Reference from different parts of the country. However,

Reference ID:  2018 – 00544

Title – Hospital based Cancer
profile – a record based retrospective study

Introduction:

          Cancer,
one of the most dreaded non-communicable diseases is an important contributor
to the global burden of diseases. It is the second leading cause of death
worldwide, second only to cardiovascular disease. 1 The continuing
global demographic and epidemiologic transitions signal an ever-increasing
cancer burden over the next decades, particularly in developing nations like
India. 2 The ICMR has estimated that India is likely to have over
17.3 lakh new cases of cancer and over 8.8 lakh deaths due to the disease by
2020. 3 The role of prevention and early diagnosis has been
emphasized for various types of cancer in the recent decade. 4, 5 Information
on cancer trends and patterns provides an important basis for determining the
priorities for cancer prevention in different regions of the world. Moreover, recent
studies indicate a change in demographics for various cancers. 6, 7
Although deaths and years of life lost from cancer are primarily used as the
basis for cancer prevention, cancer incidence data provide valuable information
on the risk of different cancers, independent of prognosis, which is important
in the planning and evaluation of cancer prevention. In India, the incidence
and mortality data is mainly generated by cancer registries. As of March 2016,
there are 27 Population Based Cancer Registries and 29 Hospital Based Cancer
Registries in India. 8 These registries reflect the cancer profile
of the country fairly well owing to representation of registries from different
parts of the country. However, the coverage is less than 10% of the population
of India. Hence, in their absence recourse must be made of hospital-based data.
The present study is therefore conducted to find the incidence data for
different types of cancer in our hospital and also to focus on variation with
patient’s age, sex and location.  

Objectives:

1.     To describe the
socio-demographic, clinical and follow-up profile of patients diagnosed with
cancer attending a tertiary care hospital in South India.

2.     To find the rates of
individual cancer types and to compare it with that of the cancer incidence and
patterns in cancer registries.

3.     To determine the association
between the socio-demographic factors, type of cancer and the disease outcome.

Methodology:

·       
Study design:

 Record based retrospective study.

 

·       
Study setting:

The study will be conducted at the Department of
Oncology, Coimbatore Medical College Hospital. It receives cases referred from
hospitals in the neighbouring districts like Tiruppur, Erode, Namakkal and
Palakkad. The department deals with approximately 1500-2000 patients per year and
extensive care and follow up is given for each patient. The leading site of
cancer reported in the Department of Oncology, Coimbatore Medical College
Hospital is the head and neck cancer followed by breast cancer and cervical cancer.

 

·       
Study population:

The cancer patients during the period – January 1, 2017
to December 31, 2017 will be included in the study.

 

·       
Study duration: 

The study will be conducted over a period of two
months from May 2018 to June 2018.

 

·       
Sample size:

Time bound sampling will be done. So all the patients
admitted in the department during the last year will be included in the study.

 

·       
Study tool:

A pre-tested semi structured case study form will be
used to collect the patient information. The case study form has three parts:

Ø Demographic details: It includes
the patient’s age, sex, occupation and the address.

Ø Clinical information: It
includes the cancer type, its histopathology, stage and the treatment modality.

Ø Follow-up information: It
includes the follow up data of the patient.

·       
 Data Collection
Methodology:

The Department of Oncology, Coimbatore Medical College
Hospital maintains an extensive tumour register whereby all reported
malignancies are assembled into a standardized versatile format, which is
available for the examination of disease patterns. The Institutional Human
Ethics Committee approval would be obtained before starting the study. The
Medical Records Officer of the hospital will be approached and the tumour
register as well as the patient records would be accessed. The diagnosed cases
of cancer who attended the Department of Oncology, Coimbatore Medical College
Hospital during the period – January 1, 2017 to December 31, 2017 will be
included in the study. The case study form will be used to obtain data from the
Tumour Register and the patient records. The data will be void of personal
identifiers and the patient confidentiality will be maintained.

 

·       
Outcome Variables:

It
includes the primary and secondary variables.

Primary
variables:

Ø Type of cancer – The cancer
cases will be divided into 11 types based on the site. It includes the head and
neck cancer, cervical cancer, breast cancer, bronchogenic cancer,
gastrointestinal tract malignancies, lymphomas, skin cancer, leukemia, urinary
tract malignancies, testicular cancer, ovarian cancer, bone tumours and soft
tissue sarcoma. The rest of the tumours will be considered as a separate
category. The tumour site was defined by the International Classification of
Disease for Oncology, Second Revision (ICD-O-2) topography and morphology
codes.

Ø Stage of cancer: It includes
the clinical stage – TNM staging and histopathological stage.

Ø Treatment modality: The type
of therapy – chemotherapy, radiotherapy and/or surgery will be analysed

Secondary
variables:

Ø Disease outcome: The current
status of the patient will be analysed

 

         

·       
Statistical analysis:

The collected data will be entered in Microsoft Excel and
analysed using Statistical Package for Social Sciences (SPSS) version 20. Data
will be collected as categorical variables and results will be displayed as
proportions. Tables, pie-charts and graphs will be used to demonstrate the
results. Association between the socio-demographic factors, the type of cancer
and the disease outcome will be evaluated using Chi-Square test. A p value < 0.05 will be considered statistically significant.   Implications: Heredity and environment remain the two major determinants of cancer. There are marked differences in distribution of cancers in different regions of the world. Epidemiological information on cancer including the pattern and socio-demographic factors will form an important basis to determine the priorities for cancer control in the given population group. Moreover investigation into various possible risk factors particular to the cancers with high incidence can be made. Hence the cancer pattern revealed by the present study could provide valuable information to cancer prevention as well as in the early diagnosis of various types of cancer, thus reducing the morbidity and mortality associated with cancer. References: 1)    Kasper, D.L., et al. Harrison's Principles of Internal Medicine. 19th edition. New York: McGraw Hill Education, 2015; 19: 467. 2)    Ferlay, J., et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer., U.S. National Library of Medicine, 1 Mar. 2015; 136: E359–E386 3)    Press Trust of India. Over 17 lakh new cancer cases in India by 2020: ICMR ­ News, 5/19/2016. Available at http://www.mid­day.com/articles/over­17­lakh­new­cancer­cases­in­india­by­2020­icmr/17248152 4)    Hundt, S., et al. Blood Markers for Early Detection of Colorectal Cancer: A Systematic Review. Cancer Epidemiol Biomarkers Prev., 2007; 16(10). 5)    Bolondi L., et al. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut 2011; 48: 251-259. 6)    Cleries, R., et al. Contribution of changes in demography and in the risk factors to the predicted pattern of cancer mortality among Spanish women by 2022. Cancer Epidemiology 2016; 40: 113-118. 7)    Sankaranarayan, R., et al. Managing the changing burden of cancer in Asia. BMC Medicine 2014, 12:3. 8)    Three-Year Report of Population Based Cancer Registries 2012-2014., National Centre for Disease Informatics and Research., 2016; Summary xi.