Abstract
Background: Comprehensive data on early outcome of cancer management including treatment drop out, mortality, follow-up and survival, for all registered cases is scarce.Methods: From a prospectively maintained record system in the department of Medical Oncology, an audit was done for all patients registered in the calendar year 2015 for diagnosis, treatment course, follow-up and vital status. We follow a system of outpatient clinic booked appointment and for patients who default, serial phone calls are made to counsel about compliance and give a next review date.Results: Of total 1173 cases registered, 73.5% had solid (n = 863), and 25.5% had hematological malignancies (n = 300). Median age was 48 (1 month – 85 years); 11% pediatric, 72% adults and 17% were elderly. Male to female ratio was 0.74:1. Five most common cancers were breast (27.7%), lymphoma (11.6%) acute leukemia (9.4%), esophago-gastric (9.2%), followed by ovarian and lung carcinoma, 7% each. Almost a quarter (28%) were lost to follow up (LTFU) on different treatment phases and another one third (33%) had died during the study period. Almost half of all deaths were for patients on chemotherapy with either curative or palliative intent. Significantly higher rate of LTFU was noted for patients’ age > 18 years, with solid malignancies and with longer distance (>100 kilometres) from hospital.Conclusion: Periodic audit is essential for effective functioning of any cancer treatment program. High rates of treatment defaults and early deaths on chemotherapy demands strengthening of counselling and supportive care services to improve overall outcomes.
Highlights
Cancer is rising in incidence globally and in developing countries making it a significant public health problem
From a total of 1420 microscopically confirmed and clinically/radiologically suspected cases of cancer referred from various other intramural departments or hospitals, a total of 1173 cases were registered and indexed in the department of Medical Oncology for further management
Our department is not registering cases for concurrent or palliative chemotherapy for head & neck carcinoma, cervical carcinoma and brain tumors, and these tumors are currently primarily dealt by the department of Radiotherapy and the respective surgical departments
Summary
Cancer is rising in incidence globally and in developing countries making it a significant public health problem. Realising the problem of treatment drop outs and essentiality of long term follow up, ICMR (Indian Council of Medical Research) have initiated pattern of care and survival studies (POCSS) on three of the most common cancers of the Cervix, Breast and Head & Neck which are underway in all the HBCRs of India [4]. Comprehensive data on outcome of cancer including information on intent of treatment, treatment drop-out, follow-up, mortality and survival for all registered or diagnosed cases is generally lacking either from population based cancer registries or hospital based cancer cohorts. In this study we have attempted to analyze the clinical profile of all cases registered in the department of Medical Oncology, in a calendar year and determined their treatment course and outcome over a one year period. Comprehensive data on early outcome of cancer management including treatment drop out, mortality, follow-up and survival, for all registered cases is scarce. High rates of treatment defaults and early deaths on chemotherapy demands strengthening of counselling and supportive care services to improve overall outcomes
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