Demography and treatment pattern of patients with head and neck carcinoma presenting to a tertiary care center in India

Mihir N. Chandarana; Prathamesh S. Pai

doi:10.4103/sajc.sajc_26_19

South Asian Journal of Cancer, Table of Contents

CC BY-NC-ND 4.0 · South Asian J Cancer 2020; 09(01): 38-42
DOI: 10.4103/sajc.sajc_26_19

ORIGINAL ARTICLE: Head and Neck Cancers

Demography and treatment pattern of patients with head and neck carcinoma presenting to a tertiary care center in India

Need for urgent decentralization of cancer care

Authors

Mihir N. Chandarana

Department of General Surgery, Forth Valley Royal Hospital, Larbert, Scotland
Prathamesh S. Pai

Department of Head Neck Oncology, Tata Memorial Hospital, Mumbai

Abstract

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Abstract

Aims: This study aims to report on the demographic profile and treatment pattern of head and neck cancer patients and impact of an early treatment decision on treatment. This study also aims to suggest recommendations to improve treatment compliance. Methods: All new patients registered under the head and neck disease management group (DMG) over a period of 3 months at a single center were included. Their demographic details, time to treatment decision, and treatment compliance were determined. The findings were presented to head and neck DMG, and changes were implemented to patient workup with an aim to improve compliance. A reaudit was performed over a period of 3 months and results were compared. Results: Two thousand two hundred and forty patients were included in the analysis. Patients with a treatment decision at 1–4 weeks stood at 28.32%, 63.88%, 80.8%, and 89.87%, respectively. Dropout rate was 26%. About 50% of patients planned for surgical intervention could be treated within the institution. After implementation of changes as recommended by DMG, 2418 patients were analyzed and findings were compared to the previous audit. The dropout rate reduced to 17.57%. The number of patients with a treatment decision at 1–4 weeks were 51.26%, 77.42%, 89.46%, and 94.31%, respectively. Conclusion: Early treatment decision and referral could significantly improve patient dropout and possibly compliance to treatment. Decentralization of cancer care is urgently needed to manage the high numbers of patients presenting to tertiary care centers. Setting up of new regional cancer centers and increasing infrastructure in the existing centers should be the long-term goals.

Key words

Head and neck cancer - patient demography - treatment compliance

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References

References
1 Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015;136:E359-86.
2 GLOBOCAN; 2012. Available from: http://www.globocan.iarc.fr/Pages/fact_sheets_cancer.aspx?cancer=all. [Last accessed on 2018 Aug 23].
3 Pramesh CS, Badwe RA, Sinha RK. The national cancer grid of India. Indian J Med Paediatr Oncol 2014;35:226-7.
4 Eskander A, Monteiro E, Irish J, Gullane P, Gilbert R, de Almeida J, et al. Adherence to guideline-recommended process measures for squamous cell carcinoma of the head and neck in Ontario: Impact of surgeon and hospital volume. Head Neck 2016;38 Suppl 1:E1987-92.
5 Nandi M, Mandal A, Asthana AK. Audit of cancer patients from eastern Uttar Pradesh (UP), India: A university hospital based two year retrospective analysis. Asian Pac J Cancer Prev 2013;14:4993-8.
6 Pramesh CS, Badwe RA, Borthakur BB, Chandra M, Raj EH, Kannan T, et al. Delivery of affordable and equitable cancer care in India. Lancet Oncol 2014;15:e223-33.
7 Goss PE, Strasser-Weippl K, Lee-Bychkovsky BL, Fan L, Li J, Chavarri-Guerra Y, et al. Challenges to effective cancer control in China, India, and Russia. Lancet Oncol 2014;15:489-538.
8 7^th Edition of AJCC/UICC TNM Staging. Available from: https://www.cancerstaging.org/reference-tools/deskreferences/Documents/AJCC%207th%20Ed%20Cancer%20Staging%20Manual.pdf. Last accessed on 2018 Sep 09].
9 Siddiqui MS, Chandra R, Aziz A, Suman S. Epidemiology and histopathological spectrum of head and neck cancers in Bihar, a State of Eastern India. Asian Pac J Cancer Prev 2012;13:3949-53.
10 Mohanti BK, Nachiappan P, Pandey RM, Sharma A, Bahadur S, Thakar A, et al. Analysis of 2167 head and neck cancer patients' management, treatment compliance and outcomes from a regional cancer centre, Delhi, India. J Laryngol Otol 2007;121:49-56.
11 GDP Contribution to Health. Available from: http://www.data.worldbank.org/indicator/SH.XPD.TOTL.ZS?locations=IN. [Last accessed on 2018 Dec 12].
12 Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster-randomised controlled trial. Lancet 2005;365:1927-33.