Introduction:In India, mortality rate in breast cancer is high because more than half are diagnosed late at locally advanced or metastatic stages. This might be due to presentation delay (recognition of symptoms to first provider consultation) and treatment delay (first provider consultation to initiation of treatment), together known as overall delay. We aimed to estimate the overall delay in diagnosis and treatment in breast cancer and the associated factors, describe pathway of care and explore the reasons for delay from a patients' and providers' perspective. Methods: Explanatory sequential mixed-methods study with a quantitative component (retrospective cohort study including breast cancer patients registered at Dr. Borooah Cancer Institute (BBCI), Guwahati during February-June 2019) followed by descriptive qualitative component (in-depth interviews with 15 patients and 10 care providers). Results: Of 269 breast cancer patients, median (Inter Quartile Range) overall delay was 203 (110-401) days, presentation delay was 35 (10-112) days and treatment delay was 130 (75-258) days. Majority of patients approached private sector (190, 70.6%) as the first care provider. Nearly half of all patients (136, 50.6%) visited one health care provider before reaching the BBCI and another one-third (90, 33.5%) visited two providers. Reasons for presentation delay were misconception about the disease, perceived stigma, fear and denial of cancer, attribution of symptoms to trivial conditions, family responsibilities and embarrassment of breast examination by a male doctor. Treatment delay was due to initial visit to, misclassification of disease severity, dissatisfaction with care at public facilities, poor accessibility and affordability, fear of treatment and its side effects. Conclusion: Treatment delay was the major contributor to overall delay. Private providers need to be sensitized and trained in screening of breast cancer and referral of suspected cases of cancer. More awareness is needed about warning symptoms of breast cancer and misconceptions regarding the disease.
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.
Background and context: Two-thirds of global cancer deaths are from less developed countries. Late stage presentation and inability to access care are observed to be higher in lower and middle-income countries resulting in avoidable deaths and disability. Kamrup district in Assam has the fourth highest incidence of cancers in India. Detect Early Save Her, Him (DESH) initiative by Piramal Swasthya in Kamrup district focuses on reducing late-stage diagnosis and mortality. Aim: To reduce the proportion of late-stage diagnosis and mortality from breast, cervical and oral cancers through a community based screening and referral program. Strategy: 1. Community level interventions to increase awareness, improve knowledge, alter attitudes and motivate and mobilize people to undergo screening. 2. Evidence based highly sensitive screening and referral through mobile cancer screening unit. 3. Partnering with a regional cancer care institute (Dr. B. Borooah Cancer Institute - BBCI) to ensure end to end care to the patients. Program: DESH initiative in partnership with BBCI was launched in November 2017. The Mobile Cancer Screening Unit (MCSU) is fully equipped with state-of-the-art cancer screening facilities including a mammography unit. It is staffed by trained medical doctor, two nurses, a radiographer, two community mobilization officers, a counselor, a driver and a helper. Apart from the driver and the helper, the entire staff is women. In consultation with community networks, a schedule is prepared to conduct awareness programs at the community level. Subsequently, the MCSU visits the village and the staff screen the adult population over the age of 30 years for the presence of oral, breast and cervical cancer. A vehicle ferries those who are screened positive, to BBCI for diagnostic tests. The program is also supported by a helpline, which provides tele-counseling for suspected cases of cancer. Outcomes: A total of 1750 beneficiaries have been screened for oral, breast and cervical cancers through 43 screening clinics in 18 villages of Kamrup district from November 2017 through March 2018. Of them, 57% were females. 57 beneficiaries (3.25%) were screen-positive. Majority were positive for oral cancers (n=50) followed by breast and cervical cancers. Out of the 15 beneficiaries who visited BBCI, 3 were confirmed to have oral cancer. What was learned: Rural community of Kamrup district has been very receptive of the screening program with 1750 people screened in a short duration of time. Many screen-positive patients have not yet to visited the hospital for diagnostic tests, due to their financial difficulties. With financial support from the government through a special scheme, the number of screen-positive patients reaching the hospital for diagnostic tests is expected to increase substantially. DESH initiative aims to screen 15,000 individuals in the next 12 months and the results will provide better insights about the scalability and impact of the program.
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.
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