Manoj Kalita

Community Based Intervention for Tobacco Cessation: A Pilot Study Experience, North East India

BACKGROUND North East India has a high prevalence of tobacco consumption, but only few individualsseek help for tobacco cessation. Impact of community based tobacco cessation intervention in this part needs more research. MATERIALS AND METHODS Retrospective analysis was done on the dataset from a community-based tobacco cessation intervention pilot project conducted in Guwahati metro during 2009-10. Subjects, both male and female tobacco users, age>15 years, permanent residents of these blocks giving consent were included in the study. RESULTS The sample was 800 tobacco users, of whom 25% visited any health care provider during last 12 months and 3% received tobacco cessation advice. An 18% quit rate was observed at six weeks follow up, more than the National average, with a 47% quit rate at eight months, while 52% of subjects reduced use. CONCLUSIONS Higher tobacco quit rate and reduced tobacco use, no loss to follow up and negligible relapse was observed with this community based intervention design. Such designs should be given more emphasis for implementation in specified communities with very high tobacco consumption rates, cultural acceptance of tobacco and less motivation towards quitting.

Patterns of tobacco use in patients with upper aero digestive tract cancers: A hospital-based study

Background: Tobacco use is a major risk factor for increasing the burden of upper aero digestive tract (UADT) cancer in the population of Northeast India. Objective: The objective of this study was to investigate the pattern of tobacco use in different UADT cancer. Materials and Methods: This was a retrospective study of electronically recorded data of the Hospital Cancer Registry for the period of May 2014 to December 2014. The UADT cancers were evaluated for gender and age-group distribution, their relative proportion, and association with tobacco use and tobacco-associated risk in males to develop UADT cancers. The type of tobacco usage was clustered as chewable, smoking, and both. Relative risk (RR) of UADT with tobacco usage was identified for males. Results: A total of 1965 (n) UADT cancer patients were identified, male:female was 2.9, tobacco habits was in 1608 (81.8%) patients, both forms of tobacco use in 705 (43.8%), chewable tobacco use in 588 (36.6%) and smoking in 315 (19.6%) patients, tobacco habits in males ranges from 67.3% to 94.3% and in females range from 5.7% to 32.7%, RR of UADT cancer in males for tongue cancer was 1.5 (confidence interval [CI] =1.2–1.9), oropharynx was 1.4 (CI = 1.0–1.8), hypopharynx 1.4 (CI = 1.1–1.7), esophageal cancer was 1.4 (CI = 1.3–1.7), and for laryngeal cancer RR was 1.7 (CI = 1.0–3.0). Conclusion: Consumption of chewable tobacco is the major form of tobacco use alone or in combination in UADT cancer patients of our population.

Epidemiology of gynecological cancers in Kamrup Urban District cancer registry

BACKGROUND Cancers of the female reproductive system - namely cancer of the cervix, corpus uteri, ovarian, vulvar, vaginal, fallopian tube cancers and choriocarcinoma are an important cause of cancer morbidity and mortality among women worldwide. It is estimated to be the third most common group of malignancies in women. The comprehensive global cancer statistics from the International Agency for Research on Cancer indicate that gynaecological cancers accounted for 20% of the 14.1 million estimated new cancer cases and 8.2 million cancer deaths among women in the world in 2012. The estimation of cancer burden is necessary to set up priorities for disease control. Gynaecological cancers have increased in India and are estimated to be around 182,602 by the year 2020 constituting about 30% of the total cancers among women in India. Among these, cancer of the uterine cervix followed by ovary and corpus uteri are the major contributors. METHODS AND MATERIALS Cancer is not notifiable in India, so method of collecting information on cancer was active with voluntary participation of different sources including major hospitals, diagnostic centers, state referral board and birth and death registration centers within registry area. RESULTS A total of 3767 (44%) cases were registered in women out of the total number of 8561 cancer cases during the period from 2010-2014. In case of gynaecological cancers a total of 661 cases of cervical, ovarian and corpus uterine cancers were registered out of the total 3767 female cancer cases (17.5%) for the year 2010-2014.The annual average crude rate in women for all sites of cancer was 117.4 per 100000 population. The corresponding AARs was 166.6. CONCLUSIONS Womens health issues have attained high concern in recent decades. Utmost efforts should be made to educate women in early cancer detection by creating awareness on risk factors and symptoms.

A study of head and neck cancer patients with special reference to tobacco use and educational level

Background: In India, head and neck cancers (HNCs) are common and constitute 20%–30% of all cancers. The most common risk factors are consumption of tobacco and alcohol. Betel nut chewing with or without tobacco is a major risk factor for HNC in India, especially in the Northeast India. Materials and Methods: This was a hospital-based retrospective study to measure the descriptive scenario of HNC cases along with their demographic and risk factor profile. The patients diagnosed from June 01, 2014, to December 31, 2014, were included in the study. The data of patients were analyzed for age, gender, subsites, stage at diagnosis, pattern and prevalence of tobacco usage, and different education level of patients. Chi-square test was performed to assess the association of gender and tobacco habits. Results: One thousand four hundred and twenty-eight patients were included in the study, M: F was 4:1, hypopharynx in males (36.2%) and mouth in females (39.8%) were leading HNC sites, and majority (83.8%) presented in locally advanced stages. Majority of patients (34.1%) and tobacco users (34.7%) were illiterates, and 82.9% of all HNC patients were tobacco users. Males with cancers of the tongue, hypopharynx, and larynx (P < 0.05) were significantly at an increased risk of developing HNC with tobacco consumption. Conclusion: Our findings suggest that improvement in the education level may lead to decline in the use of tobacco and thereby reduction in the burden of HNC patients.

Cancer statistics in Kamrup urban district: Incidence and mortality in 2007–2011

PURPOSE The aim of this study was to report cancer statistics in Kamrup Urban District, including incidence and, mortality. INTRODUCTION In the last five year PBCR-Guwahati witnessed a remarkable growth in cancer incidence cases. The number of new cases of all cancer was increased from 155.3 to 188.5 and 102.7 to 165.3 per 100,000 men and women respectively from the year 2007 to 2011 in KUD. The data from KUD also have shown that for some of the specific types of cancer are highest or some of the highest incidence in rates in the world; particularly cancers of upper aero-digestive tract consist of anatomical sites such as oral cavity, hypopharynx, larynx gallbladder, stomach, lung, prostate and oesophageal cancer. MATERIALS AND METHODS Age-standardized rates (ASR) (per 100,000 person-years) for incidence, mortality were calculated using the World Standard Population as proposed by Segi and modified by Doll et al. Descriptive statistics were presented by tables and figures. RESULTS A total of 6623 number of cases (male = 3809, female = 2814) were diagnosed with cancer in the last five years (2007-2011) period of time. The overall age standardized cancer incidence rate is almost 21% higher in men than in women. The pooled ASR for the five year period is 175.2 and 144.7 per 100,000 men and women. CONCLUSION Overall cancer incidence and mortality rates have increased since 2007.

Patterns of Upper Aero-digestive Tract Cancers in Kamrup Urban District of Assam: A Retrospective Study

BACKGROUND The incidence of upper aero-digestive tract (UADT) cancers, including C00-C14, C30-C32, C15 and C16, is increasing rapidly in Kamrup Urban District (KUD) of Assam, North East (NE) India. According to the NCRP (2013) report 37.6% of all cancers in both sexes are UADT cancers in the NE region, accounting for 53.3% in males and about 27.5% in females of the total cases MATERIALS AND METHODS A retrospective study was conducted for patient information from the period of 2008-2011. Age-standardized or age-adjusted rates (ASR or AAR) (per 100,000 person-years) were calculated using the World Standard Population as proposed by Segi and modified by Doll et al. The registry population area at risk was estimated using the 1991 and 2001 census population by sex, as well as the growth rate during that interval using the difference distribution method. RESULTS There were 5,638 cases registered during the last four years of the study (2008-2011) accounting for 56.7% (3,198/5,638) of the total in males and 43.3% (2,440/5,638) in females. The male: female ratio was 1.31: 1.00. The overall age adjusted rates (AAR) were 179.4 and 153.8 per 100 000 males and females respectively. Cancer of the oesophagus was most common in both sexes, with most appreciable gender variation for tongue and hypopharynx, presumably reflecting differential exposure to risk factors.

Descriptive Report on Pattern of Variation in Cancer Cases within Selected Ethnic Groups in Kamrup Urban District of Assam, 2009-2011

BACKGROUND The global burden of cancer is continuously increasing. According to recent report of the National Cancer Registry Programme (NCRP) on time trends it is estimated that future burden of cancer cases for India in 2020 will be 1,320,928. It is well known that knowledge of the incidence of cancer is a fundamental requirement of rational planning and monitoring of cancer control programs. It would help health planners to formulate public health policy if relevant ethnic groups were considered. North East-India alone contains over 160 Scheduled Tribes and 400 other sub-tribal communities and groups, whose cancer incidence rates are high compared to mainland India. As since no previous study was done focusing on ethnicity, the present investigation was performed. MATERIALS AND METHODS In this paper PBCR-Guwahati data on all cancer registrations from January 2009 to December 2011 for residents of the Kamrup Urban District, comprising an area of 261.8 sq. km with a total population of 900,518, including individual records with information on sex, age, ethnicity and cancer site are provided. Descriptive statistics including age adjusted rates (AARs) were taken as provided by NCRP. For comparison of proportional incidence ratios (PIR) the Students t test was used, with p<0.05 considered as statistically significant. RESULTS AND CONCLUSIONS Differences in leading sites of Kamrup Urban District since from the beginning of the PBCR-Guwahati were revealed among different ethnic groups by this study. The results should help policy makers to formulate different strategies to control the level of burden as well as for treatment planning. This study also suggests that age is an important factor of cancer among different ethnic populations as well as for overall population of Kamrup District of Assam.

A survival study of uterine cervical patients in the North East India: Hospital-cancer registry-based analysis

Background: Uterine cervical cancer constitutes a major proportion of cancer in females of our population. The objective of this study was to conduct a clinical study of uterine cervical cancers including their survival from hospital-cancer registry data. Materials and Methods: Data of uterine cervical cancer patients diagnosed from January 1, 2010 to December 31, 2010 and that were treated at a regional cancer center in North East (NE) India was recruited. The cases were analyzed for age group distribution, stage, and treatment types. Survival from the date of first diagnosis and hazard ratios (HRs) was estimated. Survival probability and HRs were calculated by Kaplan–Meier method and Cox-proportional regression analysis, respectively. Active follow-up was done for the survival analysis. Results: One hundred and ninety-three patients (53.4%) were included for the analysis. Median age was 48 years, 56.5% (108/193) of patients were in the age group of 45–64 years, 56.5% (109/193) were Stage II patients, radiotherapy alone was the main treatment modality in 65.8% (127/193) of cases, 5-year overall survival (OS) was 40.7%, median survival was 44 months, early staged and advanced stage patients had 47.7%, and 29.4% 5-year OS (P = 0.002), respectively, and HR for advanced stages was 1.8 (P = 0.003, confidence interval (CI) = 1.2 to 2.7). Conclusion: Describing the clinical characteristics and survival of uterine cervical cancer patients is important for planning and identifying the gaps for its control in the NE India.

Quitting: in male versus female users of different types of tobacco at 8 months postintervention in a community setting.

Background: North-East India shows a very high prevalence of tobacco use. Very little is known about the factors that affects tobacco cessation. Materials and Methods: Community-based tobacco cessation counseling was provided and follow-up visits were done until 8 months. Retrospective analysis was done on data set collected during the period of 2009-2010. Both sexes of age >15 years with mild, moderate and severe category of tobacco addiction and giving consent for the intervention were included in the study. Descriptive statistics and Chi-square test were used to see the significance differences among categories. Results: Totally, 800 tobacco users were intervened and followed-up. Male:female ratio of tobacco use was 4.3:1. Against one female, 27 male smokers were found. At 8 months postintervention, maximum number of quit rate was amongst the users of smokeless tobacco (52%) irrespective of their sex as well as in both sexes. The difference in quit rates between female smokeless tobacco users and female smokers was found statistically significant. No female smokers quitted tobacco whereas 46.6% male smokers quitted tobacco. Conclusion: Quit rate in females with different types of tobacco use habits differ significantly. There is an alarming disparity in the quit rates of male versus female smokers which needs further research. Capacity development of the cessation service providers toward the liberal use of nicotine replacement therapy and other chemo interventions in addition to counseling should be further facilitated.