Profile of cancer patients attending a tertiary care center

Introduction: In India, around 555,000 people died of cancer in the year 2010. Cancer is a major cause of morbidity and mortality in developing and developed countries. In many low-income and middle-income countries, including India, most of the population does not have access to a well organized and well-regulated cancer care system. Objective: (1) To study the socio-demographic profile of cancer patients attending tertiary care center.(2) To study the type, site and at what stage cancers are being reported to tertiary care center (3) To study the association of the cancer type with socio-demographic variables. Material and methods: A Hospital-based Cross-Sectional Study carried out from November 2013 to October 2014. Detailed pre-designed and pre-tested proforma is used to collect information on the socio-demographic profile. All diagnosed cancer patients admitted at S DM College of Medical Sciences and Hospital. A total of 381 were studied during the study period. Results: Total of the 381 cancer patients, Males were 154 (40.4%) and females were 227 (59.6%), it was found that majority of male, 78 (50.6%) study subjects were in the age group of 60-69 years, in socioeconomic status male subjects were in lower-middle and upper lower class i.e. 40 (26%) female were in upper-middle-class i.e. 70 (30.8%), according to the present study breast cancer (21.3%) was most prevalent, followed by CA liver and biliary tract (14.7%), followed by lungs (8.7%). the male was diagnosed in stage III of disease accounting 67(43.5%) female patients were diagnosed in stage II 86 (37.9). Conclusion: Breast cancer more common among younger age group and upper SES, Cervical cancer more common among lower SES, Lung cancer in literates’. Liver cancer more common among the older age group and lower SES. So, these groups can be targeted for health education and screening for early diagnosis and treatment.


Introduction
Cancer is a major cause of morbidity and mortality in developing and developed countries. In many low-income and middle-income countries, including India, most of the population does not have access to a well organized and well-regulated cancer care system [1].
There were 14.1 million new cancer cases, 8.2 million cancer deaths and 32.6 million people living with cancer (within 5 years of diagnosis) in 2012 worldwide. 57% (8 million) of new cancer cases, 65% (5.3 million) of the cancer deaths and 48% (15.6 million) of the 5-year prevalent cancer cases occurred in the fewer developedregions [2].
The overall age-standardized cancer incidence rate is almost 25% higher in men than in women, with rates of 205 and 165 per 100,000, respectively.
Manuscript received: 13 th January 2020 Reviewed: 24 th January 2020 Author Corrected: 29 th January 2020 Accepted for Publication: 4 th February 2020 Male incidence rates vary almost five-fold across different regions of the world, with rates ranging from 79 per 100,000 in Western Africa to 365 per 100,000 in Australia/New Zealand (with high rates of prostate cancer representing a significant driver of the latter).
There is less variation in female incidence rates (almost three-fold) with rates ranging from 103 per 100,000 in South-Central Asia to 295 per 100,000 in Northern America [2]. In terms of mortality, there is less regional variability than for incidence, the rates being 15% higher in more developed than in less developed regions in men, and 8% higher in women.
In men, the rates are highest in Central and Eastern Europe (173 per 100,000) and lowest in Western Africa (69). In contrast, the highest rates in women are in Melanesia (119) and Eastern Africa (111), and the lowest in Central America (72) and South-Central (65) Asia [2].

International Journal of Medical Research and Review
Available online at: www.medresearch.in 98 | P a g e In India 1 million of these new cases and nearly 700 000 of the deaths occurred, which is home to about 17% of the global population [3]. In 2012, almost 145000 Indian women were diagnosed with breast cancer. Nearly 400000 of those who had reportedly been diagnosed with breast cancer in the previous 5 years were still alive [4].  [3].
The rapid epidemiological transition has resulted in a shift in the focus from communicable to non-communicable diseases in terms of morbidity and mortality. The cancer profile varies in different parts of the world and an epidemiological study helps us to know the common cancers prevalent in particular segments of a population. However, there is a lack of definitive information regarding hospital-based cancer profile in northern Karnataka. So, the present study is being undertaken with the aim to find out the profile of Cancer patients at SDM College of Medical Sciences and Hospital, Dharwad which is located in Northern Karnataka.

Material and Methods
Study design: Hospital-Based, Cross-Sectional Study Study population: All diagnosed cancer patients admitted in SDMCMSH, Dharwad for treatment Sample size: All diagnosed cancer patients admitted in SDM College of Medical Sciences and Hospital, during the study period (November 2013 to October 2014) will be enrolled in the study. As per the retrospective data collected from the hospital records, the average number of patients admitted during the last 3 years (who satisfy the present study criteria) accounted for 320. So, the expected sample size for the present study is estimated to be around 300.
Sample population: Cancer cases admitted to the hospital for the duration of more than 24 hours and meeting study criteria. A total of 381 were studied during the study period.

Study instrument:
Pretested, semi-structured questionnaire was administered by the investigator which relied on ICD-10 for classifying the type of cancer
The majority of female study subjects were housewives i.e. 115 (50.7%) followed by agriculturist 47 (20.7%) followed by laborer 27 (11.9%). In the male's majority were agriculturist 43 (27.9%) followed by those who were unemployed 29 (18.8%). According to socioeconomic status majority of study subject males were in lower-middle and upper lower class i.e. 40 (26%) followed by upper class 81 (24.8%) followed by upper-middle-class 27 (17.5%) and in female group majority of study subjects were in upper-middle-class i.e. 70 (30.8%) followed by lower-middle-class subjects 54 (23.8%) followed by upper lower class 49 (21.6%). The present study shows that 239 (62.7%) of study subjects were belonging to the nuclear family in both groups. In male group 106 (68.8%) study subjects belonged to the joint family which was more compared to urban area 81 (24.8%) ( Table  1).  It was observed that breast cancer was the most common cancer followed by liver cancer and lung cancer and common cancers among the female group of population were cancer breast 79 (34.8%) followed by cancer cervix 20 (8.8%) followed by cancer ovary 19 (8.4%) and thyroid 18 (7.9%). And the most common cancers among the male group of the population were cancer liver 42 (27.3%) followed by cancer prostate 19 (12.3%) followed by cancer stomach 18 (11.7%) and lungs 15 (9.7%).
The present study showed that around 69 (44.8%) of them were free from any comorbidity followed by 31 (20.1%) suffering from hypertension followed by 19 (12.3%) with diabetes as comorbidity and 25 (16.2%) suffered from both diabetes and hypertension.
It was observed that majority of cancer in males were diagnosed in stage III of disease accounting 67 (43.5%) followed by stage II 58 (37.7%) and in female patients majority of cancer was diagnosed in stage II 86 (37.9) followed by stage III 60 (26.4%) ( Table 2).

International Journal of Medical Research and Review
Available online at: www.medresearch.in 101 | P a g e A significant association was found between socio-demographic factors with breast cancer. It was found that in 19-50 years age group 43 (30.2%) were diagnosed with breast cancer as compared to the older age group. This difference between age group with respect to cancer breast was found to be statistically significant (p= 0.0009), and 70 (40.4%) of the study subjects belonging to Upper SES were diagnosed with breast cancer when compared to lower SES 11 (5.2%). This difference was found to be statistically significant (p<0.01) ( Table 3). Women with lower SES had a higher risk of cancer cervix 17(14.9%) compared to higher SES 3(2.6%). This difference was found to be statistically significant (p=0.0016) ( Table 4). Lung cancer was seen more in literates when compared to illiterates. In the present study, Lung cancer was seen in 29(11.2%) of literates while 4(3.3%) in illiterates. This difference between education with respect to Lung cancer was found to be statistically significant with p-value (p=0.01) ( Table 5). When compared socio-demographic factors with cancer liver. It was found that study subjects in the age group >50 years i.e. 45 (18.8%) had more diagnosed lung cancer as compared to <50 years age group. This difference between the age group with respect to cancer liver was found to be statistically significant (p= 0.00313). Liver cancer was different in males when compared to females. In males, 42 (27.2%) had liver cancer and 14 (6.1%) were seen in females. This difference between gender with respect to liver cancer was found to be statistically significant (p=<0.0001). Liver cancer was seen more in Lower SES i.e. 39 (18.7%) when compared to Higher SES i.e. 17(9.8%) of study subjects. This difference was found to be statistically significant (p=0.014) ( Table 6).

Discussion
Cancer breast (21.3%) in subjects was most prevalent, followed by the liver and biliary tract (14.7%), followed by lungs (8.7%) a study done by Puri et al, showed that Cancer lung (22.3%) in subjects was most prevalent, followed by ca breast (13.1%) [6].
A study done in Kashmir by Wani et al shows that the ten leading sites of cancer are esophagus and GE Junction, lung, stomach, colorectal, lymphomas, skin, laryngopharynx, acute leukemias, prostate and brain in males. In females, the leading sites are breast, esophagus, and GE Junction, ovary, colorectal, stomach, lung, gallbladder, lymphomas, acute leukemias and brain. The esophagus and stomach alone constituted over 27% of the total cancers, these findings were not similar to the present study [7].
Another study in Maharashtra by Bangal et al showed that the Cancer cervix was the commonest site (19.5%), followed by cancer breast (10.2%), cancer of the lung (9.7%) and cancer of the floor of mouth (7.3%). In males, the commonest site for cancer was lung (9.7%), followed by the floor of mouth (7.3%), while in females; cancer cervix (19.5%) predominated, followed by cancer breast (10.2%) and cancer ovary (2.4%) [8].
Similar study in Kolar by Kalyani et al showed that Cancer of oral cavity predominated in both genders and the top ten sites most frequently involved by cancer in males were oral cavity, stomach, esophagus, bone, NHL, prostate, liver, larynx, penis, and Hodgkin's disease/bladder cancer, whereas, the sites in females were oral cavity, cervix, breast, stomach, esophagus, thyroid, ovary, bone, rectum, and melanoma skin, this result was contrasted to present study [9]. In the Global Adult Tobacco Survey 2009-10 (GATS), the majority of study subjects were homemakers and self-employed and this finding was similar to the present study [10].
Similar observations were found in a study done in Karnataka by Rajesh et al, shows that 23.3% were unemployed and unskilled 46.6% [11].
A study done by Suthahar et al, at Malaysia findings were similar to the present study, which shows that 50% were unemployed and 64.7% was pensioner [12].