markets continue to remain the immediate focus because of greater acceptance of specialised oncology facilities, stronger insurance penetration, and the availability of oncologists. However, the company is also evaluating partnerships in smaller towns over time.

 

MOC estimates that establishing a community cancer centre in a metro city requires investments of around ₹3 crore to ₹3.5 crore, with costs in smaller cities remaining broadly similar because compliance and infrastructure requirements do not materially change.

 

As India’s cancer burden rises, healthcare companies and non-profits alike are betting that decentralised cancer care networks spanning treatment, diagnostics, and patient support will become central to the country’s oncology infrastructure in the years to come. 

Looking beyond

• Factors such as rising patient load, migration to metros for better treatment, and better infrastructure are driving the change
• Rental costs are lower outside metros; equipment and compliance costs to remain largely unchanged
• Logistics and skilled manpower continue to be major operational challenges facing Tier-II and Tier-III cities
• As most patients rely on out-of-pocket expenses, making of lower-cost community-based models becomes vital