Clinical and sociodemographic profile of cervical cancer patients visiting a tertiary care hospital in India

 

Preethi A^1*, K V S Latha², S Suresh Kumar³, E Senthil Kumar⁴

 

Abstract              Background: Cervical cancer, the most common genital tract malignancy, is a major health burden in developing countries. Understanding the clinical and sociodemographic profile of patients helps in planning control measures and treatment facilities. Aim: To determine the sociodemographic and clinical profile of cervical cancer patients and study their association with tumor related factors. Methods and Materials: This is a retrospective study of 400 cervical cancer patients visiting a tertiary care hospital in Chennai during the period of January 1,2015 to June 30, 2018. Data was analysed using descriptive statistics and Chi square and Kruskal Wallis test were used to assess the relationship. Results: The median age was found to be 54 years. Around 54% were illiterate and 92% had squamous cell carcinoma. Only 5% had early stage disease and 81.5% did not have any prior treatment. Concomitant comorbidities were seen in 29.5% of the patients with hypertension being the most common (16.75%). The stage of the disease was found to be significantly (p<0.05) associated with age and educational status. Conclusion: This study shows important baseline characteristics of cervical cancer patients, which can help in planning for optimum utilization of hospital services and treatment facilities, especially in developing countries like India.

Key Word: cervical cancer.

 

INTRODUCTION

Cervical cancer is the most common female genital tract malignancy and a major health problem in developing countries¹. The majority of the cases are seen in the developing countries. It is estimated that the incidence of cervical cancer is approximately 1 in 53 Indian women during their lifetime^2-3. The exact cause of cervical cancer is still unknown. However it is more common in women living under lower socioeconomic conditions and with lack of education. The risk factors related to cervical cancer are exposure to human papilloma virus, early age at marriage, early age at first sexual intercourse, more number of sexual partners, high parity, smoking and several others^4-7. In India, large section of population belongs to below poverty line lacking awareness and access to cervical cancer screening, diagnosis and treatment facilities. Cervical cancer accounts for almost 17% of the cancer deaths among women aged 30-70 years³. Studying the clinical and sociodemographic profile, additional comorbidities along with patient presentation remains the first step to plan control measures. Hence this study has been conducted in a tertiary care hospital in India to study the clinical and sociodemographic profile of cervical cancer patients.

 

SUBJECTS AND METHODS

STUDY DESIGN

This is a retrospective study based on hospital records of Department of Medical Oncology, Institute of Obstetrics and Gynaecology, Chennai, India.

 

STUDY POPULATION:

Hospital medical records of 400 cervical cancer patients who had reported to Department of Medical Oncology, Institute of Obstetrics and Gynaecology, Chennai, during the period of January 1, 2015 to June 30, 2018 were retrospectively analyzed. Patients who were diagnosed before the study period and already on treatment were not included in the study.

DATA COLLECTION

The clinical and sociodemographic details obtained from hospital medical records were age, religion, marital status, education, occupation status, treatment history, parity, menopausal status, symptoms, stage, tumor histology, performance status and presence of comorbidities.

STATISTICAL ANALYSIS

Data was analyzed by using descriptive statistics. Chi-square test and Kruskal-Wallis test were used for assessing relationship between variables. P<0.05 was considered statistically significant.

 

RESULTS

The total number of patients included in the study is 400. Table 1 shows the sociodemographic profile of carcinoma cervix patients. Most of the patients belonged to 45-54 age group (32%) followed by 55-64 (29%) and only 19.75% were below 45 years of age. The median age of patients was 54 years. Majority of the patients were Hindus (85%) followed by Muslims(9%) and the rest were from other communities. More than half were illiterate (54%) and only 3.5% completed college education. 76% were married and 23.5% were widows and 0.5% were unmarried. Nearly 75% had 2 to 4 children with 15% having more than 4 children while only 9.75% reported to have less than 2 children. Postmenopausal patients comprised about 73.75% of the study population. Most of the patients were homemakers (87%) with 4.5% working in agricultural fields. About 18.5% had taken treatment for cancer previously before reporting to this centre. Symptomatology, clinical stage, histology, performance status and associated comorbid conditions described the clinical profile of the cervical cancer patients(Table 2). Most common symptom was bleeding per vaginum (81.25%) followed by abdominal pain (78.5%), white discharge (53.25%), loss of appetite and weight (49.5%), back pain (44%) and others like post coital bleeding, burning micturition and difficulty to defecate. Stage-wise analysis had shown that most of the patients belonged to Stage IIB (45.75%) and IIIB (42%). Majority of the patients had squamous cell carcinoma (92%) followed by adenocarcinoma (5.75%). Eastern Cooperative Oncology Group scale was used to measure the performance status. This revealed that most of the patients (68%) were able to carry out all normal activities without any restrictions and only 0.75% were bedridden. Around 118 patients (29.5%) had associated comorbidities like hypertension, diabetes, HIV, hypothyroidism, bronchial asthma and tuberculosis, the most common being hypertension (16.75%) followed closely by diabetes mellitus (16.5%). An analysis to find any association between stage and sociodemographic factors such as age and education level was also done. There was significant association between stage of the disease with both age and educational status.

 

Table 1: Sociodemographic Profile of cervical cancer patients:

 

Table 2: Clinical Profile of Cervical cancer patients:

 

Table 3: Comparison of age with respect to stage:

 

Table 4: Association between stage and education

 

DISCUSSION

India is a very diverse country when it comes to ethnicity. In contrast to the developed countries of the world, cervical cancer is a major health issue faced in India. Conventional cytology screening programs have reduced the incidence of cervical cancer in developed countries^11,12. However, owing to the low availability of resources in India, a high risk of developing cervical cancer still remains. Hence the clinical profile of cervical cancer patients is very essential for early diagnosis and treatment which is important for cancer control. The median age of cervical cancer patients in this study was 54 years, which is almost similar to the average age reported in Sankaranarayanan et al.¹³. in his study of 452 cervical patients conducted by Kerala. The average age of patients was higher than that which was reported by other researchers¹⁴. Relative lack of awareness and non-availability of screening facilities for cervical cancer in our country have led to higher incidence in older age groups^15-16. Majority of them belonged to the age group 45-54 year followed by 55-64 which was similar to other research works in our country^17-22. Median age of the higher stage patients was found to be higher than the median age of the lower stage patients, as with Flores-Luna et al.¹⁴. The higher median age seen in patients with advanced stage may be due to late diagnosis of cancer. It could also point towards the differences in awareness of cervical cancer symptoms in elderly and also differences in healthcare seeking behaviour²³. Thus, improving the knowledge, skills and confidence of elderly so that they present early with symptoms might help to downstage the cervical cancer in older women and further improve their survival. In this study, 54% were illiterate and only 3.5% had a college qualification and above. The association between stage and educational status was studied. This is in concordance with many studies which have proven illiteracy to be a risk factor for carcinoma cervix^24-26. Lack of education is linked with early marriage and high parity which are also risk factors for carcinoma cervix. Thus improving the educational status of women in India can be an important component of holistic approach for control of cervical cancer in India. Improvement of living standards and formulation of public health policies aimed at improving awareness along with cancer screening programs help in reducing cervical cancer in India²⁴. In our study, 76% were married which was higher than 62.4% which was reported in Sankaranarayanan et al.¹³, but lower than 88.61% which was reported by Thulaseedharan et al.¹⁸. Among all patients, 29.5% had associated comorbidities, of which hypertension was the most common. The prevalence of comorbid conditions in this study was higher than that was reported by Ibfelt et al.¹⁹. The distribution of religion reported in this study showed similar results in other studies¹⁵. In our study, only 3.5% belonged to stage I and around 50% had advanced stage diseases (III and IV). Similar stage-wise distributions was seen in Nandakumar et al.¹⁶ and Shrivastava et al.²⁷. Squamous cell carcinoma was reported in around 92% of the patients which was similar to several other researches^19,28. Only 68% reported to belong to ECOG score 0 in terms of performance status which was below the values reported by Sankaranarayanan et al.¹³ (81%) and Vishma Baliyada Kaverappa et al.²⁶. Several limitations of this study have to be taken into account. Important characteristics like socioeconomic status and family income were not considered. The time of incidence of comorbid conditions was not reported. These limitations were present because the study was based on secondary data and the information in medical records were only recorded. However, the importance of this study lies in the fact that very few studies have described sociodemographic and clinical profile of patients in India and this study also explores the relationship between tumor factors and patient characteristics.

 

CONCLUSION

In our country, very few studies are present describing clinical profile of cancer patients visiting health care facilities. Understanding it can help ensure proper accessibility and utilization of hospital care services in resource poor countries like India. The information gathered can be helpful in formulating proper guidelines, public health policies and implementation of cancer control programs.

 

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