Malignant Neoplasm Burden in Nepal - Data from the Seven Major Cancer Service Hospitals for 2012

A Hermeneutic Phenomenological Study of Aesthetics in Nursing Practice Among Hospitalized Cancer Patients in Nepal

Background: Aesthetics is the art of nursing that is expressive, subjective, and visible in the act of caring in nursing practice. Aesthetics in nursing practice satisfies holistic needs and achieves the quality of whole-person care. Purpose: The aim of this study is to describe the meanings of the lived experiences of cancer patients in terms of receiving care from the perspective of aesthetics in nursing practice. Methods: The hermeneutic phenomenological approach grounded on Gadamerian philosophy guided this study. Eleven Nepalese cancer patients who met the inclusion criteria shared their experiences through graphic illustrations (drawings) and interviews. Data were analyzed and interpreted following van Manen's phenomenological approach reflective of the four life worlds. The trustworthiness of findings was established following the criteria by Lincoln and Guba. Results: Thematic categories of the lived experience of cancer patients were revealed, reflecting the four life worlds: lived relation expressed as being nurtured as a family; lived space as appreciating the healing space; lived time as being hopeful; and lived body as receiving a new life. This experience was described as experiencing self and other while appreciating the healing space, being hopeful and nurtured as family and having a new life Implications for Practice: Aesthetics in nursing practice values on politely nurturing cancer patients as nurses' family members in a pleasant healing environment. Further, cancer patients experience having a new life.

Epidemiologic Pattern of Cancer in Kathmandu Valley, Nepal: Findings of Population-Based Cancer Registry, 2018

PURPOSE

Although cancer is an important and growing public health issue in Nepal, the country lacked any population-based cancer registry (PBCR) until 2018. In this study, we describe the establishment of the PBCR for the first time in Nepal and use the registry data to understand incidence, mortality, and patterns of cancer in the Kathmandu Valley (consisting of Kathmandu, Lalitpur, and Bhaktapur districts), which comprises 10.5% of the estimated 29 million population of Nepal in 2018.

MATERIALS AND METHODS

The PBCR collects information from facilities and communities through the active process. The facilities include cancer or general hospitals, pathology laboratories, hospice, and Ayurvedic centers. In the communities, the field enumerators or female community health volunteers collected the data from the households. In addition, the Social Security and Nursing Division under the Department of Health Services, which provides subsidy for cancer treatment of underprivileged patients, was another major source of data. The collected data were verified for residence, accuracy, and completeness and then entered and analyzed using CanReg5 software.

RESULTS

In the Kathmandu Valley, the PBCR registered 2,156 new cancer cases with overall age-adjusted incidence rate for all cancers of 95.7 per 100,000 population (95.3 for males and 98.1 for females). The age-adjusted mortality rate for males was 36.3 (n = 365) and for females 27.0 (n = 305) per 100,000 population. We found that the commonest cancers in males were lung and stomach, whereas in females, they were breast and lung cancer. Gallbladder cancer was among the top five common cancers in both sex.

CONCLUSION

These findings provide a milestone to understand the cancer burden in the country for the first time using the PBCR and will be helpful to develop and prioritize cancer control strategies.

Cancer burden in Nepal, 1990-2017: An analysis of the Global Burden of Disease study

Introduction

Cancer is the second leading cause of death and a major public health problem in the world. This study reports the trend and burden of cancer from 1990 to 2017 along with its risk factors in Nepal.

Methods

This study used the database of the Institute of Health Metrics and Evaluation’s Global Burden of Diseases on cancer from Nepal to describe the most recent data available (2017) and trends by age, gender, and year from 1990 to 2017. The data are described as incidence, prevalence, disability-adjusted life years (DALY), and percentage change.

Results

In 2017, the age-standardized cancer incidence and mortality rates were 101.8/100,000 and 86.6/100,000 respectively in Nepal. Cancer contributed to 10% of total deaths and 5.6% of total DALYs in Nepal. The most common cancers were the breast, lung, cervical, stomach and oral cavity cancers. The number of new cancer cases and deaths in Nepal have increased from 1990 to 2017 by 92% and 95% respectively. On the other hand, age-standardized incidence and mortality rates decreased by 5% and 7% respectively. The leading risk factors of cancer were tobacco use, dietary factors, unsafe sex, air pollution, drug use, and physical inactivity.

Conclusions

This study highlighted the burden of cancer in Nepal, contributing to a significant number of new cancer cases, deaths and DALY. A comprehensive approach including prevention, early diagnosis and treatment, and rehabilitation should be urgently taken to reduce the burden of cancer.

Prevalence of Cervical Cancer among Cervical Biopsies in a Tertiary Care Center

Introduction:

Cervical cancer is one of the most common cancer among the female population in Nepal. The incidence and mortality rate due to cervical cancer is higher in developing countries like Nepal due to a lack of proper screening and early diagnosis. This study aims to find out the prevalence of cervical cancer among cervical biopsies in a tertiary care center.

Methods:

A descriptive cross-sectional study was conducted among the hospital records of cervical biopsies from the department of pathology of Shree Birendra Hospital from 1st May 2018 to 30th April 2019. Ethical approval was taken from the Institutional Review Committee in February 2020. This study was conducted among 146 cervical biopsies by using convenience sampling method. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Data were analyzed using excel 2016 software.

Results:

The prevalence of cervical cancer among 146 cases included in our study is found to be 6 (4.11%) at 95% Confidence Interval (0.90-7.32). Among those cases of cervical cancer, 4 (66.67%) were squamous cell carcinoma, 1 (16.67%) was adenocarcinoma, and 1 (16.67%) was of other type. Maximum cases of cervical cancer were prevalent among higher age groups.

Conclusions:

Cervical cancer-related morbidity and mortality are different in different parts of the world. It's burden is primarily seen in developing countries where there is a lack of effective screening programs.

Trends and clinicopathological characteristics of oral squamous cell carcinomas reported at a tertiary cancer hospital in Nepal during 1999 to 2009

OBJECTIVE

Reliable data describing the trends and clinicopathological characteristics of oral squamous cell carcinoma (OSCC) in the Nepalese population are very limited. The current study aimed to examine the demographics, trend, and clinicopathological characteristics of OSCC reported to the main referral/tertiary cancer hospital, the B.P. Koirala Memorial Cancer Hospital (BPKMCH) in Nepal for a period of 11 years (1999-2009).

MATERIAL AND METHODS

This is a cross-sectional study. Data were retrieved retrospectively from hospital register maintained in the Department of Ear, Nose, Throat at BPKMCH, categorized into demographic and clinicopathological variables and SPSS (V25) was used for the analysis.

RESULTS

In a period of 11 years, 3,452 cases of head and neck cancer were registered at the Department of Ear, Nose, Throat, BPKMCH. Out of 1,111 oral cancer cases, 1,081 (97.3%) were OSCC. A trend for increasing number of OSCCs presenting to BPKMCH was observed during that period. OSCC was found to be more common among males (73.0%), Brahmin/Chhetri ethnic groups (33.0%), in age group of 51-60 years (31.9%), and in Terai region (62.0%). Tongue (42.8%) was the most common site, followed by buccal mucosa (27.2%). Nevertheless, when stratified with respect to the geographical location and ethnicity, buccal mucosa was the most common site for OSCC in Terai region (63.9%, p = .002) and in Madhesi ethnic group (34.2%, p < .001). Majority of OSCC cases were diagnosed at advanced stage (49.7%, Stage IV) and received a combination therapy (42.0%).

CONCLUSIONS

Hospital-based records can provide valuable information on disease characteristics in countries like Nepal. This study revealed that the clinicopathological characteristics of OSCC in Nepal follow the global trend. Nevertheless, relationship between specific intraoral sites for OSCC with geographic location and ethnic groups is an interesting observation and requires further population-based studies to clarify these findings.

Infiltrating CD4 and CD8 lymphocytes in HPV infected uterine cervical milieu

PURPOSE

Tumor infiltrating lymphocytes (TILs) have been extensively described in anti-tumor immunity, but their functional alterations in the immunoediting processes during neoplastic progression in the uterine cervix are still not clear. Our aim was to gain insight into cervical tissue T cell populations, determine if there are any differences in the localization and quantity distribution of T lymphocytes, and to evaluate their role in disease regression or progression in the cervical neoplastic milieu.

PATIENTS AND METHODS

Serial section analysis of immunohistochemically stained CD4 and CD8 lymphocytes was performed on a total number of 72 samples, categorized into four cohorts: 23 HPV non-infected (HPV-) normal cervix, 20 HPV infected (HPV+) normal cervix, 17 HPV+ low grade cervical intraepithelial neoplasia (CIN), and 12 HPV+ high grade CIN.

RESULTS

Low infiltrating lymphocytes (ILs) in normal cervix and high ILs in CIN were observed, while the trend of ILs increased with increasing grade of CIN, which was statistically significant (P<0.0001). Quantitative and localization analysis between the subsets of T cells showed that, in the epithelial layer, infiltrating CD8+ lymphocytes (CD8+ILs) were significantly higher than CD4+ILs in HPV+ normal cervix, while the trend decreased with increasing grade of CIN (P=0.011). Whereas, in the stromal layer, CD4+ILs were predominant in all study groups and no statistical difference was found between these groups. However, tumor infiltrating CD8+ lymphocytes (CD8+TILs) were noted to be significantly higher than CD4+TILs in severe dysplastic cases.

CONCLUSION

T cell infiltrates were predominant as the grade of the lesion progressed into more advanced lesions, which likely represent the lesions that have persisted over time. The variation in the infiltration rate and the location of CD4+ILs and CD8ILs may suggest the efficacious role of CD8 T cells in eliminating HPV infected cervical epithelial cells and also provides insight into the complex role of TILs in facilitating and mediating sustained anti-tumor responses, hence preventing tumor outgrowth.

Prevalence and type-specific distribution of human papillomavirus infection among women in mid-western rural, Nepal- A population-based study

Background

Cervical cancer is the most common cancer among women in Nepal. The prevalence of human papillomavirus (HPV) 16 and or HPV 18 among women with cervical pre-cancer and cancer is higher than the incidence of HPV in the world population. The population-based epidemiological data of HPV in the general population in most parts of the country remains unknown. The objective of this study was to assess the prevalence and type distribution of HPV infection and association of abnormal cytology with high risk HPV infection among women in mid-western rural, Nepal.

Methods

A population-based cross sectional study was conducted in Jumla, one of the most remote districts in Nepal. A total of 1050 cervical samples were collected from married and non- pregnant women aged 20–65 years during mobile Cervical Cancer Screening Clinics conducted from May 2016 to January 2017. The presence of HPV DNA was firstly confirmed by HPV consensus PCR using PGMY09/PGMY11 designed primers, then HPV positive samples were further genotyped by the membrane hybridization method to detect the 21 high-risk HPV (HR-HPV) and low-risk HPV types. The prevalence of HR-HPV among women with normal and abnormal cytology was calculated. Data were analyzed using SPSS software for Windows. P < 0.05 was considered statistically significant.

Results

A total of 998 women were eligible for this study with the mean age 32.6 ± 8.6 years, and the mean marital age was 16.7 ± 3.8 years. The overall prevalence of HPV infections was 19.7%. HR-HPV and low-risk HPV were 11.7 and 8.7% respectively. The six most common HR-HPV types were HPV16, 39, 58, 33, 51 and 18. HR-HPV infection among the women with abnormal and normal cytology was of 27.3 and 10.8% respectively.

Conclusions

There was a higher prevalence of HR-HPV infection among women living in Jumla than other parts of Nepal. This study provides preliminary information on overall HPV and type-specific HR-HPV prevalence, HR-HPV 16, 39, 58, 33, 51, and 18 are the most prevalent genotypes in this region. The data contribute to the epidemiological knowledge about HPV and type-specific HR-HPV genotypes prevalence in mid-Western Nepal.

Can clinical pharmacists bridge a gap between medical oncologists and patients in resource-limited oncology settings? An experience in Nepal

The clinical pharmacist's part is emerging as a key extension to the human services care team bringing about enhanced patient care in the world. The main objective of this article is to highlight the role of clinical pharmacist in an oncology setting of Nepal. An enrollment of clinical pharmacist in an oncology hospital or in oncology settings can work as a bridge between medical oncologist and patients.

Breast Cancer in Nepal: Current status and future directions

Breast cancer is the second most common malignancy among Nepalese women. Breast cancer places a substantial burden on the Nepalese healthcare system, but information regarding the number of women living with breast cancer is not well recorded. In countries with lower levels of resources such as Nepal, breast cancers are commonly diagnosed at late stages and women may receive inadequate treatment, pain relief or palliative care. Socioeconomic disparities and insufficient financial resources hinder prevention of breast cancer in Nepal. The current review provides an overview of the burden of breast cancer, of risk factors associated with breast cancer, and of screening and treatment modalities for breast cancer in Nepal. Additionally, this review highlights the current awareness of breast cancer among Nepalese women and prevention strategies for breast cancer.

Treatment-Related Quality of Life in Nepalese Women with Breast Cancer

Objective:

To identify the level of quality of life and its predictors in Nepalese women with breast cancer while receiving chemotherapy.

Methods:

This cross-sectional study with a predictive design was conducted for a conveniently selected sample of 85 Nepalese women with primary breast cancer receiving chemotherapy at outpatient clinics of three cancer hospitals of Kathmandu, Nepal. Data were collected during December 2016 and February 2017 using demographic sheets, the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire and the modified Medical Outcomes Study Social Support Survey. Descriptive and inferential statistics were employed for data analysis.

Results:

The mean age of the sample was 50.2 years (SD = 11.50). Study participants reported moderate to poor quality of life (M = 33.5, SD = 23.5). Multiple regression analysis showed that age, years of education, stage, past breast surgery, overall symptom severity, and social support significantly explained 56.8% of the variance in quality of life (R² = .568, F (8,76) = 12.469, p = .000). However, overall symptom severity (β = -.477, p= .000) and social support (β = .183, p = .050) were the most important predictors.

Conclusions:

As Nepalese women reported decreased quality of life, nurses should provide preventive and supportive services to improve the quality of life of their patients during chemotherapy.

Distribution of Cancer by Sex and Site in Nepal

Background:

Cancer is one of the leading causes of death throughout the world. The indicators of cancer by site are significant to identify the problem of cancer. The purpose of this retrospective study is to perform the incidence of all cancers both in males and females over the ten years in Nepal.

Methods:

The data collected from all the seven hospital based cancer registries of Nepal have taken for the study. This retrospective study has presented the number of cases, frequencies, and crude incidence of all cancers by sex and site.

Results:

A total of 55,931 cancer cases with known age were registered throughout the hospital based seven cancer registries of Nepal from 2003 to 2012. Throughout the ten years, Lung (incl. trachea and bronchus) cancer (19.08%) was the major cancer in males followed by stomach cancer (7.86%) and Pharynx cancer (5.4%). Similarly, Cervix cancer (21.9%) was the most common cancer in females followed by breast (15.48%) and Lung (incl. trachea and bronchus) cancer (10.47%) over the ten years. This retrospective study presented the distribution of the cancer site over the ten years in Nepal.

Conclusion:

This retrospective study showed that lung cancer is the major cancer in male while in female cervix uteri is the most common cancer ranging from 2003 to 2012.

A 15-year-old Nepali boy with metastasised colorectal cancer

Nepal suffers from vast inequalities in modern healthcare. The low-income country wrestles with far-reaching insufficiencies in minimal preventative medicine, health awareness, limited infrastructure and difficult topography-all of which contribute to poor access and poor care-seeking behaviour. Our patient came from rural Nepal, where primary healthcare outposts are frequently understaffed and underequipped. He received supportive treatment in his village from the time symptoms presented until he was diagnosed 2 years later, at a tertiary medical centre, with colorectal cancer. An examination of the relevant literature indicates that younger patients often present in later stages of the disease due to initial misdiagnosis or overlooking colorectal cancer as a possibility. Beyond the rarity of the patient's condition, the logistical and financial obstacles he faced in Nepal, particularly outside of the capital of Kathmandu, deterred his access to a higher level of care and delayed his correct diagnosis and treatment.

Hospital-Based Cancer Incidence in Nepal from 2010 to 2013

Background:

Cancer is one of the leading causes of death throughout the world. Analyzing the incidence of cancer by site, sex and age is essential to detect the burden of cancer. Throughout the twelve hospital based cancer registries of Nepal, a total of 29,802 cancer cases with known age, were registered from January 1st 2010 to 2013 December 31st. The purpose of this retrospective study is to present the incidence of all cancer sites in both males and females for this period.

Materials and Methods:

This paper reviews data from all the hospital based cancer registries over a four-year period. This retrospective study has illustrated the number of cases, frequencies and crude incidence of all cancers by sex and site. For statistical analysis, SPSS (version 23.0) and Microsoft Excel 2010 were used.

Results:

Over the four-year period from January 1st 2010 to 2013 December 31st the major cancer in males was identified as follows: lung cancer (17.5%) followed by stomach cancer (7.6 %) and larynx cancer (5.4%). Among females, for the same four-year period, the three common cancers were identified as cervix (18.9 %) followed by breast (15.6 %) and lung (10.2%).

Conclusion:

This retrospective study concluded that cancer is being increased by calendar years both in males and females however, the incidence of cancer is higher in females compared to males. .

Prediction of the Cancer Incidence in Nepal

Background:

The burden of cancer will increase both in males and females in Nepal. Due to the unavailability of a population based cancer registry it is difficult to precisely predict of future incidence rates. However, using hospital-based data to predict the cancer incidence in Nepal it was found that it will certainly increase both in males and females from 2013 to 2020.

Material and Methods:

For this research we used the cases from the first national cancer registry report (2003) to the cases of the most recent (2012) accumulated by all the hospital based cancer registries in Nepal. We used simple linear regression to analyze the data and thereby obtained a simple linear regression equation.

Result:

In 2020 the highest incidence rate will be for males 38.5 per 100,000 and for females, 41.4. The present study demonstrated that female cancer incidence will be higher than that in males in Nepal.

Conclusion:

This study provided evidence of future trends, which will feature an increasing rate of cancer in Nepal.

Genetic testing in a gynaecological oncology care in developing countries-knowledge, attitudes and perception of Nepalese clinicians

Background

Genetic testing for an inherited susceptibility to cancer is an emerging technology in medical practice. Little information is currently available about physicians’ attitudes towards these tests in developing countries.

Methods

We conducted an email survey of Nepalese physicians practicing in academic and non-academic settings in Nepal, regarding knowledge, attitudes and perception towards genetic testing for gynaecologic cancer.

Results

Responses were received from 251 of 387 practitioners (65%). Only 46% of all respondents felt prepared to answer patients’ questions about genetic testing for gynaecologic cancer, despite 80% reporting that patients had asked questions about genetic testing, and 55% being asked more than 5 times in the past year. 42% reported more than 10 of their patients having had genetic testing for cancer, the majority for BRCA1/2. Access (40%), cost (37%) and lack of physicians’ information (24%) were cited as the main barriers to testing. The most commonly identified concerns regarding genetic testing were the potential for increased patient anxiety, misinterpretation of results by patients, and maintaining confidentiality of results (64%, 47% and 38% of respondents respectively).

Conclusion

This study shows the gap among the health care providers in developing countries and the available modern scientific tools and skills in regard to the benefits of genetic testing for gynaecological cancers in a developing nation. These findings indicate the need for the introduction of further genetic counselling education and support into gynaecological care in Nepal.

Electronic supplementary material

The online version of this article (doi:10.1186/s40661-016-0034-5) contains supplementary material, which is available to authorized users.

Age specific incidence of five major cancers in Nepal, 2012

Background:

Population based cancer registry is inevitable to measure the indicators of cancer. This retrospective study was conducted to perform the age specific incidence and age standardized rate of cancer by sex, age and sites in Nepal, 2012.

Materials and Methods:

The data collected by hospital based National cancer registry programme of Nepal were used to calculate the age specific incidence of five major cancers by sex and sites. The age standardized rate of ten major cancers, both in males and females of 2012 was also performed.

Results:

The 70-74 years age group had the highest incidence rate (188.08) for men while for women the age group of 65-69 years had the highest incidence (140.61) per 100,000. For male, lung cancer had the highest incidence rate (4.45) whereas bladder had the lowest rate (0.98). Similarly for female, Cervix Uteri cancer had the highest incidence rate (5.35) whereas stomach had the lowest (1.06).

Conclusion:

This study presented that cancer was increased with age both in males and females. The leading cancer in males was bronchus and lung while in females it was cervix uteri. .

Changes in the Distribution of Cancer Incidence in Nepal from 2003 to 2013

Background: Cancer incidence data are vital for cancer control planning in any nation. This retrospective study was conducted to compare the cancer incidence of all sites between the first cancer registry report and the most recent example in Nepal. Material and Methods: The cases in the first (2003) and latest (2013) national cancer registry reports, accumulated by all the hospital based cancer registries in Nepal were taken for the research. The frequencies, crude incidences and age specific incidences (per 100,000) of the five major cancers were calculated for both males and females. Result: The most common cancer type for males in both years 2003 and 2013 was lung. Stomach was the third most common cancer in 2003 while it was the second in 2013. Similarly, the first four major cancers (cervix, breast, lung and ovary) did not change between 2003 and 2013 in females. The total cancer incidence rate increased from 12.8 in 2003 to 30.4 per 100,000 in 2013 for males and from 15.1 to 33.3 in females. Conclusion: The most common cancers in males in 2003 and 2013 were in the bronchus and lung. Similarly, the most common cancer in females was cervix at both time points. The cancer incidence rate in females was higher than in males both in 2003 and 2013.