HealthCare Global Enterprises Limited (HCG) Earnings Call Transcript & Summary

Ladies and gentlemen, good day, and welcome to HealthCare Global Enterprises Q3 FY '20 Earnings Conference Call. [Operator Instructions] Please note that this conference is being recorded. I now hand the conference over to Mr. Niraj Didwania, Head of Corporate Development and Investor Relations. Thank you, and over to you, sir.

Thank you. Good evening, and a very warm welcome to all participants to HealthCare Global Enterprises Limited Q3 FY '20 Earnings Conference call. Today, we have with us Dr. B.S. Ajai Kumar, Chairman and CEO of HCG, along with the management team to share highlights of our business and financials. We have uploaded an earnings update presentation to the stock exchanges and also shared the same to our mailers. So without further ado, I hand over the call to Dr. B.S. Ajai Kumar.

Thank you, Niraj, and warm welcome to all the participants. We are pleased to report Q3 and YTD FY '20 results with strong performance and outlook. The recently published study by World Health Organization predicts 1 out of 10 Indians to get cancer in their lifetime with high mortality rates, which is alarming statistic. HCG's oncology network through its presence and depth uniquely positions us to address the growing cancer burden in India holistically, while delivering quality cancer care and outcomes. With South Mumbai center being operational, we have entered a period of consolidation, with no further CapEx and new centers in the medium term. Through focus on driving profitability in our new centers and improving efficiencies in our existing centers, we expect to see robust growth in operating cash flows and subsequent reduction in leverage. The company has successfully achieved scale-up across specialized platforms in oncology, fertility and precision diagnostics, with pan-India leadership, and we remain committed to driving long-term value creation for all our stakeholders. Business update for Q3 FY '20. Center of Excellence in Bangalore established new standards of precision, accuracy and speed in cancer diagnosis and treatments. It becomes the first hospital with fully digitized pathology platform, which we plan to expand across our network; launches South India's second digital PET/CT technology. HCG emerging as leading private cancer care provider across Mumbai. Mumbai center ramping up well with 30.9% y-o-y revenue growth. Comprehensive oncology services launched in South Mumbai center, which is in a very prestigious location, and the first CyberKnife technology for advanced radiosurgery in Western India. Rajkot multi-specialty center achieves breakeven to commence oncology services offering in near future. Launched HCG centralized call center service for increased patient accessibility and care. Milann center in Whitefield, Bengaluru achieves breakeven towards continued leadership in an attractive market for comprehensive fertility services. I now request our CFO, Srinivasa Raghavan, to share the financial highlights. Srini?

Thanks, Dr. Ajai, and very good evening to everybody. Effective April 1, 2019, the company has adopted Ind AS 116 Leases standards applied to lease contracts existing on 1 April '19. The effect of this adoption have not been retrospectively adjusted for the year ended March '19 and previous period financials are not comparable. Highlights for quarter ended December 31, 2019. Consolidated income from operations was INR 2,779 million as compared to INR 2,488 million in the corresponding quarter of the previous year, reflecting a y-o-y increase of 12%. Consolidated EBITDA was INR 482 million. In other words, INR 325 million, excluding Ind AS 116 adjustment as compared to INR 299 million in the corresponding quarter of the previous year. Consolidated profit before other income, depreciation and amortization, finance costs, exceptional items, I mean, the operating EBITDA was INR 457 million, in other words, INR 300 million, excluding Ind AS 116 adjustment, as compared to INR 289 million in the corresponding quarter of the previous year. Operating EBITDA for existing centers were INR 419 million, excluding Ind AS 116 adjustment, reflecting an operating EBITDA margin of 18%. Loss from new centers was INR 118 million, excluding Ind AS 116 adjustment, as compared to loss of INR 85 million in the corresponding quarter of the previous year. Consolidated PAT was a loss of INR 228 million, loss of INR 187 million, excluding Ind AS 116 adjustment as compared to a loss of INR 62 million in the corresponding quarter of the previous year. I now request your attention to Slide #10 of earnings update presentation. Q3 '20 revenue grew 11.7% y-o-y basis. HCG centers grew by 11.9%, Milann centers 8.6%. Q3 '20 operating EBITDA. Existing centers INR 419 million, 18% margin versus 17.1% margin in Q3 FY '19. New centers loss of INR 118 million versus loss of INR 85 million in Q3 FY '19. Moving on to Slide #11. YTD '20 revenue grew 14.5% y-o-y. HCG centers grew by 14.7%, Milann centers 12.4%. YTD '20 operating EBITDA. Existing centers INR 1,230 million, 17.6% margin versus 17.7% margin in YTD FY '19. New centers loss of INR 301 million versus loss of INR 214 million in YTD FY '19. I now request Dr. Ajai Kumar to share the operating highlights.

Thanks, Srini. I would like to draw your attention to Slide 12 of the presentation. Revenue split for our business is 94% contribution by HCG centers and 6% by Milann fertility centers. Within HCG centers, Western India comprising of Gujarat and Maharashtra contributes 43% of the total revenue followed by Karnataka at 35%, East India and Andhra Pradesh at 8% each. Tamil Nadu contributes 4% and North India contributes 2% as of Q2 FY '20. I would like to draw your attention to Slide 13 of the presentation. Strong growth continues at several existing and new centers in Q3 FY '20. Vizag 37.5% y-o-y, Borivali 30.9% y-o-y, Cuttack 22.1% y-o-y, Suchirayu 21.5% y-o-y. New centers contributed revenue of INR 40.8 crores in Q3 FY '20 versus INR 25.7 crores in Q3 FY '19. Revenue from existing HCG centers grew at 6% in Q3 FY '20 on a y-o-y basis. I would like to draw your attention to Slide 14 of the presentation. ARPOB for existing centers had INR 33,918 as against INR 31,375 (sic) [ INR 31,763 ] in Q3 FY '19. ALOS at 2.24 on account of trend towards day care procedures and changing patient profile. Operating EBITDA margins impacted the scale-up and losses of new centers. Existing centers operating EBITDA margin improved by 64 bps to 21.8% in Q3 FY '20 from 21.2% in Q3 FY '19. Looking at key geographies in Slide 15. Karnataka region continues its focus on improving realization parameters. The Center of Excellence ARPOB is INR 63,300, with 29.8% operating EBITDA margin. And Q3 FY '20 Center of Excellence ROCE improved from 20.8% to 29.6%. Focus on margins and returns optimization across regions. With respect to Gujarat region, Rajkot center achieves breakeven in a very short period of time. Bhavnagar oncology ramps up with 14% revenue growth y-o-y. EBITDA margin of existing centers at 15% for Q3 FY '20. In Maharashtra, South Mumbai operational with first CyberKnife technology in Western India. Nashik center expansion driving enhancement of specialized service offerings. Borivali and Nagpur centers ramping up with continued reduction in losses and nearing their breakeven points. In Andhra Pradesh, center in Vizag continues to ramp up well; focus on improving revenue mix through reduction of scheme patients. In East India, Kolkata center operational; offers advanced and comprehensive oncology services. Existing centers had EBITDA margin of 26.2%. Driving improvements in patient and procedure mix. Coming to Slide 16, covering key highlights of Milann fertility business. Whitefield center in Bangalore achieves breakeven and continues to ramp up well. Leadership in attractive Bangalore market. Restructuring Ahmedabad operations to increase focus on key regions of North India and Bangalore. Now I request our CFO, Srini Raghavan, to explain the CapEx and debt highlights.

Thanks, Dr. Ajai. I would now like to draw your attention to Slide #17. With respect to the CapEx table, we are nearing the last leg of our expansion. Total CapEx was INR 325 million, of which INR 188 million was in the new centers. With respect to net debt, we closed the quarter at net debt of INR 7,027 million. I would like to draw your attention to Slide #18. South Mumbai center commenced outpatient services and will be operationalized in Q3 FY '20. We are not expecting any new centers for next few quarters. We do not have any more committed new centers for Milann. I would now like to hand over the call back to Niraj.

Thanks, Srini and Dr. Ajai for sharing the financial and business highlights. We would now like to open the call to take questions from the participants.

[Operator Instructions] The first question is from the line of Sudarshan Padmanabhan from Sundaram Mutual Fund.

Sir, my question is on this new center. I understand that the OPD of South Mumbai had started. One is, if you can give -- because if one is looking at the new center losses, there has been a Q-on-Q INR 2 crores, INR 2.5 crores kind of a jump. Is it primarily only because of this South Mumbai? And even if the entire thing is taken on South Mumbai, it looks like on a Q-on-Q basis, I mean, the other centers have not shown an improvement in terms of the losses coming down. Sir, if you can help us reconcile this number?

Sudarshan, what has happened here is entire quarter, we have taken South Mumbai as well as Calcutta, which were not there on y-o-y basis. So the -- actually, the other centers in Borivali and Nagpur have shown an improvement. And also, Nashik because of the expansion, the improvement has also happened there. But initially, compared to y-on-y Nashik was actually down because of the expansion. So in order to just summarize the 2 centers added is what has -- which were not there before was what has caused the jump in the losses. But actually...

This is Q-on-Q, sir. I'm looking at Q-on-Q actually.

Q-on-Q also the same thing, which is the same. And you can answer.

So Sudarshan, in quarter 2, we did not have entire Calcutta impact, and South Mumbai was not operational. So the entire Kolkata impact came in Q3 currently. And also incrementally, South Mumbai impact came for the full month of December and some more period. So that is the main quarter-on-quarter impact on the new center losses.

How much would that be, if I look at these 2 centers, specifically on a Q3 versus Q2?

This is more than the quarter-on-quarter delta, which shows that the other centers have improved as we have announced Rajkot and Whitefield have also broken even. But the impact from South Mumbai and Kolkata is more than the improvement on the others.

Yes, sure. And where are we standing in terms of -- earlier, we had talked about breakeven in the fourth quarter for Borivali. I mean, are we on course to that? Or is there any change in the...?

The losses have narrowed significantly. So we believe we are very close to that. Either it is going to be in the last quarter or the first quarter of the coming year. But also, more importantly, the way we have structured Borivali, in the past, we had the talent acquisition and all, there were some delays. Today, we are very happy to report this fully talent acquisition has happened among doctors. Initially, we had very good talent in radiation. But now we are -- have significant talent and stability with medical oncology and even surgical oncology. And we have also identified and now on the verge of doing some bone marrow transplants there. Our footfall is also definitely increasing. And with all this, we see -- and also, we are improving our international patient revenue there, which is taken -- which is going upside. Added to this, when you look at South Mumbai, which is in a very prominent area, we are seeing, as anticipated and even maybe better than we have programmed, the run up is happening there. So we do think even South Mumbai may breakeven quite fast. So with all this happening, we see a very bright future for Mumbai together. And whatever difficulties happened in Borivali, we have definitely overcome. As you know, in the past, you have given high rent reasons and a few others. But we are more or less, we are over that. We are on the upside in both centers.

Sure, sir. Sir, in terms of the overall losses, I mean, if I look at the -- excluding loss and what we are running at. I mean, we're running at a good INR 42 crores kind of a run rate. I mean, the broad assumption would be that now that the entire CapEx is behind and as Borivali gains traction and the other hospitals kind of gather momentum and reduce the losses. I mean, this typical INR 10 crore, INR 12 crore loss. I mean, in your expectations, when should we see this more or less getting marginalized because that would mean INR 160 crore kind of a number. I mean, plus, you would also grow on that. So some color on that, sir.

Yes. The thing is with South Mumbai, Kolkata coming into the play, you will see some rise in the losses, and then it will start tapering down in the next couple of quarters. So that is the trend we kind of see. And we should start getting it reflected in the results.

Yes. Just to add to that, we see Borivali, South Mumbai breaking even. South Mumbai, of course, being a little bit later than Borivali and Nagpur. But Calcutta will take time because this has just started in July. So Calcutta is one which will still have certain negative reporting for a while, and also Jaipur. As you know, Jaipur also we have started now. But Jaipur will also have some negative EBITDA impact for first 2 quarters. But we expect that to breakeven by that time.

So by the second half, we should more or less have this almost to 0. This INR 10 crore loss.

As we said, Calcutta. Calcutta may still run up to third quarter, third quarter. But minimal loss may even be experienced in fourth quarter.

So to a large extent, you can see it tapering down of these losses.

Sure, sir. And sir, with respect to the debt. I mean, now that the entire CapEx is done, and I can see that whatever was the CapEx that was required has been added in terms of debt, almost INR 35 crore increase in the debt versus the INR 32 crores kind of a CapEx that is required. Should I assume that more or less, this debt would be kind of a peak-ish debt? And second is from your comfort point of view, I mean, we also have several plans in progress, which we can actually encash and bring down the debt. So if you can give some route map on that for the next 12 months.

Yes, the thing is, as we said earlier, we are coming to the close of the CapEx cycle. There are a few stock that is still left out in the Gurugram project. So I expect it to get over by Q1 time frame, Q1, early Q2 time frame. So during this case, you can expect a marginal increase in debt, after which it should kind of stabilize.

And starts coming down.

And it will start coming down based on the cash generated from the operations.

Sure. And any other plans we have? I mean, would it only be necessarily from internal cash? Or is there any opportunity that we can see in terms of monetizing any assets or anything? Is there any option?

No, we are...

Obviously, I don't want to make any comment on that. But what I want to convey to our investors, shareholders is that the management is looking at various options. As we have said even in the past that, including what are the ways we can reduce debt, what are the ways we can even monetize or even fundraising, we are looking at all options. So we will convey as and when certain things do come to play, okay?

The next question is from the line of Chandramouli from Goldman Sachs.

First question, Srini, is just a clarification on one of the comments you made. You said that for the next few quarters, we do not have any projects on the CapEx pipeline. So could you just clarify what the status of the Delhi or Gurugram project is at this point? And how are you thinking about Kochi? Because as far as I can remember, those are the only 2 projects on the anvil at this point.

Regarding Gurugram, while the work is going on, it is going on in terms of infrastructure. So there is very little CapEx requirement at this point. We have already invested. So we are not looking at any major requirement in the near future. We are looking at possibly, not even this coming fiscal year. Regarding Kochi, certainly, the contractor there who is to complete the project is going to take over a year to do anything. So again, we are looking at only the next fiscal year, if at all, any material capital investment is needed. Even that we have locked out of various models. So as and when those models fructify, we will convey to the investors what are the models. So our goal is very clear. Whatever way we can, we want to reduce the CapEx requirements and look at alternate ways of really doing it. So the CapEx requirement will come down or stabilize.

Got it. Got it. Second question is on the Milann business. I think you've put it on strategic review. I read in a recent interview that you had given as well that this is a business that you're considering a sale off. So I just wanted to understand how to think about that business going forward? And then how much that could be a part of your deleveraging plan going forward?

Yes, I think, I was not fully correctly quoted there. So second thing I want to say is, Milann, like I said, just now, we will look at all the options. And when something really comes up, we will communicate. Otherwise, I don't want to comment much on it. As far as the Milann operations are concerned, we do believe we have broken even in Delhi, we have run the upside in Delhi as well as in Chandigarh. And as I said in Ahmedabad, we have restructured it such a way that our losses will be minimal and we are working with a partner there. As far as Bangalore, Whitefield has broken even. So compared to last year, definitely, we are on the upside. And looking forward next year, we are also looking at some andrology partner also. As we incorporate those, we see, there'll be healthy growth next year and years to follow. So this is our take at this time on Milann.

Got it. Got it. And just finally, on your deleveraging process, you just mentioned that Q1, Q2 FY '21, you might see a slight inch up in the net debt number. I think your pre-Ind AS net debt number this quarter is about INR 700 crores. So is there any quantum of debt reduction that you have in mind in the fiscal year 2021 that you can share with us?

Yes, like I told you, we have for -- we have, management is looking at various options of debt reduction. One of the things we mentioned what are the option, you said the deleveraging, looking at assets, looking at fundraising, all of the options are on the table. We have been looking at all this. But further, I don't want to comment anything. When anything does happen, we will certainly convey that to the investors.

[Operator Instructions] The next question is from the line of Vivek Agrawal from Citigroup.

It's regarding to sluggish growth in the existing centers, existing grew by 6% in the quarter. Any specific reason for that why we are seeing growth is tepid over the last 2 quarters?

Yes. One of the things we mentioned, as you know, in the revenue growth is, we being a totally oncology center, the pharma issue had an impact on us. Now just to give you an example, if MRP of the drug some INR 100 is brought down to INR 20, obviously, that affects our revenues significantly. So that has been one impact. Second is, with the impact of fully operational Nashik centers, which, as it expanded, that also had the impact of revenue. So the main reason is being the pharma reason. And hopefully, government will not come up with any other measures for going forward. With that, we do feel the revenue growth will pick up in the coming year.

Okay. And sir, on the margin improvement of...

Yes, what I feel about the base correction has happened now. So from this base, we should see the growth happening.

Yes, okay. Noted. Sir, 64 bps y-o-y margin improvement in the existing center. So is it like-to-like? Or is it basically mainly because of India?

Not like-to-like.

Yes, it is the like-to-like margin improvement in the KR-DR. You're talking about KR-DR, right?

Yes.

There, as I mentioned, this -- the Center of Excellence, one of the things very important for investors to understand is, however, Center of Excellence is performing and how we have hit a very high EBITDA margin, ROCE, all of that, and we want to really look at and where we have looked at it. As you know, in the past, there was some downside because of the mix was changing. Today, with the mix change, we are having more cash patients, international patients. This is the model we want to really -- we're working on to take it to places like Mumbai, South Mumbai, Borivali and Calcutta. This is where our focus will be. So those are the areas which are high revenue-generating areas. So that is where we want to focus going forward.

The next question is from the line of Senthil Kamaraj from ithought Financial. I'm sorry, Mr. Kamaraj, but your voice is not clear.

Could you provide the number of patients treated during the quarter and for the 9 months FY '20?

Yes. So we -- generally, on the patient count, we disclose it annually in our annual report. We don't give interim numbers out because for accuracy reasons. So we will be able to disclose patient only in the annual report.

Last year, our annual report.

73,000 was the FY '19...

Last year was 73,000. Obviously, we expect it to be close to 90,000 or more. But we can give you the accurate number when the quarter closes and the year closes. Yes.

And my second question is with respect to the multi-specialty hospitals that we have on our group. So what is the outlook going forward? And what is the -- operationally, what was the performance during the 9 months and during the quarter?

So we're not looking to add any more multi-specialty facilities. And in fact, like Dr. Ajai read out in his overview, after Rajkot breaking even, we are looking at some oncology services there like surgeries and medical oncology also. So currently, the multi-specialty business is doing well, and we don't expect to add any facility.

Just to add to Niraj, as some of you know, we are very oncology focused. And going forward, we want to be very directional in oncology. And that is the reason our Mumbai center, South Mumbai, Nagpur and Calcutta are all oncology focused. The reason the -- previously, when we started in Ahmedabad, we did the multi specialties primarily because we could convert that to oncology. And that is how we ended up with that. Later on, we had -- when we did Bhavnagar center, we have made -- converted that to actually oncology center now, some multi-specialty. Similarly, in Rajkot also, we'll be doing at the right times oncology. This is how we want to move forward. We want to really focus more on oncology, not only in India but in other parts like Africa, we have centers beginning. So our goal will be to become highly specialized in oncology care. That is where I think the future is also. As we read out the number of oncology cases, unfortunately, increasing. The number of the specialized center not being there. For example, like what we have on HCG oncology, there's no other specialized center. And one of the things we look at is really outcome-based. We have been written up by Harvard Business School, World Bank and all because of outcome. So people are now beginning to look at outcome and the value-based medicine. And in fact, HCG Bangalore, the reason we have such good numbers, and we are beginning to see now growth and all is because it's a destination. Patients come for a final opinion, treatment of care. This is the model we want to take it across in centers like Mumbai, Calcutta.

[Operator Instructions] The next question is from the line of Harith Ahamed from Spark Capital.

What we are hearing from some of your specialty care hospital competitors is that a greater focus on oncology as a specialty is something that all of them are talking about and some of them are adding oncology centers to their existing specialty care hospitals. So will this lead to more competition for the comprehensive cancer care providers like HCG? And what are the advantages of a pure-play cancer care provider like HCG versus some of these specialty care providers who are getting into oncology?

Thank you very much for your question. I can answer and take the rest of the half an hour for that if you want. Let me try to summarize it. This is a question which has been asked in the past, certainly. But one point I want to make is, if you look at the global cancer scenario, dedicated cancer centers always do better. Like I trained in MD Anderson. Today, there are so many cancer center as Sloan Kettering. They are the destination. Second thing is when a tertiary hospital says they want to do oncology, it is part of the multi-specialty. So they are looked upon as a multi-specialty with an oncology wing. So the most of the patients who come there, for example, even big multi-specialty hospitals see approximately, you can say, 1,000 to 1,500 new patients a year. Because they are internally generated. From outside, suppose you are a multi-specialty hospital and outside a patient is diagnosed as cancer, let's say, breast cancer or stomach cancer, patients are not referred to this multi-specialty because 2 reasons. One is, obviously, the referring doctor wants the patient to come to a highly specialized center. Two, the referring doctor also is concerned about what is going to happen to the patient in future. If the patient goes to multi-specialty, let us say, and I call it the Mayo Clinic syndrome because when I was practicing, I used to refer patients to Mayo Clinic, and this is what used to happen. You refer them for, let's say, colon cancer. I remember this incidence very well. The patient had surgery for colon cancer. It was a very complicated surgery. But came and said, doctor, you know, I am now a new man. They found this aneurysm in my brain. The cardiac problem. They treated for my atherosclerosis and the bone problem. So you have got it overall completely. This is one thing that a referring doctor will never like because they will lose the patient completely. Once the patient goes into the multi-specialty system, they never come back. So that is part of the reason. Part of the reason is Center of Excellence. A multi-specialty cannot have 80 oncologists sitting and giving opinion, tumor boards. For example, we do tumor boards on Tuesdays, where all our centers are connected, where we measure outcomes, where we look at quality parameters, 152 quality parameters. We will produce papers. We do a lot of research, data collection. So patients are well aware of it. Just to give you an example, yesterday, a patient came to my clinic on Tuesday from a faraway distance in Bangalore only from 30 miles. Why did the patient come even though multiple hospitals, she has breast cancer. Why did she come, because she wanted to come to Center of Excellence. So this is where the dynamics changes and patients, of course, do Google reviews and other reviews. So essentially, any patient wants to come, this patient only I wanted to come to the Center of Excellence, are they a dedicated oncology center. So people are more and more looking at it. So that is why even though multi-specialty hospitals have come, you are right, a lot of hospitals have come with oncology attachment. But when we collect the data, we know they are not capable of generating that kind of patient load. I can't talk about the financial part. But all I can say is the patient load generation won't be there that high. Like we see 10,000 new patients in Bangalore KR Road. That's the kind of a number we've not seen anywhere. Government hospital, Kidwai sees that kind of number because the government dedicated cancer center. So that is a -- hopefully, I've answered your question.

Yes. One follow-up there. When it comes to cancer patients, there will be a lot of co-morbidities, which -- I mean, the tertiary care hospitals aren't they even better positioned to manage those co-morbidities because they have all specialties under the same roof? Is that a right understanding?

I will answer that question, another half an hour. No, I'm kidding. In this case, actually, it is the other way around because there is a ceiling, which some of these multi-specialty hospital say, I have like a cardiology service, I have pulmonary service. But if you come and visit our center in Bangalore or even Mumbai, actually, it is fully equipped. Actually in Bangalore, because of the size, we have full-time cardiologists, pulmonologists, nephrologists, name it. But even otherwise, what I want to say is, who knows better of taking care of an oncology patient than an oncology group, which is dedicated ICU. For example, this is my 43rd year in oncology. I can say, clearly, that an oncology patient in ICU, in an oncology center has far better chance of recovering than in a multi-specialty. Because you have to know how to take care of the onco patients because they may be having sepsis without fever. So if you go to multi-specialty, there is no way they will know, because you cannot be experts. They may know how to take care of pneumonia. They may know how to take care of cardiac. But to take care of an immunosuppressed onco patient is a rarity. So that is why we actually do audit to see how many patients go to ICU with 0 blood pressure, 0 blood count come out. Our rate in our ICU in Bangalore is almost 95% come out. And how many patients who were intubated come out of it. So we measure all this. And we have a concept of EICU, where the ICU people are trained to look at the anomalies of an oncology patient compared to a patient who is non-oncology. So the matter is quite deep. The assumption -- a superficial assumption that we do not have and we cannot is not correct. In fact, the data is what really speaks for it. If you look at MD Anderson outcome, if you look at Sloan Kettering outcome, if you look at a multi-specialty outcome there, MD Anderson outcome is far more, far better for the very reasons I said. Similarly, we've run calculations, we have done, we don't -- even though we don't get data from other hospitals, our data, outcome of our patients is equal to the best of the centers in the world. That is what Harvard or World Bank has shown as IFC. So we are very clear that the patient who walks into our center definitely has a better chance of long-term survival or even short-term survival due to complications in oncology.