Patients with advanced cancer frequently face substantial declines in health-related quality of life (HRQoL) due to both the disease and its treatments. In India, where palliative care services are still limited, individuals from socially or economically disadvantaged groups may be at higher risk of poor HRQoL outcomes. This study examined multiple dimensions of HRQoL—including physical, functional, emotional, social/family, pain, psychological, and spiritual well-being—among advanced cancer patients and explored how socioeconomic and cultural factors influence these outcomes. It was hypothesized that financial hardship, female gender, lower education, reduced social/family support, minority religion, and non-general caste status would be associated with lower HRQoL. A cross-sectional survey was conducted among 210 advanced cancer patients attending a regional cancer center in Hyderabad, India. Standardized tools were used to assess general well-being (FACT-G), pain severity and interference (BPI), psychological distress (HADS), and spiritual well-being (FACT-SP), alongside socio-demographic and economic data. Participants demonstrated lower overall well-being (FACT-G = 62.4 ± 10.0) and spiritual well-being (FACT-SP = 32.7 ± 5.5) compared with reference U.S. cancer populations. Pain levels were generally mild to moderate (severity 3.2 ± 1.8; interference 4.0 ± 1.6), anxiety scores were within normal limits (5.6 ± 3.1), and depressive symptoms were borderline (9.7 ± 3.3). Financial distress was a strong predictor of poorer outcomes across most HRQoL domains (p ≤ 0.01). Belonging to a minority religion was associated with reduced physical well-being (p ≤ 0.05) and higher pain severity (p ≤ 0.05), while married women reported lower social/family well-being (p ≤ 0.05). Pain severity and interference were consistently linked with diminished HRQoL. Advanced cancer patients in India, particularly those facing financial challenges or from minority religious groups, experience reduced well-being across multiple domains and exhibit borderline depressive symptoms. These findings highlight the need for targeted interventions to support vulnerable groups and improve HRQoL outcomes in this population.
