India faces a significant oncology challenge, with 1.5 million new cancer cases reported annually, resulting in an incidence rate of 0.102%. These figures represent only reported cases, and the true incidence is likely 1.5 to 2 times higher due to limited access to healthcare and screening. For major cancers, such as breast and lung, early detection remains a challenge, with fewer than 30% of patients diagnosed at early stages. With increasing awareness, enhanced government focus on screening along with rising exposure to risk factors like pollution, processed foods, tobacco use, and an aging population, the annual number of new cancer patients is projected to reach 2.5 million by 2030, leading to a caseload of more than 4 million. Here, early detection and the right treatment can save so many lives.

The oncology spend in India is currently around $3 billion and has been growing at an annual rate of 12% over the last five years. This growth is projected to push the market to over $6 billion by 2030. Among the various cancer treatments, chemotherapy (and immunotherapy) represents the largest share of spending, with a total pool of $1.3 billion.

Role of Medical Oncologists

Medical oncologists play an increasingly pivotal role in the cancer treatment landscape, as only they are authorized to prescribe and administer chemotherapy and immunotherapy. When chemotherapy is involved at any stage of a patient’s cancer treatment, the medical oncologist typically becomes the primary care provider, guiding the patient throughout their journey. Since chemotherapy requires prolonged care, patients often spend the most time with their medical oncologist. In addition to managing chemotherapy and immunotherapy, medical oncologists are responsible for prescribing other medications—such as those for fever or pain—taken between or after treatment cycles. As cancer patients are often immunocompromised, these prescriptions must come from their medical oncologist to ensure comprehensive, coordinated care. Beyond treatment management, medical oncologists also serve as the central point of contact for patients, offering referrals to radiation and surgical oncologists, as well as coordinating diagnostic and imaging services.

State of Cancer Care in India

Unfortunately, cancer patients in India endure a long and arduous treatment journey which is exacerbated by inadequate infrastructure and quality of care for oncology services.

The current healthcare infrastructure remains ill-equipped to support chemotherapy treatments effectively.

In many larger hospitals, chemotherapy is often administered in general wards shared with other patients or in recliners, offering little to no privacy. For a typical 4-hour chemotherapy cycle, patients are required to spend nearly an entire day at the hospital. By the end of the cycle, they are usually left feeling completely exhausted. Here is what they need to go through:

➤ Registration - Before commencing each chemotherapy cycle, they (or their caregivers) need to move from pillar to post to complete several administrative processes, e.g., billing and insurance.

➤ Diagnostics - Often, for diagnostics, they need to wait a few hours to get the reports as these get in the same queue as all other tests in the lab, which may not be as time-critical (it is mandatory to get the CBC bloodwork done before chemotherapy to ascertain whether hemoglobin levels are enough to sustain the cycle). They wait for the doctors to approve the cycle even after reports are provided.

➤ Access to oncologist - The medical oncologist does not spend more than 2-3 minutes per patient, given hospitals often do not have a full-time medical oncologist.

➤ Nursing staff - Since the nursing staff is common, they are not trained to handle dosages and manage the complications and side effects of chemotherapy drugs, and they are not able to answer routine queries.

➤ Billing and insurance - Post-completion of the chemotherapy cycle, a patient waits another 1 hour for symptom monitoring and waits for the doctor to approve their discharge. If the patient has insurance, they are again made to wait 1-2 hours until approval from their insurance company is received for their cashless claim.

➤ Drugs cost - Patients must procure chemotherapy drugs from the hospital pharmacy at MRP. On top of that, hospitals often load up a long list of administrative expenses and other charges as everything is sold at a hefty markup. Net-net, the patients end up with huge hospital bills for every cycle, which typically range between Rs 50,000 and Rs 1,00,000 at large hospitals.

➤ Quality of facilities - Private and unorganized nursing homes, where most of the chemotherapy care is delivered in India, lack clinical talent as well as infrastructure - they have general ward beds, poor hygiene, and no medical oncologist or trained nursing staff. Unfortunately, patients continue to flock to these nursing homes as they offer lower prices than larger hospitals. Often, these nursing homes are run by non-oncologists who continue to administer chemotherapy drugs without established clinical protocols and experience. These are patients whose mobility is severely challenged and are in pain, so the experience at the hospital and nursing homes only exasperates their condition.

The MOC Differentiation

Founded by four medical oncologists, Dr. Vashishtha Maniar, Dr. Ashish Joshi, Dr. Pritam Kalaskar, and D.r Kshitij Joshi, MOC has been on a mission to change this in India. MOC, built on a patient-first model, is the largest independent chain for chemotherapy in India, with 23 centers across Mumbai, Pune, Ahmedabad, and other cities in Western and Central India. MOC’s dedicated chemotherapy format, along with its patient-centric processes and infrastructure, offer superior patient experience. We have been tracking this space and the MOC team closely for some time and have always been impressed with their core ethos of patient-centricity and high clinical standards. When we first met the MOC founding team in 2024, we were simply blown away by their mission of building the largest, clinician-led patient-first chemotherapy network. This is reflected in the deliberate choices that the company has taken for the selection of its medical oncologists across its footprint, as well as the design of the infrastructure of its facilities.

In our interactions with the company and our field visits, we came across multiple areas where MOC stands out versus other players in the space.

➤ Culture of patient-centric care: We visited all 22 MOC centers, where a dedicated medical oncologist is present throughout the chemotherapy cycles, supported by an experienced second-level clinical team. During our visits, we spoke with the medical oncologists at each center and were impressed by the strong alignment between the founders' ethos and the entire MOC network in delivering patient-centered care.

➤ Equipment and processes built for oncology: MOC centers are NABH-certified. They are equipped with in-house diagnostics and a pharmacy for quick turnaround. Chemotherapy beds are placed inside private rooms within hygienic, well-maintained facilities, ensuring privacy for both patients and their caregivers. Patients and caregivers spend minimal time waiting for chemotherapy administration as workflows are designed around cancer patients. State-of-the-art equipment, such as the Paxman Scalp Cooling System, is available at many centers to prevent chemotherapy-induced alopecia (hair loss).

➤ Doctor and nursing support: Trained onco-nurses lead the charge and can manage any complications, e.g., infection management and side effects that may occur during or after the chemotherapy cycle. There is 24x7 access to doctors for addressing routine and advanced queries that patients may have when they are at home.

➤ Patient love: Despite the disease burden, all patients and their caregivers gave glowing feedback across the board on the medical oncologists, other clinical staff, and administrative staff. We consistently received feedback highlighting the time and attention given by medical oncologists, the comforting, homely atmosphere, and the exceptional courtesy of both the medical and administrative staff. The feedback resonates well with patient reviews available online – e.g., almost all MOC centers are rated 4.9 or 5 out of 5 on Google, an achievement that is hard to deliver in healthcare delivery (please see below).

Strong Business Built on Foundation of Clinical Expertise

Expectedly, this strong customer-focused execution has led to a strong word-of-mouth for MOC and the company has been growing 50%+ y-o-y over the last 3 years with great centre-level economics and ROCE. When we analyzed the financials of the business, we were not surprised to see a fantastic business being built on this foundation of quality patient care.

We at Elevation have been long-time backers of “Customer Obsessed” companies like MOC and are super excited to join hands with this mission-driven team, as well as our co-investors Tata Capital Healthcare Fund, to provide high-quality and affordable cancer care across the country.

If you are building in healthcare or healthtech, please reach out to mayank@elevationcapital.com and vishap@elevationcapital.com. We would love to hear from you.

Learn more about our Healthcare thesis, team and portfolio at elevationcapital.com/healthcare.