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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 3  |  Issue : 2  |  Page : 56-59

Linkage of cancer registration with cancer treatment in predominantly rural district: A model form Sangrur district, Punjab state, India


1 Tata Memorial Centre, Mumbai, Maharashtra, India
2 Post Graduate Institute of Medical Education and Research, Chandigarh, India
3 Homi Bhabha Cancer Hospital, Sangrur, Punjab, India

Date of Web Publication26-Jun-2018

Correspondence Address:
Atul Budukh
Tata Memorial Centre, Mumbai, Centre for Cancer Epidemiology – Actrec Campus, Sector 22, Ustav Chowk, CISF Road, Kharghar - 410 210, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_19_18

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  Abstract 


Background: The Punjab state health administration has approached to Tata Memorial Centre (TMC), Mumbai, to tackle the cancer problem of the state and requested to provide the support in strengthening the cancer care services. To understand the magnitude of the cancer, population-based cancer registry at Sangrur was established in 2013.
Objective: The objective of the study is to show that the population-based rural cancer registration is the way to develop the infrastructure for cancer treatment a model from Sangrur district, Punjab State, India.
Methods: Population-based cancer registry staff has visited several hospitals and pathology laboratories, and also, they have interaction with the village leaders for cancer case registration. The cancer treatment facility was not available in the district. The registry has reported that for the cancer treatment, a patient from these areas travels to Patiala, Bhatinda, Faridkot, Ludhiana, Chandigarh, and New Delhi and to the neighboring state Rajasthan. It was felt that there is dire need of cancer treatment facility in the district. Based on the information provided by the rural cancer registry, the Government of Punjab and TMC have established Homi Bhabha Cancer Hospital (HBCH), Sangrur. The hospital has started functioning since January 2015.
Results: In the 2-year period (2013–2014), the cancer registry has registered 1735 cancer incidence cases (808 males and 927 females). The age-adjusted incidence rate for males was 46.7/100,000, and for females, it was 57.6/100,000. The rates of the rural area of Sangrur are in comparison with other rural registries. The cancer registry data were utilized in planning the cancer care services in the Sangrur district.
Conclusion: Population-based cancer registry with cancer treatment facility and HBCH with mentoring at Sangrur district in Punjab state could be an ideal potential model for the establishing and augmenting of cancer care services in the rural population in India.

Keywords: Cancer registration is the way to develop the infrastructure, linkage of cancer registration with cancer treatment, Rural cancer registration and cancer care model


How to cite this article:
Budukh A, Dikshit R, Thakur J S, Kadam P, Dora T, Sancheti S, Chaudhary D, Badwe R A. Linkage of cancer registration with cancer treatment in predominantly rural district: A model form Sangrur district, Punjab state, India. Int J Non-Commun Dis 2018;3:56-9

How to cite this URL:
Budukh A, Dikshit R, Thakur J S, Kadam P, Dora T, Sancheti S, Chaudhary D, Badwe R A. Linkage of cancer registration with cancer treatment in predominantly rural district: A model form Sangrur district, Punjab state, India. Int J Non-Commun Dis [serial online] 2018 [cited 2018 Jul 19];3:56-9. Available from: http://www.ijncd.org/text.asp?2018/3/2/56/235208




  Introduction Top


The health administrator, policymaker, lay public, and politicians from Punjab state of India have feeling that reported cancer incidence and mortality rates are higher in the state as compared to other parts of India. The Department of Health and Family Welfare of the Punjab state has conducted door-to-door survey to know the cancer burden in the state.[1],[2] The health administrator from the Department of Health and Family Welfare and the policymakers of the Punjab state visited Tata Memorial Centre (TMC), Mumbai, a premier cancer center of the country which is Grant-in-Aid Institute of the Department of Atomic Energy, Government of India. The state government has requested TMC to guide to tackle the cancer problem of the state. TMC management agreed to guide the Punjab State Government to tackle the cancer problem of the state. To know the magnitude of the cancer problem in the area, the TMC and Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, entered into joint collaboration with the Government of Punjab and had started the population-based cancer registries in Punjab state.[3] The objective of the study is to show that the population-based rural cancer registration is the way to develop the infrastructure for cancer treatment a model from Sangrur district, Punjab State, India.


  Methods Top


Establishment of population-based cancer registry in Sangrur district

To know the cancer burden in the area, population-based cancer registry in Sangrur district of Punjab state was established by TMC in collaboration with PGIMER, Chandigarh, in 2013. The cancer registry covers the population of 1.7 million covering 7 blocks and 585 villages. More than 65% population of the district is rural. The cancer registration method involves community interaction as well as visits to the different cancer centers, medical colleges, pathology laboratories, and private practitioners to collect the clinical details of the cancer patient. The detail method of cancer registration has been published.[4],[5] The cancer patients from this area travel through 57 km to 420 km for the cancer treatment. Facility was not available in the district. For the cancer treatment, patients from these areas travel to Patiala, Bhatinda, Faridkot, Ludhiana, Chandigarh, and New Delhi and to the neighboring state Bikaner, Rajasthan. To understand the cancer burden in the rural area, it was felt that community interaction will give us the accurate information at the grass-root level. Due to interaction with the community leaders, patients, and their relatives, it was noted that patient and their relatives spend lot of time in travel. It was inconvenient for them in taking the care of their patient. It was felt that there is dire need of cancer treatment facility in the district.

Establishment of Homi Bhabha Cancer Hospital Sangrur district

The registry has reported that there is an urgent need of diagnosis and treatment facility in the Sangrur district. Based on the information provided by the population-based cancer registry, the Government of Punjab requested TMC management to establish the cancer treatment facility in the district. TMC management agreed to establish the cancer treatment facility in the district with the help of the State Government of Punjab.

TMC has planned the satellite center at Sangrur district and comprehensive cancer center in SAS Nagar district of the state. It was decided to establish satellite center first and then comprehensive cancer center in SAS Nagar. The planning was done and construction was started in 2014, and hospital became functional in 2015, with medical, paramedical, and administrative staff trained at TMC. The diagnostic facilities such as computed tomography-scan, magnetic resonance imaging, ultrasonography, mammography, biochemistry, hematology, tumor marker, histopathology, immunohistochemistry, and cytology have been established under supervision and support of senior faculty from TMC, Mumbai. The surgical, radiation, and medical oncology services function on similar evidence- and protocol-based guidelines such as TMC with mentoring from senior faculties from TMC.

Cancer registry data were utilized in planning the cancer care services of the district. The services for diagnosis, operation theater, Intensive Care Unit, and day-care ward for chemotherapy were established on priority. To support the hospital administration, a hospital-based cancer registry was established in the year 2017 with the help of the population-based cancer registry. The population-based cancer registry will monitor the effect of cancer care services in the population by providing cancer survival results.


  Results Top


In the 2-year period (2013–2014), the cancer registry has registered 1735 cancer incidence cases (808 males and 927 females).[3] The age-adjusted incidence rate for males was 46.7/100,000, and for females, it was 57.6/100,000. The cumulative risk for the age group of 0–74 years in males is 5% (1 in 20 males is at risk of getting cancer), and in females, it is 6% (1 in 17 females). In males, esophagus, prostate, tongue, brain, and liver are the leading cancer sites. In females, breast, cervix uteri, esophagus, ovary, and gallbladder are the leading cancer sites. The cancer registry has registered 1039 cancer deaths (553 males and 486 females). The age-adjusted mortality rate for males was 32.1/100,000, and for females, it was 30.4/100,000. The cancer incidence and mortality rates are presented in [Table 1]. The registry has also reported 231 cases (13.3%) of other and unspecified sites. Most of the cases from other and unspecified sites were primary unknown cases.[4],[6] Moreover, the primary unknown cases are clearly related to the quality of diagnostic information as well as poor documentation of the medical record. The registry has also documented the survival status of the cancer patient. It was observed that around 35% of males and 50% of females are surviving.[3] The cancer registry has reported that the cancer incidence and mortality rates are in comparison with other rural cancer registries in the country.[4],[5] The hospital has registered 7500 cases and more than 4000 cancer patients have been treated so far. The hospital is listed in the Punjab State Government-sponsored health scheme for the treatment of the cancer patient. Most of the patients are benefited and they have completed treatment under the state government scheme.[6] Due to effective cancer care services, the survival and quality of life in cancer patients are likely to improve. The patient from Sangrur, Mansa, Patiala, and Bhatinda districts visit the hospital for the cancer treatment. Due to establishment of the cancer care services in the Sangrur district, the travel time of the patient and their relatives was saved. Due to treatment facility within the district, the cancer registry is able to collect more clinical details of the patient, which will be useful in survival analysis.
Table 1: Population covered, incidence and mortality cases registered, and incidence rate and mortality rate by sex (2013-2014)

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  Discussion Top


Population-based cancer registry information was utilized in planning the cancer care services. It is the first step toward the cancer control. Since cancer diagnosis and treatment facilities are lacking in the several parts of India, Homi Bhabha Cancer Hospital (HBCH), Sangrur, should be considered as an ideal model for the development of infrastructure with hub and spoke model, especially in rural area.

Despite recent advances in cancer management and treatment, access to and cost of cancer care remain a big challenge in many countries. In low- and middle-income countries, limited access to affordable cancer diagnosis and treatment has contributed to mortality-to-incidence ratios approximately 20% higher than industrialized countries.[7] Africa and Southeast Asia face the largest shortages of radiotherapy units, with approximately 30 countries without radiotherapy services.[7] There is a need to strengthen cancer registration in the rural area of the country supplemented with good treatment facilities. The present model is a fruitful collaboration between state government and premier cancer center, TMC, for the establishment of cancer care services in the rural population, and further, it will play an important role in cancer control activities in the area. Similar collaboration is required in other rural parts of India between regional cancer center/premier institutes and state governments. It is projected that by the year 2025, there will be an estimated 19.3 million new cancer cases and 11.4 million cancer deaths, and the proportion of these occurring in less developed regions will be increased by 59% and 68%, respectively.[7] Cancer registration in the metro cities such as Mumbai, Chennai, Chandigarh, and Bangalore is the byproduct of cancer treatment facilities available while rural registry like Sangrur has shown the way for the development of infrastructure for cancer treatment in predominantly rural district. In the coming years, the cancer registry will monitor the survival of the cancer patients at population level. The comparison of the survival of the cancer patients before the establishment of the facility and after the establishment of the facility will be done. The comparison will be effective in monitoring the cancer care services.


  Conclusion Top


The population-based cancer registry has reported that cancer incidence and mortality rates are in comparison with other parts of rural India. For effective cancer care services, one medical college or district hospital could be identified in each state for developing on this model in predominantly rural districts with a mentor institute. This will help in developing sustainable rural cancer registration and care model which is dismally lacking at present in India with few exceptions.

Acknowledgment

We gratefully acknowledge the dedicated work done by Mr. T. Anbumani, project consultant of TMC, Mumbai, in establishing HBCH at Sangrur. We thanks the support provided by Ms. Vini Mahajan, ex-health secretary, Department of Health and Family Welfare, Government of Punjab as well as district health authority of Sangrur, staff of the civil hospital, and several government authorities of Punjab state in establishing HBCH, Sangrur, Punjab, India.

Financial support and sponsorship

The funding is provided by the Department of Atomic Energy to TMC, Mumbai, and A Grant-in-Aid Institute of DAE, Government of India.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Report of Government of Punjab State wide Door to Door Campaign Cancer Awareness and Symptom Based Early Detection. Punjab: NRHM Department of Health and Family Welfare; 2013.  Back to cited text no. 1
    
2.
Thakur J, Prinja S, Jeet G, Bhatnagar N. Costing of a state-wide population based cancer awareness and early detection campaign in a 2.67 million population of Punjab state in Northern India. Asian Pac J Cancer Prev 2016;17:791-7.  Back to cited text no. 2
[PUBMED]    
3.
Summary Report of Population Based Cancer Registries at Chandigarh and SAS Nagar, Sangrur, Mansa districts, Punjab state, 2013-2014, Tata Memorial Center. Mumbai and Chandigarh: Post Graduate Institute of Medical Education and Research; 2018.  Back to cited text no. 3
    
4.
Sangrur Population Based Cancer Registry Report 2013: Tata Memorial Center. Mumbai and Chandigarh: Post Graduate Institute of Medical Education and Research; 2016.  Back to cited text no. 4
    
5.
Thakur JS, Budukh A, Kapoor R, Malhotra P, Bashar A, Kathirvel S, et al. Urban-rural differences in cancer incidence and pattern in Punjab and Chandigarh: Findings from four new population based cancer registries in North India. Int J Noncommun Dis 2017;2:49-59.  Back to cited text no. 5
    
6.
Sangrur Population Based Cancer Registry Report 2014: Tata Memorial Centre. Mumbai: and Chandigarh: Post Graduate Institute of Medical Education and Research; 2018.  Back to cited text no. 6
    
7.
Jemal A, Vineis P, Bray F, Torre L, Forman D. The Cancer Atlas. 2nd ed. Lyon, France: American Cancer Society, UICC and IARC/WHO; 2014.  Back to cited text no. 7
    



 
 
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