Lung Cancer In India Research Articles

P1.01-058 Demographic Profile of Lung Cancer from Eastern India

The clinico-pathological profile of primary lung cancer has changed considerably over the last few decades in India. Available literature suggests that the features of lung cancer in India like prevalence, incidence, aetio-pathogenesis and presentation vary markedly from the west. We performed a prospective evaluation of the unique demographic features of lung cancer with specific emphasis on smoking and histopathological trends. We analyzed all pathologically proven lung cancer cases registered over a period of initial 30 months in the department of Pulmonary Medicine of this All India Institute of Medical Sciences, Bhubaneswar. The patients were evaluated for their epidemiological, clinical and pathological profiles. The data were recorded in MS Excel spreadsheets and subjected to appropriate statistical analysis. Data was collected directly from patients’ paper and electronic medical records. All patients of histologically proven lung cancer were included. A total of 179 patients were included in the database of which 6 patients were excluded for significant missing data. There were 114 male and 59 women) average age 57.24 with a M:F ratio of 1.93 :1. Over half (56%) of the patients were active or past smokers, while 48% patients had not been exposed to active or passive smoking. Bidi (tobacco flake wrapped in tendu leaf) smoking was more common (37%) than cigarettes (19%) while 9% smoked both. Exclusive chewed tobacco use was seen in 12% while combined use of chewed and smoked tobacco was seen in 4% patients. The proportion of women never-smokers with lung cancer was significantly higher (89%) compared to men (28%). More than two-thirds patients (69.8%) presented with metastatic disease. Amongst patients with a definitive cytohistological diagnosis, the prevalence of adenocarcinomas was highest (56.3%) followed by squamous (30.8%), small cell (8%) and NSCLC NOS (4.9%). Adenocarcinoma is the commonest histological subtype in this region. Prevalence of lung cancer among non-smokers is also high in the eastern part of India. The demographic profile of patients with lung cancer in eastern India is unique with a much higher proportion of tobacco chewers and non-smoker especially in women. There is significant epidemiological trends towards a predominant adenocarcinoma histology. Most of the patients present at an advanced stage, probably due to lack of awareness and limited diagnostic resources in this part of the country. Although there are direct associations with smoking, there has been an increase in the non-smoking lung cancers worldwide.

SC17.03 Lung Cancer in India: Challenges and Perspectives

SC17.03 Lung Cancer in India: Challenges and Perspectives

Evolving epidemiology of lung cancer in India: Reducing non-small cell lung cancer-not otherwise specified and quantifying tobacco smoke exposure are the key.

Adenocarcinoma is the most prevalent histological type of lung cancer (LC) in developed countries while squamous cell carcinoma (SqCC) has so far been the most common type at our center. Herein, we report our continued assessment of the epidemiological trend of LC aimed at determining any change in the histological distribution. Retrospective analysis involving all consecutive newly diagnosed LC patients over a 4-year period (March 2011-February 2015). Demographic characteristics, histology, and staging data for current data set were compared with our previously published data (2008-2011). As before, smoking index (SI) was used to group patients as never (SI = 0), light (SI = 1-100), moderate (SI = 101-300), and heavy (SI ≥301) smokers. Majority of 1301 patients had advanced disease (Stages IIIB = 30.1%; IV = 53.3%), were males (82.3%) and current/ex-smokers (76.9%). Adenocarcinoma and SqCC (36.4% each) were equally prevalent. As compared to our previous study, adenocarcinoma increased (36.4% vs. 27.5%) and nonsmall cell lung cancer-not otherwise specified (NSCLC-NOS) decreased (5.1% vs. 10.9%) significantly (P < 0.001). The current study had more heavy smokers (68.3% vs. 61.1%; P = 0.013) and median SI was also higher (500 vs. 400; P = 0.001). Among SI-based groups, significant differences were observed for age, gender, body mass index, histology, TNM stage, and metastatic disease distribution. Reduction in NSCLC-NOS has led to adenocarcinoma and SqCC being equally prevalent at our center in North India despite an increase in heavy smokers. Accurate histological NSCLC subtyping is necessary for optimal epidemiological assessment.

P1.01-005 First of Its Kind Study in India Finds That Government's Ban on Gutka (Highly Popular Smokeless Tobacco Product) DID NOT Increase Smoking at All

India with 11.2%(111.9 million) of world’s smokers has 2nd largest population at elevated risk of lung cancer. Almost twice, 206 million(GATS, 2010), are Smokeless tobacco(ST) users in India, highest globally. Supreme Court of India observed that gutka and pan-masala are food products. Beginning in 2012, almost all state governments in India banned gutka and pan-masala containing tobacco. APPREHENSION was raised that ban on ST products will cause switching to smoking by huge ST user population vastly increasing risk of lung-cancer in India. This ban provided natural experiment on which this observational research studied how ban on popular ST products alters pattern of tobacco-use, especially smoking. Findings are expected to be strategically significant to inform future policies. Questionnaire of Global Adult Tobacco Survey-India (2010), developed by WHO,CDC and Govt. of India was modified to answer research questions and accommodate retrospective-cohort study design. Through 2-step randomization process, 500 households were sampled from Delhi. Participants were adults and interviewed during March-June, 2016 comprehensively, including tobacco-use currently and before gutka-ban. Inbuilt mechanisms in standardized questionnaire cross-validated self-report and minimised recall bias. Data was entered into SPSS and statistically analyzed. 94% of 500 households visited agreed to participate. 73.4% of pre-ban gutka-users switched to twin-sachet (pan-masala and chewing-tobacco sold separately by gutka-manufacturers to circumvent law). Delhi’s order bans all ST products. But, except premixed gutka, remaining ST products are freely available and consumed. 21.8% switched to khaini or other ST products. A large fraction switched from single dose sachets to multidose sachet. Interestingly, 96.2% respondents believed tobacco as very harmful (84.6%) or somewhat harmful (11.6%). However, only 18.6% gutka users attempted quitting after ban. 4.8% successfully quitted. In our sample, we DID NOT find anyone switching to smoking due to gutka unavailability. On an opposite thought, one may expect, ban on an ST product (Gutka) will increase awareness and motivate smokers to quit as spillover effect. But it wasn’t observed either. In absence of strong quitting promotion campaign, ban on selective tobacco products has limited role in changing prevalence of tobacco use. If selective ST products are banned, ST users preferably switch to other available ST products, BUT NOT to smoking. As majority ST users switched instead of quitting (after gutka-ban without simultaneous quitting campaign), we may logically conclude that effective ban on all ST products may lead ST users to switch to less favourable option of smoking. This is, however, subject to verification by similar study if there is ever effective ban on all ST products.

Lung Cancer in India: A Scientometric Study of Publications during 2005–14

Lung Cancer in India: A Scientometric Study of Publications during 2005–14

Lung cancer in the Indian subcontinent.

Smoking tobacco, both cigarettes and beedis, is the principal risk factor for causation of lung cancer in Indian men; however, among Indian women, the association with smoking is not strong, suggesting that there could be other risk factors besides smoking. Despite numerous advances in recent years in terms of diagnostic methods, molecular changes, and therapeutic interventions, the outcomes of the lung cancer patients remain poor; hence, a better understanding of the risk factors may impact the preventive measures to be implemented at the community level. There is a lack of comprehensive data on lung cancer in India. In this review, we attempt to collate the available data on lung cancer from India.

Clinicopathological Profile of Lung Cancer Patients in a Teaching Hospital in South India

Introduction: Lung cancer is one of the leading causes of cancer related deaths in the world. The incidence of lung cancer is increasing in India and there is a need to understand the natural history of this disease. Aim of the study: To study the clinico- pathological- radiological profile of patients diagnosed with lung cancer from January 2013 to May 2015 at a tertiary care teaching hospital. Materials and Methods: Inpatient records of all patients admitted during the study period were examined and all patients with a histologically proven diagnosis of bronchogenic carcinoma were recruited. Demographic characteristics, clinical, radiological and pathological details of each patient were recorded. Results: Fifty four patients with lung cancer were identified. Forty three (79.6%) were male and 11 (20.4%) were female. Thirty two (59.7%) were smokers and 22 (40.7%) were non smokers. Cough and expectoration (61.1%) was the most common presenting symptom followed by breathlessness (59.3%). Mass lesion (81.5%) was the most common radiological presentation and adenocarcinoma (42.6%) was the most common histological subtype. When compared to fiber optic bronchoscopy, image guided percutaneous biopsy had a better yield for diagnosing lung cancer (51.9% vs 48.1%). But this difference was not statistically significant (p=0.892) Conclusion: Adenocarcinoma is replacing squamous cell carcinoma as the most common type of lung cancer in India.

Physician Related Delays in the Diagnosis of Lung Cancer in India.

Lung cancer is associated with a poor prognosis, if detected late in the disease course. Delay in seeking health care, wrong diagnosis and delay in specialist referral can contribute to delay in diagnosis. This study was done to assess physician related delays in the diagnosis of lung cancer and the treatments given before presenting to our center. A total of 96 consecutive patients diagnosed with lung cancer were enrolled in this study. Details of previous physician consultations, their specialization, diagnoses made and treatments given were obtained from records available with the patients. Patients, on an average consulted two physicians before presenting to our center. Less than half of the physicians (45%) suspected lung cancer during their evaluation. Around 18% of physicians made an incorrect diagnosis of tuberculosis, out of whom, 88.6% had prescribed anti-tuberculous therapy. Only 27% of physicians referred the patients to higher medical centres for evaluation. Pulmonology Specialists (PS) were the most likely to diagnose lung cancer (p<0.0001). General Medicine Specialists (GMS) were the most likely to misdiagnose cancer as tuberculosis, followed by General Practioners (GP) when compared to PS (p-value =0.0422). Our study demonstrates that, many physicians have a low index of suspicion to diagnose lung malignancy and most commonly misdiagnose it as tuberculosis. It is likely that most patients failed to seek the services of PS directly or through referral either due to a shortage of PS or due to other reasons.

A study of the sociodemographic, clinical, pathological and radiological profile of lung cancer in a tertiary care center

Background: Lung cancer now constitutes the majority of all cancer diagnosis in the world. It has the most unfavourable prognosis accounting for the maximum number of cancer related deaths worldwide. The objective of this study was to study the complete profile of lung cancer. Prevalence of EGFR mutation in adenocarcinoma. Methods: 116 lung cancer patients were enrolled. They were subjected to diagnostic procedures like transthoracic FNAC/biopsy, bronchoscopy, thoracoscopy, closed pleural biopsy, lymph node FNAC/biopsy, besides routine blood and sputum examinations and CECT thorax. Data was analysed retrospectively after 1 year. Results: Most patients presented in the sixth decade. Mean duration of symptoms was 7.24 months. 62% patients were smokers, 54.3% were exposed to non-smoke tobacco, 18.9% to environmental tobacco smoke (ETS) and biomass fuel. Mass as the single radiological lesion was the most common radiological finding. Pleural effusion was seen in 51.7% patients and was more common in females. Liver (3.4%) and brain (5.9%) were the most common sites of metastasis. EGFR mutation was positive in 34.2% of adenocarcinoma. Exon 19 deletion was more common. ALK was positive in 1 patient. Maximum number of patients (70.7%) presented in stage 4. Transthoracic biopsy could diagnose 61.2% of all lung cancers. Adenocarcinoma was the most common diagnosis (60.3%) and was more common in females and non-smokers. Conclusions: Most patients present in an advanced stage. Adenocarcinoma now seems to be the most common histological subtype of lung cancer in India. EGFR mutation is common in the Indian population. Biomass fuel exposure is a significant risk factor in females. Bronchoscopy is the procedure of choice for diagnosing central tumours and transthoracic FNAC and Biopsy for peripheral tumours.

PCN158 - Health Related Quality of Life Among Patients Diagnosed with Advanced Non Small Cell Lung Cancer in India

PCN158 - Health Related Quality of Life Among Patients Diagnosed with Advanced Non Small Cell Lung Cancer in India

CURCUMIN AND ITS PROMISING ROLE IN THE PREVENTION OF CANCER

Cancer is a disease in wh ich cells grow abnormally in a group, uncontrollably deviating from the normal rules of cell division. It is regarded as the leading cause of death in economically developed countries and the second leading cause in developing countries. Cancer rates in In dia are lower than those seen in western countries, owing to the diverse populations and diets. The rate of colorectal, prostate and lung cancer in India are one of the lowest. Prevention of diseases through healthy diet and eating habits has been recogniz ed in various mythological books. Turmeric or curcumin which is a common ingredient in the Indian curries has shown anti - oxi dant and anti - inflammatory action, which helps it to act as a chemo - pr otective agent . The role of curcumin includes inhibition at mu ltiple levels of several cell signaling pathways. The use of turmeric in Indian dishes could be a reason for low cancer rates; hence turmeric can be included in diet to prevent the development of tumor.

Clinicopathologic features of non-small cell lung cancer in India and correlation with epidermal growth factor receptor mutational status

We performed retrospective analysis of 106 patients with lung cancer for which formalin-fixed paraffin-embedded tissues was available. Their epidermal growth factor receptor (EGFR) mutation status and treatment outcomes are described. All patients with confirmed non-small cell lung cancer (NSCLC) during Jan 2008 to Dec 2010 were included. EGFR sequencing was performed with ABI PRISM 310 genetic analyzer. Forty-two (39.6%) patients had mutation in one of the four exons characterized. Patients whose EGFR mutational status was not available at presentation before the start of treatment were started on chemotherapy, n = 46 (43.39%). If EGFR mutational analysis was available and mutations were present, the patients were started on either upfront tyrosine kinase inhibitor (TKI), n = 15 (14.15%) or if on chemotherapy arm were allowed to finish six cycles and then start with maintenance TKIs, n = 26 (24.52%). The median progression free survival for patients with and without mutations was 11 months (95% CI,7-14) and 9 months (95% CI,7-10) respectively. A median PFS of 14 months (95%CI, 12-16) was seen in the mutation-positive group that received both chemotherapy followed by switch maintenance with TKIs versus 8 months (95%CI, 7-8 months) in the group that received only TKI. The prevalence of EGFR mutations in this population of NSCLC patients was 39.6% with exon 19 mutation being the most common. The observed benefit of addition of chemotherapy over TKI in EGFR mutation-positive group raises the question, can we offer the therapy of chemotherapy-TKI combination to EGFR mutation-positive lung cancer patients as shown in the present study.

The role of Gefitinib in patients with non-small-cell lung cancer in India

Background:Gefitinib, an epidermal growth factor receptor-tyrosine kinase inhibitor, represents a new treatment option for patients with advanced non-small-cell lung cancer (NSCLC). We analyzed the data of patients who received Gefitinib for NSCLC in a tertiary care center in South India.Materials and Methods:Sixty-three patients with advanced NSCLC who had received Gefitinib either after failure of conventional chemotherapy or were previously not treated as they were unfit or unwilling for conventional treatment were included in the analysis.Results:The median follow-up for the cohort was 311 days (range 11-1544 days). Median time to progression was 161 (range 9-883) days. Complete and partial remission was seen in 1 (2%) and 6 (9%) patients, respectively, with overall response rate of 11%. Twenty-four (38%) patients had stable disease. Gefitinib was well tolerated with no significant side effects.Conclusion:Gefitinib shows anti-tumor activity in pretreated or previously untreated patients with advanced NSCLC. It has a favorable toxicity profile and is well tolerated. Gefitinib should be considered as a viable therapy in patients with NSCLC.

The relevance of "Nonsmoking-associated lung cancer" in India: A single-centre experience

Lung cancer remains a major cause of morbidity and mortality worldwide, accounting for more deaths than any other cancer cause. The aim of this study was to analyze the clinical profile and the epidemiological trends in lung cancer patients from a single centre with an emphasis on the smoking practices. This is a retrospective analysis of prospectively collected data of 258 consecutive hospital in-patients with a proven diagnosis of lung cancer at a tertiary care oncology centre between 2003 and 2007. The median age of patients in our study was 56 years; the male to female ratio was approximately 3.5:1. Non-small-cell lung cancer (NSCLC) was the predominant histology in 224 patients; the histology in the remaining 34 patients was small-cell carcinoma. Within NSCLC, the most common histology was adenocarcinoma followed by squamous cell carcinoma. One hundred and two patients were never-smokers as compared to 156 patients who were ever-smokers. Among the smokers, the majority of them were found to be cigarette smokers compared to 28.2% bidi smokers. There was a very significant correlation found with adenocarcinoma among nonsmokers, and with squamous cell carcinoma among the smokers compared to non-smokers. Our study suggests that the epidemiology of lung cancer in India is possibly changing, with close to 40% of our lung cancer patients being nonsmokers. More importantly, our study reflects the global trend of rise in adenocarcinoma histology. These observations need to be substantiated in similar studies of larger magnitude, preferably population-based.

Epidemiology of lung cancer in India: Focus on the differences between non-smokers and smokers: A single-centre experience

Lung cancer has varied epidemiology depending on the geographic region. Globally, there have been important changes in incidence trends amongst men and women, histology, and incidence in non-smokers. Indian epidemiological data on lung cancer is scarce. We set out to study the epidemiological patterns and clinical profile of lung cancer in India. We interviewed patients discussed in the thoracic oncology multidisciplinary meetings between 2008 and 2009. Demographic data, smoking history, place of residence, histology, stage at presentation, and treatment details were collected. Data was entered and analyzed in SPSS. There were 489 patients, with a median age of 56 years, of which 255 (52%) were non-smokers and 234 (48%) were smokers. One hundred and thirty-three patients had consumed smokeless tobacco. The male-to-female ratio was 3.5:1. Sixty-nine patients (14.1%) were incorrectly diagnosed and treated with anti-tuberculosis treatment, which delayed the diagnosis of lung cancer by four months. Eight percent of patients had small-cell carcinoma; of the 92% patients with non-small-cell carcinoma (NSCLC), the most common histology was adenocarcinoma (43.8%), followed by squamous cell (26.2%), large cell (2.1%) and other (8.3%). Eighteen percent of patients were diagnosed by cytology, therefore were diagnosed as NSCLC, without further histologic subtyping. Most patients (43%) were in Stage III at presentation. Lung followed by bone were the common sites of metastases. The majority of the patients (49%) received palliative chemotherapy. Among definitive therapy, concurrent chemo-radiation (13%) was offered more frequently than surgery (6%). Considerably higher numbers of Indian patients with lung cancer are non-smokers, compared to the West. The global trend of rise in adenocarcinoma is paralleled in India. Non-tobacco-related risk factors need further investigation.

Comparison study of clinicoradiological profile of primary lung cancer cases: An Eastern India experience

According to the first population-based cancer registry from eastern part of India, Kolkata and its surrounding areas have the highest prevalence of lung cancer in India. However, there is very limited data from this part of the country. The aim of this study is to find out the demographic and clinicoradiological profile of primary bronchogenic carcinoma. This is a retrospective review of lung cancer cases diagnosed in two tertiary institutes of Kolkata over a period of 4 years. We have reviewed the cases with proven histological or cytological diagnosis of primary bronchogenic carcinoma and chi-square test is done to calculate statistical significance. Out of 607 patients, male 489 and female 118, 67.7% are from rural area, 67.2% are smoker and only 9.4% are ≤40 years of age. Smoking is the major risk factor for primary lung cancer (P = 0.000) but no significance could be established with the different histological subtypes (P = 0.207). Though squamous cell carcinoma (SCC) is the most predominant variety (35.1%), adenocarcinoma and undifferentiated type are overrepresented in ≤40 years. SCC occurs at a significantly higher age group (60.84 ± 12.16 years) than other subtypes (P = 0.000). At least 55.2% cases of nonsmall cell lung cancer and 54% of small cell lung cancer presented in very advanced stage. SCC is the most common histological subtype of primary bronchogenic carcinoma. The relatively increased frequency of adenocarcinoma in our study as compared to other studies from India is probably due to higher proportion of nonsmokers.

Epidemiology of lung cancer in India: Is there a change in trends here too?

e12028 Background: The worldwide resurgence of interest in the epidemiology of lung cancer is due to the changing histological spectrum, global increase in non smokers, females and the introduction of targeted therapy. We set to study the epidemiological patterns of lung cancer in India and attempt to identify risk factors contributing to it. Methods: All patients presenting to the department of thoracic oncology were interviewed with the help of a carefully designed questionnaire and data entered in SPSS. Results: Of 489 patients there were 255 smokers and 234 smokers. The median age was 56 years. The male is to female ratio was 3.5:1..133 patients had consumed smokeless tobacco with same frequency of use in both the sexes.90 patients had co morbidities of which diabetes (9.2%), hypertension (6.3%) and heart disease (1.4%) were most common. 54 patients (11%)had been treated for tuberculosis in the past while 69 patients (14.1%) were on antitubercular treatment which delayed the diagnosis of lung cancer by 4 months. The most common histology was adenocarcinoma (38.4%) followed by squamous cell carcinoma (22.9%), small cell ca (7.6%), and large cell ca (1.8%).Our hypothesis that the place of residence would influence the smoking patterns and hence the location of the primary tumour was proven to be false. Most patients (43%) were in stage III at presentation and the least were in stage I /II. Lung followed by bone was by far the most common site of metastasis. Majority (almost half) received chemotherapy with palliative intent .Among definitive therapy concurrent chemo radiation (11-15%) was more offered than surgery (6%).There were 10% patients who received neoadjuvant chemotherapy. 2.3% were offered symptomatic care. Conclusions: The global trend of rise in adenocarcinoma is paralleled in India however the increase of lung cancer in non-smokers is alarming. Non-tobacco-related risk factors need further investigation .The changing epidemiological trends warrant special attention especially when viewed in relation to the amount of funding dedicated to the therapy of lung cancer. No significant financial relationships to disclose.

Clinico-pathological profile of lung cancer in Uttarakhand.

Background:Lung cancer is one of the most aggressive and prevalent type of malignancy causing high morbidity and mortality. Tobacco smoking continues to be the leading cause of lung cancer worldwide. An increasing incidence of lung cancer has been observed in India.Objective:The aim of this study was to evaluate the clinico, a pathological profile of the lung cancer in hilly state of Uttrakhand.Materials and Methods:We performed a retrospective analysis of histopathologically proven cases of bronchogenic carcinoma admitted in our hospital from January 1998 to August 2005.Results:Our study included 203 patients with confirmed cases of lung cancer. Male to female ratio was 8.2:1. The common age group being 40-60 years, 9.86% of the patients were less than 40 years old age. Smoking was found to be the main risk factor in 81.77% patients. The most frequent symptom was cough (72.90%) followed by fever (58.12%). The most common radiological presentation was mess lesion (46.31%). The most common histopathological type was squamous cell carcinoma (SCC) (44.83%) followed by adenocarcinoma (19.78%) and small cell lung carcinoma (SCLC) (16.75%). The majority patients (73.29%) were diagnosed in the later stages of the disease (III B and IV).Conclusion:It was found out that SCC was the most frequent histopathological form. SCLC predominates below 40 year and SCC over 60 years of age. Smoking still remains the major risk factors in pathogenesis of lung cancer.

Survival in small cell lung cancer in India: Prognostic utility of clinical features, laboratory parameters and response to treatment

Predictors of survival and response to treatment in patients with small cell lung cancer (SCLC) are ill-defined and unclear. In an attempt to assess the impact of common presenting symptoms and laboratory values on survival, we undertook this retrospective review of patients with SCLC. To our knowledge, there is no study on survival in SCLC patients from the Indian subcontinent. Retrospective Cohort study. All newly diagnosed small cell lung cancer cases from December 2001 through December 2004, were identified and clinical data on presenting symptoms and laboratory findings from their hospital records, noted. The influence of various pretreatment factors on survival was investigated using Kaplan-Meier plots and Cox multivariate regression model. 76 subjects were included (84% males, 91% smokers). 57% patients had five or more symptoms at presentation. Cumulative symptom burden was strongly associated with survival (P =0.02). Survival was also significantly related with Karnofsky performance status (KPS) (P =0.04), disease extent (P =0.03) and symptomatic response to treatment (P< 0.001). Patients with higher hemoglobin (P =0.02), serum sodium (P =0.04) and serum globulin (P =0.02), survived significantly longer. By multivariate regression analysis, hemoglobin, KPS and brain metastases, were significant predictors of survival (P =0.01, P =0.02, P< 0.01 respectively). Cumulative symptom burden, KPS, disease extent and symptomatic assessment of improvement after treatment, are useful predictors of survival. This has important clinical implications, keeping in view, the infrastructure and cost involved in more objective tests like CT scan, for evaluation of disease extent and prognosis. These findings can provide a simple basis for predicting prognosis in small cell lung cancer, especially in developing countries like ours.

25 Epidemology of lung cancer in India

25 Epidemology of lung cancer in India