Supot Kamsa-ard

Prevalence of Opisthorchis viverrini infection and incidence of cholangiocarcinoma in Khon Kaen, Northeast Thailand

Liver cancer is the most common cancer in Khon Kaen, Northeast Thailand, because of the high incidence of cholangiocarcinoma (CHCA). Opisthorchis viverrini (OV), a liver fluke, is endemic in the area, and has been evaluated as a cause of CHCA by International Agency for Research on Cancer. Residents of 20 districts in the province were invited to attend a mobile screening programme between 1990 and 2001. Of 24 723 participants, 18 393 aged 35–69 years were tested for OV infection, by examining stools for the presence of eggs. Prevalence of infection in each district was estimated from the sample of the population who had been tested. The incidence of liver cancer in 1990–2001 was obtained for each district from the cancer registry. The average crude prevalence of OV infection in the sample subjects was 24.5%, ranging from 2.1% to 70.8% in different districts. Truncated age‐standardized incidence of CHCA at ages >35 years varied threefold between districts, from 93.8 to 317.6 per 100 000 person‐years. After adjustment for age group, sex and period of sampling, there was a positive association between prevalence of OV infection and incidence of CHCA at the population level. Associations between CHCA and active OV infection in individuals have become hard to demonstrate, because of effective anti‐OV treatment. The relationship may, however, be clear in comparisons between populations, which, for infectious diseases, take into account the contextual effects of group exposure in determining individual outcome. The cancer registry is an appropriate tool for disease monitoring in small areas.

Survival of Cholangiocarcinoma Patients in Northeastern Thailand after Supportive Treatment

BACKGROUND Cholangiocarcinoma (CCA) is a very common cancer in Northeastern Thailand. Most CCA patients see a physician at a late stage when curative surgery is not possible. After diagnosis, they generally are treated by partial surgery/percutaneous drainage, chemotherapy and supportive treatment. OBJECTIVE This study aimed to assess the survival rates of CCA patients after supportive treatment. METHODS A retrospective cohort design was applied in this study. Data for 746 CCA patients were extracted from the hospital-based cancer registry of Srinagarind Hospital, Khon Kaen University. The patients were diagnosed (at least by ultrasonography) between 1 January, 2009 and 31 December, 2009 and then followed up for current status until 30 June, 2011. The cumulative survival rate was calculated by the Kaplan-Meier method, and independent prognostic factors were investigated using Cox regression. RESULTS The total follow-up time was 5,878 person-months, and the total number of deaths was 637. The mortality rate was therefore 10.8 per 100 person-year (95%CI : 10.1-11.7). The cumulative 3, 6, 9, 12 and 24 month survival rates were 59%, 39%, 31%, 24% and 14%, respectively. The median survival time after supportive treatment was 4 months. After adjusting for gender, age, stage, distant metastasis, histological grading and treatment, stage was a significant predictor of survival of CCA patients. Those in stage III and stage IV had a 6.78 fold higher mortality than the stage I and stage II cases (95% CI : 1.6-28.7). CONCLUSION It is very important to encourage patients to see health personnel at an early stage.

Trends in Incidence of Hepatocellular Carcinoma, 1990 - 2009, Khon Kaen, Thailand

BACKGROUND Liver cancer is the most frequent cancer among Thais especially people in northeastern Thailand, but there has as yet been no assessment of trend. The data of all cancers in Khon Kaen can be retrieved from data base of the Khon Kaen Cancer Registry (KKCR) which was established in 1984. OBJECTIVE To assess the incidence trend of hepatocellular carcinoma in Khon Kaen, Thailand, between 1990 and 2009. METHODS Population-based cases of liver cancer registered between 1985 and 2009 were retrieved from the KKCR data base and cases with diagnosis of hepatocellular carcinoma (HCC) with the coding C22.0 according to ICD-O were selected. Incidence trends were calculated using the Jointpoint analysis. RESULTS There were 7,859 cases of HCC during the study period. Males were affected two times more frequently than females. The most common age group of cases was 50 and 69 years (60.3%). Most patients were diagnosed based on radiology imaging (40.6%) while the morphology verification was 7%. The age-standardized rates (ASR) were 13.1 to 49.8 per 100,000 among males and 4.8 to 38.4 per 100,000 among females depending on year of diagnosis since 1985. Remarkably, the ASRs were clearly low during first few years of starting the registration. The overall ASRs of HCC were 30.3 per 100,000 in males (95% CI: 25.9 to 34.6) and 13.1 per 100,000 (95% CI: 10.4 to 15.8) in females. During 1990-2009, the trends in incidences have been decreasing significantly with the annual percent change (APC) of 6.2% per year (95% CI: -7.6 to -4.8) in males and by 6.5% per year in females (95% CI: -8.4 to -4.9). CONCLUSIONS The incidence trends have been decreasing in both sexes. The recent decline in incidence may represent a falling risk.

Loss-adjusted survival of cervix cancer in Khon Kaen, Northeast Thailand

For incident cancers of the cervix uteri (601 cases) registered in the population-based cancer registry of Khon Kaen province, Northeast Thailand, in 1985–1990 loss-adjusted survival probabilities were estimated by a logistic regression model with four prognostic factors (age at diagnosis, stage of disease, place of residence and treatment), and compared with observed survival, estimated by the actuarial method. All patients were followed up for a minimum of 5 years, using both passive and active methods. In all, 27.6% of patients were lost to follow-up within 5 years of the index date. The overall observed survival at 5 years was 56.8% and loss-adjusted survival was 54.7%. The difference between the loss-adjusted and observed survival at 5 years was small: 2.1% overall, varying between 0.8 and 3.5 percent units for any prognostic group. The assumption of independence of loss to follow-up and death in the calculation of survival by the actuarial method in this, and probably in other, population-based series, is reasonable and leads to no material bias in the estimates.

Effect of single-visit VIA and cryotherapy cervical cancer prevention program in Roi Et, Thailand: A preliminary report

Aim:  To assess the effect of introducing visual inspection with acetic acid and cryotherapy on cervical cancer incidence rates in Roi Et province over time, between 1997 and 2006, and compare this with two nearby provinces.

Association between Smoking and Mortality: Khon Kaen Cohort Study, Thailand

BACKGROUND Despite anti-smoking campaigns, smoking prevalence among Thai males aged 30 or older is high, at around 50%. The purpose of this study was to determine the relationship between smoking and mortality in a rural Thai community. MATERIALS AND METHODS Subjects enrolled into the Khon Kaen cohort study between 1990 and 2001 were followed up for their vital status until 16th March 2012. The death resource was from the Bureau of Policy and Strategy, Ministry of Interior, Thailand. A Cox proportional hazards model was used to analyse the association between smoking and death, controlling for age, education level and alcohol drinking, and confidence intervals were calculated using the floating risk method. RESULTS The study recruited 5,962 male subjects, of whom 1,396 died during a median 13.5 years of follow-up. Current smokers were more likely to die than never smokers after controlling for age, education level and alcohol drinking (HR, 95%CI: 1.41, 1.32- 1.51), and the excess mortality was greatest for lung cancer (HR, 95%CI: 3.51, 2.65-4.66). However, there was no increased risk with increasing dose of tobacco, and no difference in risk between smokers of yamuan (hand- rolled cigarettes) and manufactured tobacco. CONCLUSION Mortality from cancer, particularly lung cancer, and from all causes combined is dependent on smoking status among men in rural Thailand, but the relative risks are lower than have been reported from studies in high income countries, where the tobacco epidemic is more established.

Incidence and survival rates among pediatric osteogenic sarcoma cases in Khon Kaen, Thailand, 1985-2010.

BACKGROUND Osteosarcoma is the most common bone cancer in children, responsible for a high rate of amputation and death. This is the first long-term, population-based, epidemiologic and survival study in Thailand. OBJECTIVE To study the incidence and survival rates of pediatric osteosarcoma in Khon Kaen. METHOD Childhood osteosarcoma cases (0-19 years) diagnosed between 1985-2010 were reviewed. The data were retrieved from the population-based data set of the Khon Kaen Cancer Registry and medical records from Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. All cases were censored until the end of April 2012. The age-standardized incidence rate (ASR) was calculated using the standard method. Survival experience was analyzed using the standard survival function (STATA 9.0) and presented with a Kaplan-Meier curve. RESULTS 58 cases were enrolled. The overall ASR was 14.1 per million. Males and females were equally affected. The peak incidence was for 15-19 year-olds in both sexes (ASR=10.4 per million in males and 8.5 in females). The 5-year overall survival rate was 27.6% (95% CI: 15.8-40.8%). The median survival time was 1.6 years (95% CI: 1.2-2.1). In a subgroup analysis, the patients who received only chemotherapy survived longer (5-year survival 45.7%, median survival time 4.1 years, p=0.12). CONCLUSION The incidence rate for childhood osteosarcoma was slightly less than those reported for Western countries. The survival rate was also lower than reports from developed countries. Further evaluation of the treatment protocol and risk factor stratification is needed.

Long-term outcome of surgical resection for intraductal papillary neoplasm of the bile duct

Intraductal papillary neoplasm of the bile duct (IPNB) is a specific type of bile duct tumor. Studies about the surgical outcomes for IPNB are few; therefore, we investigated the survival of patients who underwent curative surgical resection of IPNB.

Retrospective Appraisal of Cancer Patients from Vientiane Capital City, Lao People's Democratic Republic (PDR), Seeking Treatment in Thailand

BACKGROUND Recent estimates suggest that in the Lao Peoples Democratic Republic (Lao PDR) the burden of cancer in terms of DALYs lost is amongst the highest in South East Asia. As such, increasingly cancer is becoming an important public health concern in the country. Lao PDR however has no population-based cancer registry and only one hospital-based registry. Cancer treatment within the country is extremely limited. Patients who can, may travel to neighboring countries for treatment, but little information about this is available in the country. The aim of this study was to estimate some of the otherwise largely unknown parameters of the cancer burden in Lao PDR. MATERIALS AND METHODS This is a retrospective, descriptive study based on the records of 847 Lao cancer cases treated with surgery, radiation and chemotherapy at Srinagarind Hospital, Khon Kaen University, in Thailand between 1988 and 2010. RESULTS The annual rate of registration of Lao cancer cases fluctuated, but showed an increasing trend. Most cancers were diagnosed by histology (65.2%), and a combination of endoscopy and radiology (15.6%). In most cases (70.2%) the stage of cancer at diagnosis could not be determined. In those whose stage could be identified, 54.0% were at the final stage (Stage IV). Among males, the commonest cancer sites were the liver (16.1%), blood (12.3%) and nasopharynx (10.6%). Those in female patients were the cervix (22.2%), breast (14.6%) and blood (8.1%). CONCLUSIONS This study indicates that despite some fluctuations, the number of Lao cancer patients presenting at Srinagarind Hospital, Khon Kaen, gradually increased between 1988 and 2010. The unfavorable pattern of late-stage cancer diagnosis among male and female patients suggests a need for cancer control interventions and the establishment of cancer registration and treatment facilities within Lao PDR.

Evaluation of Health Education in the Multi-professional Intervention and Training for Ongoing Volunteer-based Community Health Programme in the North-East of Thailand

This was a survey research conducted in Northestern Thailand during 2009-2010 and designed to evaluate the success of a health education program by comparing levels of health knowledge in the community before and after the launching of a Multi-professional Intervention and Training for Ongoing Volunteer-based Community Health Programme. The survey questionnaire included items about demographic characteristics and health knowledge. The participants were 1,015 members of various communities, who were randomly selected to be included in the survey before launching the intervention, and 1,030 members of the same communities randomly selected to be included in the survey after the intervention was completed. The demographic characteristics of both groups were similar. Overall knowledge and knowledge of all the diseases, except lung and cervical cancer, were significantly higher after the intervention. In conclusion, a Volunteer-based Community Health Programme has advantages for areas where the numbers of health personnel are limited. The use of trained community health volunteers may be one of the best sustainable alternative means for the transfer of health knowledge.