Keywords
Cancer - demography - hospital-based cancer registry - rural India
Introduction
Cancer is the second leading cause of death worldwide.[1] Cancer burden in India varies substantially across the length and breadth of the country. The two popular cancer registries in India are Population-Based Cancer Registries (PBCR) and Hospital-Based Cancer Registries (HBCR). The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 estimated that the incidence of cancer in India has increased from 548,000 in 1990 to 1,069,000 in 2016, and the crude cancer incidence rate in India has increased from 63.4 / 100,000 in 1990 to 81.2 / 100,000 in 2016.[2] Here, we present the data from Kolhapur Cancer Centre (KCC) which is a comprehensive cancer center from the western part of India situated at the border of Maharashtra, Karnataka, and Goa states. The aim of the study was to find the sociodemographic pattern of the patients coming to our center to formulate the strategies for the management. It gave us an estimate of the number of cancer patients and leading sites of cancer cases attending the cancer center. We also compared our data with the data published from the neighboring HBCRs, namely Tata Memorial Hospital (TMH), Mumbai; Kidwai Memorial Institute of Oncology (KMIO), Bengaluru; and Rashtra Sant Tukadoji (RST) Regional Cancer Hospital, Nagpur, and one rural PBCR, i.e., Barshi, Maharashtra, situated approximately 400 km, 600 km, 850 km, and 250 km north, south, east, and north-east of the present study center, respectively.[3],[4]
Materials and Methods
This was a retrospective study carried out at KCC, India. After ethics committee approval, all the cancer patients registered at the center from January 1, 2018, to December 31, 2018, were included in the study. The demographic and clinical data were extracted from the medical records in the patient files and electronic database of these patients.
Statistical analysis
The data were collected, compiled, and summarized using percentages and proportions using IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, NY, USA).
Results
The total number of new patients registered in the year 2018 was 3658. The medical records of 3534 patients could be retrieved. The total number of histologically proven cancer patients was 2813 (79.6%). On an average, 234 new cancer patients were registered in each month. Nearly 80% of the patients were from the state of Maharashtra and the rest were from neighboring states. The state-, district-, and taluka-wise distribution is shown in [Table 1], [Table 2], [Table 3].
Table 1
State-wise distribution of patients
|
State
|
Number of patients (%)
|
|
Maharashtra
|
2248 (79.9)
|
|
Maharashtra
|
543 (19.3)
|
|
Others
|
22 (0.8)
|
|
Total
|
2813 (100)
|
Table 2
District-wise distribution of patients
|
District
|
Number of patients (%)
|
|
Kolhapur
|
1569 (55.9)
|
|
Belgaum
|
492 (17.5)
|
|
Sangli
|
309 (11)
|
|
Satara
|
117 (4.1)
|
|
Sindhudurg
|
108 (3.8)
|
|
Others
|
218 (7.7)
|
|
Total
|
2813 (100)
|
Table 3
Taluka-wise distribution of patients in Kolhapur
District
|
Talukas in Kolhapur district
|
Subsite
|
|
Karvir
|
451 (28.7)
|
|
Hatkanangale
|
342 (21.8)
|
|
Kagal
|
151 (9.6)
|
|
Gadhinglaj
|
111 (7.1)
|
|
Shirol
|
97 (6.2)
|
|
Panhala
|
87 (5.5)
|
|
Chandgad
|
80 (5.1)
|
|
Radhanagari
|
68 (4.3)
|
|
Bhudargad
|
63 (4)
|
|
Shahuwadi
|
60 (3.8)
|
|
Ajara
|
50 (3.2)
|
|
Gaganbawda
|
9 (0.6)
|
|
Total
|
1569 (100)
|
The proportion of male patients was 51.1%, with a median age of 59 years (range 4 months–100 years), whereas 48.9% of patients were female with a median age of 55 years (range 3 months–98 years). The proportion of cancer patients by broad age groups, namely 0–14, 15–34, 35–64, and 65+ years, is shown in [Figure 1] and [Table 4]. The top ten leading sites in males and females at our center are shown in comparison with the neighboring HBCRs in [Figure 2], [Figure 3] and [Table 5], [Table 6], [Table 7], [Table 8]. The leading sites according to broad age groups are displayed in [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11] and [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16]. The incidence of tobacco addiction was 67% in males and 23% in females, whereas the incidence of alcohol addiction was 23% in males and <1% in female patients. The leading cancer sites in tobacco users are displayed in [Figure 12], [Figure 13] and [Table 17], [Table 18], [Table 19]. The proportion of the cancer patients with age between 0 and 14 years at KCC was 1.3% as compared to the other center ranging from 4% to 5%. The proportion of cancer patients above the age of 65 years at KCC was 37.1% and 29.0% in males and females, respectively, which is more than the other center, which ranges from 13.7% to 25%. We could retrieve the stage at presentation for 82.5% of the patients, and we found that two out of three patients presented in either Stage III or Stage IV [Figure 14] and [Table 20]. Nearly 75% of the patients diagnosed with cancer received at least one modality of treatment, i.e., surgery, chemotherapy, or radiation therapy. A vast majority of the patients (more than 90%) were low-economic class, and hence, received the cancer treatment under government schemes.{Table 4}{Table 5}{Table 6}{Table 7}{Table 8}{Table 9}{Table 10}{Table 11}{Table 12}{Table 13}{Table 14}{Table 15}{Table 16}{Table 17}{Table 18}{Table 19}{Table 20}
Figure 1: Stack diagram showing proportion of cancers by broad age
Figure 2: Top ten leading sites of cancer in males
Figure 3: Top ten leading sites of cancer in females
Figure 4: Leading sites in broad age group (0–14 years) – male
Figure 5: Leading sites in broad age group (0–14 years) – female
Figure 6: Leading sites in broad age group (15–34 years) – male
Figure 7: Leading sites in broad age group (15–34 years) – female
Figure 8: Leading sites in broad age group (35–64 years) – male
Figure 9: Leading sites in broad age group (35–64 years) – female
Figure 10: Leading sites in broad age group (65+ years) – male
Figure 11: Leading sites in broad age group (65+ years) – female
Figure 12: Top five cancer sites in male with addiction of tobacco and/ or alcohol
Figure 13: Top five cancer sites in female with addiction of tobacco and/ or alcohol
Figure 14: Stage at presentation
Table 4
Number (#) and proportion (%) of cancers by broad age groups
|
Gender
|
Age, n (%)
|
Total
|
|
0-14
|
15-34
|
35-64
|
65+
|
|
Male
|
23 (1.6)
|
97 (6.7)
|
784 (54.6)
|
534 (37.1)
|
1438
|
|
Female
|
13 (0.9)
|
90 (6.5)
|
873 (63.4)
|
399 (29.0)
|
1375
|
|
Total
|
36 (1.3)
|
166 (5.9)
|
1678 (59.6)
|
933 (33.2)
|
2813
|
Table 5
Top ten leading sites of cancer in males
|
Site
|
n (%)
|
|
n– Absolute number, % - Proportion
|
|
Mouth
|
294 (20.4)
|
|
Tongue
|
139 (9.6)
|
|
Esophagus
|
94 (6.5)
|
|
Hypopharynx
|
82 (5.7)
|
|
Lung
|
73 (5.1)
|
|
Stomach
|
57 (3.9)
|
|
Prostate
|
48 (3.3)
|
|
Rectum
|
47 (3.3)
|
|
Larynx
|
46 (3.2)
|
|
Oropharynx
|
45 (3.1)
|
Table 6
Top ten leading sites of cancer in females
|
Site
|
n (%)
|
|
n– Absolute number, % - Proportion; NHL – Non-Hodgkin’s lymphoma
|
|
Breast
|
335 (24.4)
|
|
Cervix uteri
|
205 (14.9)
|
|
Ovary
|
104 (7.6)
|
|
Mouth
|
74 (5.4)
|
|
Esophagus
|
69 (5.0)
|
|
Hypopharynx
|
51 (3.7)
|
|
Lung
|
43 (3.1)
|
|
Corpus uteri
|
42 (3.1)
|
|
Rectum
|
34 (2.5)
|
|
NHL
|
30 (2.2)
|
Table 7
Top ten sites of cancer in male comparison with neighboring cancer registries
|
KCC (%)
|
TMH (%)
|
KMIO (%)
|
RST (%)
|
Barshi (PBCR) (%)
|
|
KMIO – Kidwai Memorial Institute of Oncology; TMH – Tata Memorial Hospital; KCC – Kolhapur Cancer Centre; PBCR – Population-Based Cancer Registries; RST – Rashtra Sant Tukadoji; NHL – Non-Hodgkin’s lymphoma
|
|
Mouth (20.4)
|
Mouth (14.0)
|
Esophagus (7.6)
|
Mouth (20.9)
|
Mouth (8.6)
|
|
Tongue (9.6)
|
Lung (7.9)
|
Lung (7.6)
|
Tongue (9.6)
|
Esophagus (7.7)
|
|
Esophagus (6.5)
|
Tongue (7.4)
|
Hypopharynx (7.4)
|
Lung (8.7)
|
Liver (6.2)
|
|
Hypopharynx (5.7)
|
NHL (5.1)
|
Tongue (7.1)
|
Esophagus (8.1)
|
Rectum (4.4)
|
|
Lung (5.1)
|
Myeloid leukemia (3.8)
|
Stomach (7.0)
|
Larynx (5.4)
|
Tongue (4.4)
|
|
Stomach (3.9)
|
Esophagus (3.6)
|
Mouth (6.7)
|
Brain (3.4)
|
NHL (4.4)
|
|
Rectum (3.3)
|
Stomach (3.6)
|
Brain (4.9)
|
Pharynx (2.9)
|
Prostate (4.4)
|
|
Prostate (3.3)
|
Lymph leukemia (3.4)
|
Larynx (4.6)
|
Rectum (2.9)
|
Larynx (4.2)
|
|
Larynx (3.2)
|
Larynx (3.1)
|
Myeloid leukemia (3.5)
|
Myeloid leukemia (2.5)
|
Stomach (4.2)
|
|
Oropharynx (3.1)
|
Prostate (3.1)
|
NHL (3.3)
|
NHL (2.4)
|
Hypopharynx (4.2)
|
Table 8
Top ten sites of cancer in female comparison with neighboring cancer registries
|
KCC (%)
|
TMH (%)
|
KMIO (%)
|
RST (%)
|
Barshi (PBCR) (%)
|
|
KMIO – Kidwai Memorial Institute of Oncology; TMH – Tata Memorial Hospital; KCC – Kolhapur Cancer Centre; RST – Rashtra Sant Tukadoji; NHL – Non-Hodgkin’s lymphoma
|
|
Breast (24.4)
|
Breast (27.6)
|
Cervix uteri (29.4)
|
Cervix uteri (24.9)
|
Cervix uteri (26.7)
|
|
Cervix uteri (14.9)
|
Cervix uteri (11.2)
|
Breast (14.2)
|
Breast (23.4)
|
Breast (20)
|
|
Ovary (7.6)
|
Ovary (5.5)
|
Mouth (9.9)
|
Mouth (8.1)
|
Ovary (4.6)
|
|
Mouth (5.4)
|
Gall bladder (5.3)
|
Ovary (5.1)
|
Esophagus (4.9)
|
Esophagus (3.8)
|
|
Esophagus (5.0)
|
Mouth (4.4)
|
Esophagus (4.7)
|
Ovary (4.3)
|
Lung (3.6)
|
|
Hypopharynx (3.7)
|
Thyroid (3.6)
|
Thyroid (3.8)
|
Tongue (3.4)
|
Skin (3.2)
|
|
Lung (3.1)
|
Lung (3.1)
|
Stomach (2.9)
|
Lung (3.0)
|
Rectum (2.1)
|
|
Corpus uteri (3.1)
|
Myeloid leukemia (2.7)
|
Corpus uteri (2.4)
|
Corpus uteri (2.8)
|
Mouth (2.1)
|
|
Rectum (2.5)
|
NHL (2.6)
|
Brain (2.2)
|
Rectum (2.0)
|
Thyroid (2.1)
|
|
NHL (2.2)
|
Esophagus (2.6)
|
Myeloid leukemia (1.9)
|
Bone (1.9)
|
Brain (1.9)
|
Table 9
Leading sites in broad age groups (0-14 years) - male
|
Site
|
n (%)
|
|
Lymphoid leukemia
|
8 (34.7)
|
|
Brain
|
7 (30.4)
|
|
Bone
|
1 (4.3)
|
Table 10
Leading sites in broad age groups (0-14 years) - female
|
Site
|
n (%)
|
|
Lymphoid leukemia
|
3 (13)
|
|
Brain
|
3 (13)
|
|
Bone
|
3 (13)
|
Table 11
Leading sites in broad age groups (15-34 years) - male
|
Site
|
n (%)
|
|
Mouth
|
14 (14.4)
|
|
Brain
|
11 (11.3)
|
|
Tongue
|
10 (10.3)
|
Table 12
Leading sites in broad age groups (15-34 years) - female
|
Site
|
n (%)
|
|
Breast
|
18 (20.0)
|
|
Bone
|
10 (11.1)
|
|
Ovary
|
7 (7.8)
|
Table 13
Leading sites in broad age groups (35-64 years) - male
|
Site
|
n (%)
|
|
Mouth
|
226 (28.8)
|
|
Tongue
|
96 (12.2)
|
|
Esophagus
|
56 (7.4)
|
Table 14
Leading sites in broad age groups (35-64 years) - female
|
Site
|
n (%)
|
|
Breast
|
246 (28.8)
|
|
Cervix uteri
|
143 (16.4)
|
|
Ovary
|
68 (7.8)
|
Table 15
Leading sites in broad age groups (65+ years) - male
|
Site
|
n (%)
|
|
Mouth
|
78 (14.6)
|
|
Lung
|
40 (7.5)
|
|
Prostate
|
38 (7.1)
|
Table 16
Leading sites in broad age groups (65+ years) - female
|
Site
|
n (%)
|
|
Breast
|
70 (17.5)
|
|
Cervix
|
56 (14.0)
|
|
Ovary
|
29 (7.3)
|
Table 17
Addictions
|
Tobacco (%)
|
Alcohol (%)
|
|
Yes
|
No
|
Unknown
|
Yes
|
No
|
Unknown
|
|
Male
|
963 (67.0)
|
319 (22.2)
|
156 (10.8)
|
337 (23.4)
|
945 (65.8)
|
156 (10.8)
|
|
Female
|
447 (32.5)
|
721 (52.4)
|
207 (15.1)
|
3 (0.2)
|
1165 (84.7)
|
207 (15.1)
|
|
Both genders
|
1410 (50.1)
|
1040 (37.0)
|
363 (12.9)
|
340 (12.1)
|
2110 (75.0)
|
363 (12.9)
|
Table 18
Top five cancer sites in male with addiction of tobacco and/or alcohol
|
Total (n=996), n (%)
|
|
Mouth
|
260 (26.1)
|
|
Tongue
|
117 (11.7)
|
|
Esophagus
|
75 (7.5)
|
|
Hypopharynx
|
68 (6.8)
|
|
Lung
|
53 (5.3)
|
Table 19
Top five cancer sites in female with addiction of tobacco and/or alcohol
|
Total (n=996), n (%)
|
|
Breast
|
87 (19.4)
|
|
Cervix
|
76 (16.9)
|
|
Mouth
|
56 (12.5)
|
|
Ovary
|
29 (6.5)
|
|
Esophagus
|
28 (6.3)
|
Table 20
Stage at presentation
|
Stage
|
n (%)
|
|
0
|
11 (0.4)
|
|
1
|
119 (4.2)
|
|
2
|
357 (12.7)
|
|
3
|
839 (29.8)
|
|
4
|
996 (35.4)
|
|
Unknown
|
491 (17.5)
|
|
Total
|
2813 (100)
|
Discussion
Cancer registration helps us to know the cancer burden seen at a particular hospital, which reflects the population burden catered by the hospital. To our knowledge, this is the first report of a hospital-based cancer patient data registered at a rural nonacademic cancer center in the western part of India bordering the states of Maharashtra, Karnataka, and Goa. The leading sites of cancers in males are all tobacco related, namely mouth, tongue, esophagus, hypopharynx, and lung. The leading sites of cancers in females are breast, cervix, ovary, mouth, and esophagus. This pattern matches with the neighboring HBCRs. Needless to say, tobacco is the leading cause of majority of the cancer burden at this center. The proportion of tobacco consumption in female patients was found to be higher than that in another study.[5] Mouth cancer proportion in male patients is found to be 20.4% at KCC, which is more than TMH (14.0%), Barshi (8.6%), KMIO (7.6%), and similar to RST (20.9%), whereas the proportion of lung cancer in male patients is found to be 5.1% at KCC, which is less than TMH (7.9%), KMIO (7.6%), and RST (8.7%). More prevalence of smokeless tobacco with alcohol consumption than smoked tobacco could be the reason for this. The leading sites of cancer in female patients match with the other centers. This study gave us an insight into the leading sites of cancer in our region and the need to formulate the strategies to cater these patients without significant loss to follow-up.
Limitations
As the study was done for 12 months, the exact pattern of cancer prevalent in the region could not be estimated. Complete data from patients pertaining to treatment details, follow-up, and outcome could not be retrieved owing to the short study period. Further, we acknowledge the limitations of the patient data registered in a cancer hospital as it does not necessarily the true population picture.
