|Year : 2021 | Volume
| Issue : 1 | Page : 28-42
Cancer survival status among male population of Northeast India: A hospital based study
Manoj Kalita1, Jagannath Dev Sharma1, Debanjana Barman1, Nizara Baishya2, Chandi Ram Kalita2
1 Population Based Cancer Registry, Guwahati, Assam; Cancer Registry – Guwahati, National Center for Disease Informatics-Indian Council of Medical Research (NCDIR-ICMR), Assam, India
2 Cancer Registry – Guwahati, National Center for Disease Informatics-Indian Council of Medical Research (NCDIR-ICMR), Assam; Hospital Based Cancer Registry, Guwahati, Assam, India
|Date of Submission||21-Apr-2021|
|Date of Decision||23-Apr-2021|
|Date of Acceptance||24-Apr-2021|
|Date of Web Publication||23-Jul-2021|
Mr. Manoj Kalita
Statistician, Population Based Cancer Registry-Guwahati, National Center for Disease Informatics-Indian Council of Medical Research (NCDIR-ICMR), Assam
Source of Support: None, Conflict of Interest: None
BACKGROUND: The northeast region of India has an overall high incidence, mortality, and lower survival rate of cancer in the country. Mortality rate is increasing mainly because of difficulties in accessing the facilities for cancer diagnosis and treatment, socioeconomic conditions, lack of awareness, taboo, misconception, and wide disparity in both diagnosis and treatment of cancers in this region.
MATERIALS AND METHODS: Data were abstracted from hospital-based cancer registry of a regional treatment center from years 2010 to 2014. A total of 21,793 men were registered with cancer and 44.7% (9738/21,793) were followed up with their vital status. Kaplan–Meier method was used to generate the survival statistics.
RESULTS: The 5-year overall survival for all cancers in men is 24.3% with earlier stage at diagnosis has a better survival (Stage I: 52.1%) than later stage (Stage IV: 18.8%). The 5-year survival for completed cancer directed treatment is 27.5% followed by 12.5% for incomplete and 8.5% for those with no cancer-directed treatment group. Inequality in survival was observed among different sites of cancer, as some cancers harm more than others. The 5-year absolute survival for all sites was ranged from 0% to 75.8%. Cancer of liver (0%), pancreas (0%), lung (2.4%), gallbladder (7.9%), and stomach (10.3%) is found as more lethal than other cancers as the 5-year survival was in-between the range 0%–10%. Cancer of Hodgkin lymphoma (75.8%) has the highest 5-year cancer survival rate, followed by testis (60.1%), breast men (55.3%), penis (49.7%), and skin cancer (49.1%).
CONCLUSION: With close to 0%–2.6% 5-year overall survival in hospital setting for cancers of liver, pancreas, and lung, respectively, it needs to mobilize resources for these three cancer sites, in terms of treatment, supportive care, and palliation.
Keywords: Cancer, fatal cancer, survival
|How to cite this article:|
Kalita M, Sharma JD, Barman D, Baishya N, Kalita CR. Cancer survival status among male population of Northeast India: A hospital based study. Ann Oncol Res Ther 2021;1:28-42
|How to cite this URL:|
Kalita M, Sharma JD, Barman D, Baishya N, Kalita CR. Cancer survival status among male population of Northeast India: A hospital based study. Ann Oncol Res Ther [serial online] 2021 [cited 2022 Jun 25];1:28-42. Available from: http://www.aort.com/text.asp?2021/1/1/28/322151
| Introduction|| |
Cancer is rising with an alarming warning in the Northeast India. The northeastern part of India has the highest incidence, mortality, and low survival in the country. The overall age standardized cancer incidence rate is higher in men and in women in Northeastern states of India, with rates of 270 (Aizwal, Mizoram) and 249 (Papumpare, Arunacal Pradesh)/100,000 population. The corresponding mortality is also found nationally higher in Aizwal, Mizoram (men: 141 and women: 83)/100,000. An annual expected of around 40,000 persons (Based on the Crude rate of NCRP-ICMR, 2012–2014 report) were diagnosed with cancer every year in the Northeast India. Out of which around 25% (10,000) of cases were registered at the Regional Treatment Centre where this present study was conducted with or without history of previous diagnosis at different hospitals in India.
The northeast region of India has an overall high incidence, mortality, and lower survival rate of cancer in the country, an annual expected of around 40,000 were diagnosed with cancer every year in this region. Mortality rate due to cancer in northeastern India is increasing mainly because of difficulties in accessing the facilities for cancer diagnosis and treatment, socioeconomic conditions, lack of awareness, taboo, misconception, and wide disparity in both diagnosis and treatment of cancers among the eight different states (regions) within northeast India. Furthermore, affordability of cancer care remains a major challenge in this part of India for effective cancer control. One of the major factors of increasing cancer-related mortality in northeastern part of India mainly because of most of the primary health center or local hospitals are ill equipped with advance treatment facilities to cope up with the growing burden of cancer.
The pattern of cancer incidence, mortality, and cancer survival varies widely between countries and international comparisons of population-based cancer survival have been rare.,,,, As by the Concord-3 results, survival trends are increasing generally and highest in developed countries, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas, and lung. Ethnic difference in cancer survival is well known. There is no long-term cancer survival series was conducted so far in North Eastern Region. In North East India apart from the pattern of care and survival study project (Breast, Cervix and HNC) of the National Cancer Registry Programme (NCRP) of Indian Council of Medical Research (ICMR), only a few isolated reports on survival using standard methods and based on the hospital-based series of selected cancer cases were available from Northeast India.,
Information on the survival of all cancer patients in a population enables comparison of the effectiveness of health systems. Long-term surveillance will contribute to the evidence base for national policy on cancer control. Comparative data on cancer survival from different regions could serve as the baseline for future improvement, through adequate and determined investments in improving awareness, health services infrastructure, and accessibility.
Inequalities in access to cancer diagnosis and treatment in India exist in many ways. Northeast India lacks in proper cancer treatment and care uniformly across the region, which influence the treatment outcome and survivorship. According to the latest report of National Centre for Disease Informatics and Research, ICMR, Bengaluru (A Report on Cancer Burden in North Eastern States of India, 2017) shows that even patients with early stage cancers have a lower survival rate compared to other parts of India.
This study will give information on cancer survival rates of Northeast-Indian population to compare with national and international rate.
| Materials and Methods|| |
All the cases registered with a history of cancer in-between 2010 and 2014 calendar years in this hospital were included in the study with or without prior history of treatment. Hospital-based Cancer Registry of the regional cancer center where this study was conducted is part of National Cancer Registry Programme running under National Centre for Disease and Informatics Research, Bengaluru-ICMR since 2010 onward.
Five-year observed survival was calculated based on follow-up till December 31, 2019. Patients were followed up by their hospital visit records or by telephonic follow-up. Nearly 44.7% (9738/21,793) of all registered cases were able to trace back with their vital status and included in the study. Three categories were made for treatment-wise survival analysis, (1) those who have completed cancer treatment, (2) those who did not completed treatment, (3) those who have not taken any cancer-directed treatment (supportive treatment like palliative care was also included in this category). The 5-year overall survival rates were generated by using the SPSS V19 software (IBM SPSS V21). Kaplan–Meier method was used to generate the statistics.
| Results|| |
A total of 21,793 men were with cancer during January 1, 2010–December 31, 2014 with median age of 56 were documented. Of all registered cases, 44.7% (9738/21,793) were followed up. Out of the 9738 followed up cases, 41.0% (3994/9738) were alive and 59.0% (5744/21,793) dead till the closing of the study period. [Figure 1] shows that cancers of the eye (retinoblastoma, etc.) are generally seen in younger group with a median age of 4 followed by lymphoid leukemia.
In the treatment analysis category, 83.5% (8133/9738) of all followed up were found to have completed cancer-directed treatment followed by 4.6% (445/9738) incomplete treatment, and 11.9% received no cancer-directed treatment. Of the no cancer-directed treatment category, 3.3% (318/9738) were with other supportive care like palliative care and others have not taken any treatment.
For all cancers combined, the 5-year relative survival rate is 24.3% [Table 1] and [Figure 2]. From the table, it is observed that those with Stage I have 52.1% 5-year survival rate compared to 18.8% of Stage IV.
|Table 1: Overall observed survival for all sites correlation to stage at the time of diagnosis and treatment status|
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|Figure 2: Overall and stage-wise survival for Northeastern men population|
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Those who have completed cancer-directed treatment have a better chance of extended life (27.5% 5-year survival rate) followed by 12.5% for those who stops taking treatment after certain point of time and 8.5% who did not take any cancer direct treatment. Five-year absolute survival rate for those who were diagnosed with late Stage (III + IV) and completed cancer directed treatment is 25.0% compared to 6.9% for those who did not taken any cancer-directed treatment.
[Table 2] and [Figure 3] showed cancers with poor survival outcome for ten cancer sites.
|Table 2: Overall observed survival site wise with correlation to stage at the time of diagnosis and cancer directed treatment status|
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|Figure 3: Cancers with low survival rate among Northeastern men population, 2010–2014|
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A total of 782,451 new cases (men: 554,369, women: 228,082) were diagnosed with liver cancer in 2012 around the world with an incidence rate of 10.1/100,000 person and 745,533 persons were died, with China alone accounting for about 50% of the total number of cases and deaths. As per world cancer report 2014, Asian and African countries have highest rate of hepatocellular carcinoma and with the highest prevalence of predisposing conditions. Chronic hepatitis B virus, hepatitis C virus infections are the major causes, and in China and sub-saharan Africa, exposures to aflatoxins further increase risk.,,,, Liver cancer is found to be one of the most lethal of all types of cancers both in men and women. Liver cancer has the high fatality rate (overall mortality-to-incidence ratio: 0.95). Of all global deaths due to liver cancer, India accounts 3.6% and the 5-year survival is as low as 2% only among men. In most countries, survival has changed very little during the 20-year period 1995–1999 to 2000–2014; 5-year net survival was in the range 5%–30% throughout 2000–2014. According to the latest report of NCRP (NCRP-ICMR, 2012–2014), Northeastern states have the highest incidence liver of cancer in the country. Papumpare district of Arunachal Pradesh has the highest incidence rate (38/100,000 populations). In more developed countries, it is the sixth leading cause of cancer death among men. An estimated 782,500 new liver cancer cases and 745,500 deaths occurred worldwide during 2012.
Three hundred and twenty-four men were diagnosed with liver cancer during the study period. The mean age at diagnosis is 56. Stage was present for only 105 numbers of persons; of which 50.5% (53/105) were at Stage IV, 34.3% (36/105) at Stage III and only 1.9% (2/105) persons were presented with Stage I. Out of the total follow-up, 93% (52/56) of men patients with liver cancer were died during 5-year period. The Kaplan–Meier estimates show that the overall 5-year survival rate for northeastern population was 0% and overall median survival rate was 4 months. From the analysis, it is observed that 91.4% did not taken any treatment in this institute. Treatment plays an important role in any disease so do in cancer also. From the study, it is observed those who have completed the advised course of treatment have a better chance of extended survival than those who did not taken any treatment or those who leaves without completed the whole course of treatment. The persons with complete course of directed treatment for liver cancer have more extended survival rate (median: 19 months), than incomplete (9 months) and no treatment persons (2 months) group only.
Both incidence and mortality rate of pancreas cancer were found higher in more developed regions compared to less developed regions. Pancreatic cancer is more common among elderly persons than younger adults; it is the seventh most common cause of cancer death worldwide and the 5-year survival rate is <5%., Despite developments in detection and management of pancreatic cancer, only about 4% of patients will live 5 years after diagnosis. Even in countries like the United States, survival has not improved substantially over the past 25 years for pancreas (1975–2003) cancer, and it is still only about 5%. Nothing much about the cause of this cancer was known; tobacco and smoking are thought to be play major role in developing pancreas cancer; other environmental factors with correlation to genetic mutation were may also play a possible role in developing this cancer., Age-standardized 5-year net survival estimates were generally in the range 5%–15% throughout 2000–2014. For patients diagnosed during 2010–2014, survival was high in Kuwait (23·6%) and Malaysia (Penang; 19·0%). Pancreas cancer survival rate among men in India ranges from lowest 3.4% in Karunagappally to highest 12.5% in Mumbai, whereas in Chennai the 5-year absolute survival rate is found as 6.8%. This shows that there is a widespread variation in survival of pancreas cancer within India itself.
Hundred and fifty-eight men were diagnosed with pancreas cancer during the 5-year period on an average at 55 years of age. Stage was available for 93 persons, of which 69.9% (65/93) were at Stage IV and 16.1% (15/93) were at Stage III at the time of diagnosis. Nearly 77.2% (122/158) of persons with pancreas cancer did not go for any kind of treatment. Only 38 patients were able followed up; out of the total followed up persons, 89% (34/38) of all pancreases cancer patient were died during the study period. The median survival time is as low as 5 months (95% confidence interval [CI], 3.8–6.2) with 5-year overall survival rate 0%. It is seen that the individuals who have completed directed treatment (median: 10 months) have a better survival rate than incomplete (4 months) or no treatment (2 months) irrespective of stage.
In some of the western countries, lung cancer incidence rates continue to decline about twice as fast in men as in women, reflecting historical differences in tobacco uptake and cessation, as well as upturns in women smoking prevalence in some birth cohorts., However, in India, the current trend is in upward direction and an alarming rise in the incidence of lung cancer was seen among the nonsmokers. In India, lung cancer constitutes 9.3% of all cancer-related deaths in both sexes; it is the most common cancer and cause of cancer-related mortality in men, with the highest reported incidences from Northeastern states of India, Aizwal district of Mizoram state have the highest incidence rate in India both in men (37.9/100,000) and women (40.8/10,000), respectively (NCRP-ICMR, 2016). In northeast India, it is found that improper ventilation of kitchen, kitchen location (Inside Living Room), using Wood as a medium of fuel, smoked meat and fish carry a significant risk of developing lung cancer. Lung cancer remains the most frequent cancer worldwide. Lung cancer is the leading cause of cancer death among in both more and less developed countries. As estimated by Globocan 2012, 13% of total cancer incidence and 20% of total cancer mortality were due to lung cancer and more than one-third of all newly diagnosed cases occurred in China and more than one-half of the lung cancer deaths attributable to ambient fine particles were projected to have been in China and other East Asian countries.,, Smoking has the highest attributable fraction in developing lung cancer, and in addition, involuntary or secondhand smoke causes lung cancer., Age-standardized 5-year net survival was in the range 10%–20% in most countries, survival was high in Japan (32·9%). Survival was <10% in India. In Indian men, lowest survival rate of 5-year lung cancer is found as 1.1% in Bhopal followed by 3.6% in Barshi, 5.0% in Karunagappally, 6.1% in Chennai, and Mumbai with highest survival rate of 11.0%.
Lung cancer is the disease of older age for the Northeaster population, the mean age at diagnosis is 60 years. This may suggest that the accumulated effect of smoking might have effect later years of life with possibly correlates to other environmental exposures. Nearly 7.5% (1631/21,793) of all cancers reported cases were lung cancer. Of all lung cancer cases, stage was available for 1257 number of cases; of which 43.0% (540/1257) were at Stage III followed by 31.5% (396/1257) stage IV. Only 38.3% (625/1631) had taken complete treatment. A total of 37% (608/1631) of cases were followed up; out of the total followed-up cases, 83% (50/608) were died in due course of time. The 5-year survival rate is abysmal with only 4%. The median survival for men is 9 months, and it is observed that persons completed treatment (median: 11 months) have better survival than no treatment (median: 2 months) group. There is no significant difference in 5-year survival rate for early stage (I + II) lung cancer and late stage (III + IV) lung cancer survival, 3.9% versus 3.0%, respectively.
Gallbladder cancer is a deadly malignancy, the sixth gastrointestinal cancer, and one of the most common cancers of the biliary tract, accounting for 80%–95% of biliary tract cancers., With an overall 5-year survival of <5%, gallbladder cancer is a highly lethal and an average expected survival mere than 6 months. Gallbladder cancer has a particularly high incidence in Chile, Japan, and northern and Northeastern India. Kamrup urban District (8.8 in men and 17.1 in women, per 100,000 population) of Northeast India has the highest incidence rate in India. According to NCRP (NCRP-ICMR, 2012–2014 report), studies suggest that those countries with the highest prevalence of gallstones experience the greatest mortality from gallbladder cancer. Gallstones represent an important risk factor for this malignancy, being present in most (~85%) patients with gallbladder cancer. No such studies were conducted in Northeastern states of India so far where the prevalence of gallbladder cancer is high.
Nine hundred and forty-one men were diagnosed with gallbladder cancer during 2010–2014 periods. Out of the total follow-up, 82% (187/224) of men were died during the study period. The median follow-up time was 6 month. The 5-year survival rate for gallbladder cancer was 9%. The median survival rate was observed as 7 months (95% CI, 5.3–8.7). Those persons who have completed the treatment have better prognosis (median survival: 13 months) than those incomplete or no treatment both. The survival rate was very low as due to most of the gallbladder cancer patients were presented with Stage IV (74.8%) at the time of diagnosis. A significant difference in survival rate is found between early stage (37.5%) and late stage (6.0%) patients. Out of the total recorded cases, 73.5% did not taken any treatment.
Esophageal cancer contributes 5% of all cancer deaths in 2012. Of 400,000 estimated esophageal cancer deaths, India shares 9.7%. Low and medium level Human Development Index (HDI) countries share 73% of all incidence cases and China alone accounts 43% of total cases. Esophageal cancer is the sixth leading cause of cancer death globally and fourth common cause of cancer-related deaths in India., Esophageal cancer is one of the most common cancers in Assam and north eastern region of India. In Meghalaya, 31% in men and 22% in women cancers of all diagnosed cancers is due to esophageal cancer, while in Assam, 15% men and 10% women were diagnosed with esophageal cancer every year (NCRP: 2012–2014). Alcohol consumption and tobacco smoking, chewing, Kalakhar, a unique and locally made food item, and high amounts of chili are the strongest risk factors for the development of esophageal carcinoma. In northeast India, esophageal cancer carries a poor prognosis with the overall 5-year survival following diagnosis lower than 20%.,, According to Concord-3 programme, survival was highest in Japan (36·0%) and Korea (31·3%). Diverse range of 5-year survival was observed among men with this highest rate of survival was observed in 13.5% in Mumbai, 5.6% in Chennai, 4.0% in Bhopal, and 1.5% in Karunagappally.
Nearly 14.8% (3215/21,793) of all cancers were diagnosed at the study center were with esophageal cancer. Nearly 59.5% (1286/2163) were at Stage II, whereas 8.5% (183/2163) were at Stage IV at the time of diagnosis. Out of the total follow-up, 75% (1013/1359) were found as died due to this cancer. The 5-year survival rate is 12%. The median survival time is found as 13 months (95% CI: 11.9–14.1). Those who have completed treatment have 15 months of median survival time compared to incomplete or no treatment group (median survival: 4 months).
No significant difference was observed in subtypes of esophageal cancer (P = 0.949), 9.1% (291/3215) of cases were recorded with upper third of esophagus with 5-year survival rate of 14.9%, 29.9% (1261/3215) diagnosed with middle third of with 5-year survival 11.9% and 15.8% (507/3215) lower third of esophagus with 14.8% 5-year survival rate.
Stomach cancer is the fifth most common cancer worldwide, with an estimated 952,000 new cases and 723,000 deaths in 2012. The case fatality rate is about 75%. Gastric cancer is the third leading cause of cancer-related death worldwide. Nearly 60%–70% gastric cancer is attributed by Helicobacter pylori., For the past few decades, gastric cancer mortality has decreased markedly in most areas of the world; however, 5-year survival is not quite improved over the years., Despite advances in diagnosis and treatment, the 5-year survival rate of stomach cancer is only 20%., Age-standardized 5-year net survival was generally in the range of 20%–40%, with high in Korea (68·9%) and Japan (60·3%) and survival was in the range of 20%–29% in Indian context. Among men, the 5-year survival rate in India observed highest 13.1% in Mumbai, 8.3% in Chennai, 4.3% in Bhopal, 1.6% in Karunagappally, and 0% in Barshi. In Indian context, the highest incidence is observed in Northeast India, especially in Papumpare of Arunachal Pradesh (ASR men: 50 and ASR women: 29/100,000 populations) (NCRP-ICMR, 2012–2014 report).
A total of 1352 number of persons were diagnosed with stomach cancer during this period. 30% (404/1352) of the total diagnosed was able to follow-up; out of which, 74% (299/404) were died in this 5-year period. The 5-year survival rate is 10%, whereas median survival is 11 months (95% CI: 9.3–12.7). It is observed that those completed treatment have a better median survival (median survival: complete = 17 months, incomplete = 11 months, and no treatment = 3 months) time.
Among all stomach cancer cases, pyloricantrum is more common with 20.6% (279/1352) reported case followed by, cardia 19%, body of stomach 6.3%, pylorus 5.7%, and fundus of stomach 2.4%. The 5-year survival rate for pylorus is 38.6%, followed by pyloric antrum 14.1%, body of stomach 7.3%, cardia 3.8%, and fundus of stomach 0%.
Melanoma of skin
Melanoma of skin cancer is the most serious form of skin cancer., 232,130 numbers of cases diagnosed with this disease and 55,488 number of persons died due to this cancer in 2012. The incidence of metastatic melanoma has increased over the past three decades., The reported incidence of skin cancers in India is < 1% of all cancers. Age-standardized 5-year net survival was in the range 60%–90% in most countries. For patients diagnosed during 2010–2014, 5-year survival estimates exceeded 90% in countries such as USA, Denmark, Sweden, UK, and most developed countries.
Nearly 0.3% (70/21,793) persons were with on an average age at 53 years were diagnosed with Melanoma of skin cancer during 2010–2014. For patients with localized melanoma prognosis is good with adequate surgical excision. In this study, 51.6% were found to be at stage IV followed by 25.8% at Stage III, none of the cases were diagnosed at Stage I. Out of the total 70 cases, 30 were followed up 43% (30/70) and 67% (20/30) were died due this cancer. The 5-year survival rate is 10%. The 5-year median survival rate is 17 months.
Human papillomavirus (HPV) prevalence is notably high in or pharyngeal cancer. The global PAF for oropharyngeal cancer is 26% and for India 20.8%. HPV prevalence is lower in northeastern states of India. The 5-year survival rate of head-and-neck cancers was quite in northeast low (early stage = 40.5%, late stage = 16.9%) as compared to other regions of India (early stage = 73.6%, late stage = 44.5%).
Out of the total 485 cases, 262 (54%) were followed up and of which 162 (62%) were died due to this cancer. Most of the oropharyngeal cancer cases were at Stage III (47.1%, 212/450) and Stage IV (30.9%, 139/450) at the time of diagnosis. The 5-year survival time is found as 21% with median survival of 21 months also. Persons with early stage oropharyngeal cancer have 42.5% chance of 5-year survival, while persons with late stage oropharyngeal cancer have only 14.6% of 5-year survival rate. The 5-year survival rate is 22% and for those who have completed treatment have better survival time than those who did not have taken any treatment.
Nearly 337,860 incidence cases and 143,406 deaths were reported globally in 2012. Nearly 1.7% of all deaths worldwide due to kidney cancer; it is known as the most deadly urinary tract caner. Kidney cancer is less common in India, 9658 cases and 5973 deaths reported in 2012., It is observed that the incidence and mortality rate of kidney cancer are higher in developed countries. Over the years, it is found that mortality rates declined in a large number of nations, particularly in more developed regions. According to world cancer report 2014, the case fatality rate is lower in highly developed countries (overall mortality-to-incidence ratio, 0.4) than in countries with low or medium levels of human development (0.5). Most kidney cancers (70%) are clear cell renal carcinomas; the proportion of all cases of renal cancer attributable to overweight and obesity has been estimated to be about 40% in the USA and up to 40% in European countries.,
Kidney cancer is not so common in northeastern states of India. The median age at diagnosis is 58 years. Nearly 86.2% of cases were at Stage IV at time of diagnosis. A total of 62% persons with kidney cancer were died within 5 years of time, the 5 year survival rate is 20.4%.
Accounting a total of 7% of all cancer deaths in men, prostate cancer is the fifth most common cause of cancer death globally. Europe and North America alone contributes a total of 41% of all deaths and 60% of all new cases in 2012., The lowest incidence and mortality rate are in Asia, but in India is on rise over the years., Prostate cancer incidence is generally high in developed areas in India and a lower incidence was observed among men in northeast Indian region. Mortality rates have generally been declining in the High Income Countries (HICs) due to improved treatment and/or early detection. Age-standardized 5-year net survival was in the range 70%–100% in most countries. For men diagnosed during 2010–2014, 5-year survival was approaching 100% in Puerto Rico, Martinique, and the USA, but in India, survival rate is <50%. Among men, the 5-year absolute survival rate in India observed as 24.0% in Mumbai and 22.1% in Karunagappally.
With a median age of 65, a total of 200 persons were diagnosed with this cancer. 82.7% persons were diagnosed at Stage IV. The 5-year survival rate is only 19% with median survival time of 33 months. Those who have completed treatment was have 33 months of median time. Stage at diagnosis is found to be highly correlated with survival as early stage (Stage I + II) patients have 53% of 5-year survival compared to late Stage (Stage III + IV) only with 13%.
[Table 2], [Figure 4] and [Figure 5] shows stage wise cancer survival (High Survival Group).
|Figure 4: Cancers with high survival rate among Northeastern men population, 2010–2014|
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|Figure 5: Survival with relation to stage at diagnosis for selected cancer sites-men|
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Incidence of Hodgkin disease is lower than other cancers, 24000 thousand deaths (14,000 men and 10,000 women) globally in 2012. Prevalence of Epstein–Bar virus is more common among the patients with Hodgkin lymphoma with 49% global PAF; however, the PAF is about 40% in adults in developed countries, whereas it is closer to 90% in children, and about 60% in adults in developing countries.,. The 5-year absolute survival rate in India observed as 36.8% in Chennai and 53.3% in Mumbai.
Only 75 persons were diagnoses with Hodgkin disease in the 5-year period with median age at diagnosis is 22 years. 82% of total follow-up patients were alive at the end of the study. The 5-year survival rate among northeastern population found as 76%. 53.1% of all were diagnosed with Stage II followed by 21.9% Stage IV. Of all persons with Hodgkin disease, 76% (57/75) have taken completed the course of treatment as advised, which is found as a major factor in improving the survival of this cancer.
Carcinoma of lip
Lip cancer is more common in Asia than other parts of the world. This particular cancer has a low incidence in India; some studies suggested that, apart from exposure to sun light poor dental hygiene may play a significant role in developing lip cancer. Consumption of alcohol has been found associated with lip cancer to the tune of 47%; in India, wide varieties of alcohols available, which has high amount of illegal spirits. Five-year survival of lip cancer for men in Chennai is 46.3% and 52.8% in Mumbai.
The 5-year survival rate for lip cancer is 57%. Out of the total follow-up, 30% was dead and with a median follow-up time of 32 months. Most of the patients were diagnosed at Stage II (40.9%) compared to Stage IV (24.5%) patients. Nearly 59.6% (68/114) of all diagnosed persons were found to have completed treatment, whereas 28.1% did not took any cancer treatment.
Breast cancer (men)
Little information on survival of men breast cancer was available on Indian scenario. In Barshi of India, men breast cancer in survival rate found as 33.3%. Nearly 46.7% of all men breast cancer patients were presented with Stage III, and 69% of all follow-up patients were found as alive with a 5-year survival rate of 55%. The median follow-up time is 31 months. Around 67.1% (49/73) of all diagnosed patients have completed treatment as planned compared to 6.8% who did not competed treatment and 26.0% who did not taken any treatment.
Testicular cancer is a rare tumor type accounting for 1% of malignancies in men and more common in high or very high on the HDI countries, but recent trends indicating that testicular cancer is also becoming more common in low- and middle-income countries., India contributes 14% of all deaths due to testicular cancer and 6% of all cancer incidence globally.
One hundred and sixty-nine patients were diagnosed with testicular cancer in between 2010 and 2014 with 5-year survival rate of 60%. The median follow-up time is 28 months and the total follow-up percentage is 62% (92/169). Around 56.1% of patients were diagnosed with Stage IV. Nearly 60.9% of the persons were found to have completed treatment.
Nearly 60.9% of men were alive after 5 years of diagnosis in Barshi of India. The skin cancer is found as less lethal than many other cancers. A 5-year survival rate of 59% was observed for skin cancer. The median age at diagnosis is 54 years. Nearly 44.3% of patients were diagnosed with Stage I and 40.1 with Stage IV. Around 36% of patients were dead during the period.
Cancer of penis
The 5-year survival for men with penis cancer was 43.6% in Mumbai and 44.7% in Barshi of India. One hundred and sixty-two patients diagnosed with a median age of 51. The follow-up percentage is 44% and the median follow-up time is 17 months. The 5-year survival rate is 50%. Around 37% of patients died during this time. Around 28.4% (46/162) did not take any treatment. Nearly 46.7% of persons were with Stage III.
Cancer of connective and soft tissue
Two hundred and twenty-six cases recorded with cancer of connective and soft tissue, with a median age of 40 years. Nearly 43% of persons were died due to this cancer within 5 years of diagnosis. The overall 5-year survival is 46%. Around 37.2% of cases were recorded with Stage II followed by 32.6% at Stage IV.
India shares highest number of mouth cancer cases with low survival rate. An increasing incidence trend was observed for this disease. In Indian men, the 5-year survival rate is ranges from 201% in Barshi to 33.9% in Mumbai, whereas 30.9% in Chennai, 30.0% in Bhopal, and 34.0% in Karunagappally. In an another study on oral cancer in Mumbai, the 5-year observed survival was 59.1% for localized cancer, 15.7% for cancers with regional extension, and 1.6% for those with distant metastasis. Tobacco products smoking, smokeless, chewable, and nonchewable are the main associated risk factors.,,, In northeast India, the prevalence of this particular cancer is high mostly because of the type of tobacco use, particularly consumption of betel nut.,,
Mouth cancer represents an overall of 7.4% (1611/21,793) of all cancers. The median age at diagnosis is 55 years. About 60.2% of all mouth cancer cases were diagnosed at Stage IV followed by 25.6% of Stage III. The overall 5-year survival rate for this cancer is 46% with a median follow-up time of 20 months. 59.1% of all diagnosed persons had completed cancer treatment, whereas 31.4% did not take any treatment.
A total of 47.8% (770/1611) mouth cancers were with subsite cheek mucosa, followed by lower gum 27.9% (450/1611), soft palate 5.6% (90/1611), upper gum 3.5% (56/1611), and 3.4% (55/1611) hard palate. The 5-year survival rate for cheek mucosa was (49.7%), followed by lower gum 42.4%, soft palate 18.9%, and upper gum 50.3% and 24.3% hard palate.
Non-Hodgkin's lymphoma (NHL) is more common in more developed areas, the lowest rates are found in Asia and Eastern Europe. In 2013, there were an estimated of 465,000 incident cases of NHL and 226,000 deaths and causing 6.4 million disability-adjusted life years.
In the United States, The 5-year survival rate is 86% for follicular lymphoma and 61% for diffuse large B-cell lymphoma; 10-year survival declines to 77% and 53%, respectively. The ratio of mortality-to-incidence in India is 69.7% which reflects the poor overall 5-year survival below the global average. The overall 5-year survival rate is < 35%. H. pylori, Epstein–Barr virus, with or without HIV hepatitis C virus, Human T-cell lymphotropic virus Type 1 infections are a well-established cause of essential mixed cryoglobulinemia. The absolute 5-year survival rate among Indian men for NHL is 31.7% in Mumbai, 20.1% in Chennai, 25.6% in Karunagappally, and 17.9% in Barshi.
The median age at diagnosis is 50 years. A total of 477 patients were diagnosed during the period with a 5-year survival rate of 45%. The median follow-up time is 26 months. Nearly 50.8% of patients were found diagnosed at Stage II, while 49.7% have taken complete treatment. The median survival time is 50 months.
Nasopharyngeal cancer is more prevalent in Chinese population.,, In India, the highest incidence rate was observed among the population of northeast particularly among the residents of Nagaland, Manipur, and Mizoram states, Nagaland state has the highest incidence rate in the country while second highest globally., Epstein–Bar virus is a well-established risk factor associated with this disease.,, Consumption of smoked meat or fish, fermented or salted fish, and use of herbal medicine is found as a major risk factor among northeaster population.,,, In Chinese population, the 5-year overall survival rate is observed as around 80%.
The median age at diagnosis for nasopharyngeal carcinoma for northeastern population is 55 years. The overall 5-year survival is 50% with a median follow-up time of 20 months. 38% persons were died during this period. About 56.5% of patients were diagnosed with Stage IV and 65.2% of total all nasopharyngeal cancer cases have completed the cancer treatment.
Cancer of liver, pancreas, lung, gallbladder, and stomach is more found as the top five fatal cancers, while Hodgkin lymphoma, testicular cancer, Breast-Men, Penis, and skin cancers have good prognosis. Those who have completed treatment have a better chance of extended survival. Prostate cancer survival rate is lower than other parts of the world. Apart from the discussed sites, 50% of all the diagnosed cancers have the five survival rate in the range of 20%–40%. Carcinoma of colon have a survival rate of 39%, whereas the adjoin rectum has 23% survival. Eye cancer is found to be a disease of children with a median age of 4 years and retinoblastoma is common, the 5-year survival rate is only25%.
Survival of cancer generally found to be dependent on stage at presentation, the lower stage at the time of diagnosis the higher survival chances is. This study complete cancer treatment plays a crucial role in survival outcome, even in later stage patients; complete cancer treatment extends the 5-year survival percentage.
The study has certain limitation, as the study was based on hospital data only. Patients were followed-up for their vital status through mostly telephonic follow-up, so cause of death cannot be established for patients who have died.
The major advantage of this study is that it reports for the first time in the literature the overall survival of major cancer sites in men in the northeast India with a population of 45 million.
| Conclusion|| |
With close to 0%–2.6% 5-year overall survival in hospital setting for cancers of liver, pancreas, and lung, respectively, it needs to mobilize resources for these three cancer sites, in terms of treatment, supportive care, and palliation. The relatively poor survival of most cancer sites which were treated in a tertiary care cancer center of northeast India compared to that of mainland India's patient population warrants further investigation.
We would like to thank Dr. P. Mathur, Director, NCDIR-NCRP-ICMR, India and his team for providing guidance and valuable information in preparation of this manuscript. We sincerely acknowledge the cooperation from all the sources of registration and oncologists of Dr. B. Borooah Cancer Institute, Guwahati. We also appreciate the hard work and sincerity of all the staff members at HBCR and PBCR, Guwahati.
Financial support and sponsorship
Authors sincerely acknowledge the National Centre of Disease Informatics and Research, NCRP, ICMR, Department of Health Research, Government of India, for funding the Hospital Based Cancer Registry-Guwahati Project.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]