• Asian Pacific Journal of Cancer Prevention
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• 제14권5호
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• pp.2829-2834
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• 2013

The objective was to analyze the radiotherapy (RT) practice at the cancer centre of a tertiary academic medical institution in Delhi. This audit from an Indian public institution covered patient care processes related to cancer diagnosis, integration of RT with other anti-cancer modalities, waiting time, overall treatment time, and compliance with RT. Over a period of one year, all consecutively registered patients in radiotherapy were analyzed for the audit cycle. Analysis of 1,030 patients showed median age of 49.6 years, with presentation as stage I and II in 14.2%, stage III and IV in 71.2% and unknown stage in 14.6%. A total of 974 (95%) were advised for RT appointment; 669 (68.6%) for curative intent and 31.4% for palliation. Mean times for diagnostic workup and from registration at cancer centre to radiotherapy referral were 33 and 31 days respectively. Median waiting time to start of RT course was 41 days. Overall RT compliance was 75% and overall duration for a curative RT course ranged from 50 days to 61 days. Non-completion and interruption of RT course were observed in 12% and 13% respectively. Radiotherapy machine burden in a public cancer hospital in India increases the waiting time and 25% of advised patients do not comply with the prescribed treatment. Infrastructure, machine and manpower constraints lead to more patients being treated on cobalt (74%) and by two-dimensional (78%) techniques.

• Asian Pacific Journal of Cancer Prevention
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• 제14권7호
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• pp.4379-4386
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• 2013

Projection of cancer incidence is essential for planning cancer control actions, health care and allocation of resources. Here we project the cancer burden at the National and State level to understand the magnitude of cancer problem for the various calendar years from 2011 to 2026 at 5-yearly intervals. The age, sex and site-wise cancer incidence data along with populations covered by the registries were obtained from the report of National Cancer Registry Programme published by Indian Council of Medical Research for the period 2001-2004. Pooled age sex specific cancer incidence rates were obtained by taking weighted averages of these seventeen registries with respective registry populations as weights. The pooled incidence rates were assumed to represent the country's incidence rates. Populations of the country according to age and sex exposed to the risk of development of cancer in different calendar years were obtained from the report of Registrar General of India providing population projections for the country for the years from 2001 to 2026. Population forecasts were combined with the pooled incidence rates to estimate the projected number of cancer cases by age, sex and site of cancer at various 5-yearly periods Viz. 2011, 2016, 2021 and 2026. The projections were carried out for the various leading sites as well as for 'all sites' of cancer. In India, in 2011, nearly 1,193,000 new cancer cases were estimated; a higher load among females (603,500) than males (589,800) was noted. It is estimated that the total number of new cases in males will increased from 0.589 million in 2011 to 0.934 million by the year 2026. In females the new cases of cancer increased from 0.603 to 0.935 million. Three top most occurring cancers namely those of tobacco related cancers in both sexes, breast and cervical cancers in women account for over 50 to 60 percent of all cancers. When adjustments for increasing tobacco habits and increasing trends in many cancers are made, the estimates may further increase. The leading sites of cancers in males are lung, oesophagus, larynx, mouth, tongue and in females breast and cervix uteri. The main factors contributing to high burden of cancer over the years are increase in the population size as well as increase in proportion of elderly population, urbanization, and globalization. The cancer incidence results show an urgent need for strengthening and augmenting the existing diagnostic/treatment facilities, which are inadequate even to tackle the present load.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.6863-6870
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• 2015

Background: Breast cancer accounted for almost 25% of all cancers in women globally in 2012. Although breast cancer is the most prevalent cancer in India, there is no organised national breast cancer screening programme. Local studies on the burden of breast cancer are essential to develop effective context-specific strategies for an early detection breast cancer programme, considering the cultural and ethnic heterogeneity in India. This study examined the knowledge, attitudes, and practices about breast cancer in rural women in Central India. Materials and Methods: This community-based cross sectional study was conducted in Wardha district, located in Maharashtra state in Central India in 2013. The sample included 1000 women (609 rural, 391 urban) aged 13-50 years, selected as representative from each of the eight development blocks in the district, using stratified cluster sampling. Trained social workers interviewed women and collected demographic and socio-economic data. The instrument also assessed respondents' knowledge about breast cancer and its symptoms, risks, methods of screening, diagnosis and treatment, as well as their attitudes towards breast cancer and selfreported practices of breast cancer screening. Chi-square and t-test were applied to assess differences in the levels of knowledge, attitude, and practice (the outcome variables) between urban and rural respondents. Multivariable linear regression was conducted to analyse the relationship between socio-demographic factors and the outcome variables. Results: While about two-thirds of rural and urban women were aware of breast cancer, less than 7% in rural and urban areas had heard about breast self-examination. Knowledge about breast cancer, its symptoms, risk factors, diagnostic modalities, and treatment was similarly poor in both rural and urban women. Urban women demonstrated more positive attitudes towards breast cancer screening practices than their rural counterparts. Better knowledge of breast cancer symptoms, risk factors, diagnosis, and treatment correlated significantly with older age, higher levels of education, and being office workers or in business. Conclusions: Women in rural Central India have poor knowledge about breast cancer, its symptoms and risk factors. Breast self-examination is hardly practiced, though the willingness to learn is high. Positive attitudes towards screening provide an opportunity to promote breast self-examination.

• Asian Pacific Journal of Cancer Prevention
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• 제17권8호
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• pp.3663-3673
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• 2016

Cervical cancer (CaCx) is the second most fatal cancer contributing to 14% of cancers in Indian females, which account for 25.4% and 26.5% of the global burden of CaCx prevalence and mortality, respectively. Persistent infection with high-risk human papilloma virus (HPV- strains 16 and 18) is the most important risk factor for precursors of invasive CaCx. Comprehensive prevention strategies for CaCx should include screening and HPV vaccination. Three screening modalities for CaCx are cytology, visual inspection with acetic acid, and HPV testing. There is no Indian national policy on CaCx prevention, and screening of asymptomatic females against CaCx is practically non-existent. HPV vaccines can make a major breakthrough in the control of CaCx in India which has high disease load and no organized screening program. Despite the Indian Government's effort to introduce HPV vaccination in the National Immunization Program and bring down vaccine cost, challenges to implementing vaccination in India are strong such as: inadequate epidemiological evidence for disease prioritization, duration of vaccine use, parental attitudes, and vaccine acceptance. This paper reviews the current epidemiology of CaCx and HPV in India, and the current status of HPV vaccination in the country. This article stresses the need for more research in the Indian context, to evaluate interventions for CaCx and assess their applicability, success, scalability and sustainability within the constraints of the Indian health care system.

• Tuberculosis and Respiratory Diseases
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• 제87권3호
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• pp.234-251
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• 2024

Globally, providing evidence on the economic burden of chronic obstructive pulmonary disease (COPD) is becoming essential as it assists the health authorities to efficiently allocate resources. This study aimed to summarize the literature on economic burden evidence for COPD from 1990 to 2019. This study examined the economic burden of COPD through a systematic review of studies from 1990 to 2019. A search was done in online databases, including Web of Science, PubMed/Medline, Scopus, and the Cochrane Library. After screening 12,734 studies, 43 articles that met the inclusion criteria were identified. General study information and data on direct, indirect, and intangible costs were extracted and converted to 2018 international dollars (Int$). Findings revealed that the total direct costs ranged from Int$ 52.08 (India) to Int$ 13,776.33 (Canada) across 16 studies, with drug costs rannging from Int$ 70.07 (Vietnam) to Int$ 8,706.9 (China) in 11 studies. Eight studies explored indirect costs, while one highlighted caregivers' direct costs at approximately Int$ 1,207.8 (Greece). This study underscores the limited research on COPD caregivers' economic burdens, particularly in developing countries, emphasizing the importance of increased research support, particularly in high-resource settings. This study provides information about the demographics and economic burden of COPD from 1990 to 2019. More strategies to reduce the frequency of hospital admissions and acute care services should be implemented to improve the quality of COPD patients' lives and reduce the disease's rising economic burden.

• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5475-5482
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• 2014

Cervical cancer, the second most common malignancy all over the world, is associated with HPV infection. In a developing country like India, lack of early detection and treatment facilities is the main cause for its high burden. Therefore, through our study we e tried to present the current scenario of existing facilities for the detection and treatment of cervical cancer in hospitals and primary health centers (PHCs) of Delhi-NCR region. Data were collected from 312 healthcare facilities including public and private hospitals and PHCs of all nine districts from Delhi-NCR region. Healthcare providers including gynecologists, medical officers, women health care providers and paramedical staff were interviewed, using a questionnaire; the facilities for screening, diagnosing, and treating cervical cancer in each institution were recorded, using a previously designed checklist. Our study has shown that the basic facilities for the detection and treatment of cervical cancer are abhorrently lacking in Public hospitals and PHCs as compared to the Private hospitals in Delhi-NCR region. This study demonstrates that there is an urgent need for more investment in the diagnosis and treatment of cervical cancer facilities in public and rural healthcare facilities of Delhi-NCR region.

• Asian Pacific Journal of Cancer Prevention
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• 제17권6호
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• pp.2841-2846
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• 2016

Background: Tobacco use is the single most important preventable risk factor for cancer. Surveillance of tobacco-related cancers (TRC) is critical for monitoring trends and evaluating tobacco control programmes. We analysed the trends of TRC and evaluated the population-based cancer registry (PBCR) in Delhi for simplicity, comparability, validity, timeliness and representativeness. Materials and Methods: We interviewed key informants, observed registry processes and analysed the PBCR dataset for the period 1988-2009 using the 2009 TRC definition of the International Agency for Research on Cancer. We calculated the percentages of morphologically verified cancers, death certificate-only (DCO) cases, missing values of key variables and the time between cancer diagnosis and registration or publication for the year 2009. Results: The number of new cancer cases increased from 5,854 to 15,244 (160%) during 1988-2009. TRC constituted 58% of all cancers among men and 47% among women in 2009. The age-adjusted incidence rates of TRC per 100,000 population increased from 64.2 to 97.3 among men, and from 66.2 to 69.2 among women during 1988-2009. Data on all cancer cases presenting at all major government and private health facilities are actively collected by the PBCR staff using standard paper-based forms. Data abstraction and coding is conducted manually following ICD-10 classifications. Eighty per cent of cases were morphologically verified and 1% were identified by death certificate only. Less than 1% of key variables had missing values. The median time to registration and publishing was 13 and 32 months, respectively. Conclusions: The burden of TRC in Delhi is high and increasing. The Delhi PBCR is well organized and generates high-quality, representative data. However, data could be published earlier if paper-based data are replaced by electronic data abstraction.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1699-1703
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• 2012

Cervical cancer remains the most frequent cancer in women from the developing world. More than 88% of deaths occur in low-income countries, and it is predicted to climb to 91.5% by 2030. Although Pap-based screening programmes have shown to be effective in reducing the disease burden in high-resource countries, implementation and sustention of cytology-based programmes is quite challenging in low-resource settings. The present paper reviews evidence-based alternatives of screening methods, triaging algorithm, treatment of cervical precancerous lesions, and age-group at screening appropriate for low-income countries. Evidence shows that visual inspection methods using diluted acid acetic or Lugol's iodine, and HPV-DNA testing are more sensitive tests than the Pap-smear screening test. Visual inspection allows an immediate result and, when appropriate, may be immediately followed by cryotherapy, the so called "screen-and-treat" approach, achieved in a single visit, by trained nurses and midwives. Examples of cervical cancer prevention programmes in India and selected low-income countries are given.

• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.3949-3953
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• 2012

Head and neck cancers are amongst the commonest malignancies, accounting for approximately 20% of the cancer burden in India. The major risk factors are tobacco chewing, smoking and alcohol consumption, which are all preventable. This retrospective study presents data from the histopathology register for a five year period from 2002-2006 at Patna Medical College and Hospital, a tertiary care hospital drawing patients from the entire Bihar state, the 3rd most populous state of India with the majority of the population residing in rural areas. Incidence rates based on sex, age, site of lesion, including age standardized incidence rates for males and females, with mean age of presentation, distribution of histological variants and year wise trend were calculated. Out of 455 head and neck neoplasias, 241 were benign while 214 were malignant. The most common age group for all malignant biopsies was 7th decade for males and the 5th decade for females. Malignant cases were commoner in males than females with the male:female ratio of 3.1:1, which was found to be statistically significant by the chi-square (${\chi}^2$) test. The crude rate and age standardized incidence rate was 0.05 and 0.06 per 100,000 population respectively. Squamous cell carcinoma (SCC) contributed about 96% of all cases, with grade I being the most common. Larynx was the most common site for malignancy, the supraglottic region being its most commonly affected sub-site. This observed incidence patterns in the region are a reminder of widespread unawareness, low healthcare utilization with virtually non-existent cancer programs. It also underlines the need to advocate for reliable cost-effective programs to create awareness, for early detection and plan appropriate management strategies. There is a compelling demand for a cancer registry in this region as well as proper implementation of preventive measures to combat this growing threat of cancer, many of whose risk factors are preventable.

• Asian Pacific Journal of Cancer Prevention
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• 제16권1호
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• pp.181-184
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• 2015

Background: Breast cancer is the most common female cancer in Kerala, South India, with the incidence increasing in the past two decades, also in young women. However, there are limited data regarding the burden of disease, its epidemiology and histopathological characteristics in the state. Materials and Methods: This desciptive study covered 303 breast cancers evaluated during the period of December 2011 to August 2013 in the Department of Pathology, Government Medical College, Kottayam.The patients were also interviewed regarding selected risk factors. Results: The majority of the cases were 41-60 years of age with a mean at presentation of 53 years. Infiltrating ductal carcinoma was the most common subtype, followed by pure mucinous carcinoma and then lobular carcinoma. Of the cases, 6.6% were nullipara and 52.8% had fewer than or equal to 2 children. Median age at first child birth was 23 years (national value-19.8 years). A significant proportion (15%) had family history of breast cancer. Some 13.5%(41 cases) comprised the young breast cancer group (${\leq}40$years) with a mean age at first child birth in them was 27.4 years, 5 being nullipara and 6 having a positive family history. Conclusions: Breast cancer awareness, better availability of screening techniques and identification and targeting high risk groups all help to tackle the increasing load of breast carcinoma. A good proportion of cases comprised the young breast cancer group (under 40). Younger women should thus also be educated about breast carcinoma-risk factors, symptoms and diagnostic techniques to help in early detection and effective approach esto treatment.