Академический Документы
Профессиональный Документы
Культура Документы
150]
Original Article
Evaluation of Factors in Relation with the NonCompliance to Curative Intent Radiotherapy among
Patients of Head and Neck Carcinoma: A Study from the
Kumaon Region of India
Kailash Chandra Pandey, Swaroop Revannasiddaiah, Nirdosh Kumar Pant
Department of Radiotherapy, Swami Rama Cancer Hospital and Research Institute, Government Medical College,
Haldwani, Nainital, Uttarakhand, India
INTRODUCTION
Access this article online
Quick Response Code:
Website:
www.jpalliativecare.com
DOI:
10.4103/0973-1075.150161
[Downloaded free from http://www.jpalliativecare.com on Wednesday, December 28, 2016, IP: 117.211.68.150]
[Downloaded free from http://www.jpalliativecare.com on Wednesday, December 28, 2016, IP: 117.211.68.150]
Percentage
1840years
7 of 34
20.6
4160years
38 of 163
23.3
>60years
31 of 127
24.4
Farming/agriculture
24 of 127
18.9
Industry
22 of 85
25.9
White collar
1 of 19
5.3
Business
9 of 46
19.6
Unemployed
20 of 47
42.6
Hindu
48 of 207
23.2
Muslim
16 of 80
20
Sikh
6 of 25
24
Age group
Occupation/vocation
Religion
Christian
0 of 3
Buddhist
6 of 9
66.7
Educational status
Diploma/graduate/higher
6 of 29
20.7
10 of 42
23.8
19 of 73
26.1
21 of 94
22.3
Illiterate
20 of 86
23.3
14 of 121
11.6
No BPL card
62 of 203
35.5
Percentage
Residence at<50 km
11 of 104
10.6
Residence at 50-100 km
33 of 127
25.9
Residence>100 km
32 of 93
34.4
Hilly
64 of 244
26.2
NonHilly
12 of 80
15
23
[Downloaded free from http://www.jpalliativecare.com on Wednesday, December 28, 2016, IP: 117.211.68.150]
Percentage
0 of 2
II
0 of 2
III
5 of 39
12.8
IVA
41 of 158
25.9
IVB
30 of 117
25.6
Site of disease
Larynx
23 of 107
21.5
Oropharynx
21 of 86
24.4
Oral cavity
17 of 64
26.6
Hypopharynx
10 of 45
22.2
Maxillary antrum
0 of 4
5 of 18
27.8
Neoadjuvant chemotherapy
Received
32 of 126
25.4
Not received
44 of 198
22.2
Received
33 of 135
24.4
Not received
43 of 189
23.8
Concurrent chemotherapy
[Downloaded free from http://www.jpalliativecare.com on Wednesday, December 28, 2016, IP: 117.211.68.150]
2WKHU
)HDURIQRW
UHFRYHULQJIURP
WR[LFLW\
/RJLVWLFDOUHDVRQ
/DFNRILQWHUHVWIDLWK
LQ57
)LQDQFLDOUHDVRQ
[Downloaded free from http://www.jpalliativecare.com on Wednesday, December 28, 2016, IP: 117.211.68.150]
10.
11.
12.
13.
How to cite this article: Pandey KC, Revannasiddaiah S, Pant NK. Evaluation
of factors in relation with the non-compliance to curative intent radiotherapy
among patients of head and neck carcinoma: A study from the Kumaon region
of India. Indian J Palliat Care 2015;21:21-6.
Source of Support: Nil. Conflict of Interest: None declared.
Commentary
First postulated with radiobiological calculation by Withers
etal., in 1988[1], accelerated repopulation of tumor clonogen
is a valid contributor to our inability to cure cancers. He had
demonstrated that the clonogen doubling time of a head
and neck squamous cell carcinoma(HNSCC) may reduce
from an average of 60days to an estimated average of
about 4days, beyond 25days, amounting to a daily increase
in TCD50 of about 0.6 Gy. The clinical implication of
the same has been studied subsequently. Rosenthal[2] has
documented that the 5year survival was 5.8% for patients
with treatment breaks of more than 1week compared with
11.4% for those without.
In a survey done by the Royal College of Radiologists
(RCR),[3] it was found that 63% of patients treated with
curative radiotherapy (RT) have one or more treatment
interruptions. The most common cause of the same
was stated as public holidays(39%) followed by machine
breakdown(35%). Patient unwillingness and unauthorized
interruptions accounted for only 4% of the total
interruptions, whereas radiotherapy reactions accounted
for 8% of the breaks. Split course RT regimens definitely
show poorer control rates. Uncompensated interruption of
a single day causes loss of local control by 11.4%.[2] Timing
of the interruption also has an impact on the outcome
due to accelerated repopulation after approximately the
28thday of radiotherapy. Herrmann etal.,[4] correlated
overall survival(OS) with the timing of treatment break.
They showed that when there were no breaks, the survival
26
was 61%, with the survival being 65% with breaks during
first 3 wks, 25% for breaks during the middle 2 wks, and
18% with breaks during the last 2 wks of treatment.[4]
We commend the authors for their work[5] in this direction
and especially in the Indian setting and in HNSCC,
which comprises almost 50% of the cancer load in most
radiotherapy centers in the country. This has relevance
to a commonly encountered but important clinical issue.
Recognition of factors responsible for interruptions would
not only provide a reason for the inferior controls but
would also help identify factors that could be modified. This
would be useful in identifying factors distinct to our country
or a particular region. This would have administrative,
logistic and policy implications. The authors have taken
an innovative approach to analyze this important situation.
They have evaluated the component of unauthorized
interruptions, the defaulters. These amounted to 23.4%
of total patients (76 of 324), a value significantly higher
than that documented in the RCR survey value of 4%.
This, they concluded was attributable to the challenging
socioeconomic background (difficult to modify) as well
as the lack of awareness(a modifiable factor) about the
potential deleterious effects of interruptions among
the patients. Faith in traditional healers as stated by the
authors may also be contributory. In the Indian setting
where logistic issues abound, proper evaluation of the
contributory factors is an important step to instituting
interventions to prevent the same.
Indian Journal of Palliative Care / Jan-Apr 2015 / Vol 21 / Issue 1