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ISLAMIC MEDICAL EDUCATION RESOURCES 04

0011-TREATMENT OF LATE-PRESENTING CANCER: A PILOT NATION-WIDE CANCER REGISTRATION PROJECT

Prof Dr Mohd Tahir Azhar, Prof Dr Omar Hasan Kasule, Sr., Prof Dr Syed Hassan Al-Mashor, Dr Aziz Baba, Dr Gerard Lim, Dr Fuad Ismail, Dr Hooi Lai Ngoh, Dr Zarihah Md. Zain. Presented at the Annual Scientific Meeting of the Malaysian Oncological Society held at the Legend Hotel, Kuala Lumpur on 3-5 November 2000 by Prof Omar Hasan Kasule MB ChB (MUK), MPH, DrPH (Harvard), Deputy Dean, Kulliyah of Medicine, International Islamic University, PO Box 141 Kuantan, MALAYSIA. EM: omarkasule@yahoo.com

ABSTRACT

This paper explores the relation between stage at cancer presentation and the modality of treatment chosen. It is based on data collected in the course of a nation-wide pilot cancer registration project. A total of 1077 cancers were registered. A general pattern of advanced stage at presentation was observed. Single modality treatment was used more often that multi-modality treatment at all stages of disease presentation. The most popular method of treatment reported was surgery followed by radiotherapy.

 

INTRODUCTION

This is a preliminary report from a nation-wide cancer registration project which was undertaken with 4 objectives in mind: assessment of the feasibility of district-level cancer registration, baseline epidemiological description of cancer, description of cancer management practices, and survival of cancer patients.

 

METHODS

Newly diagnosed cancer cases in the study period January 1 1997December 31, 1997 in the study area were identified by active surveillance in hospitals and pathology laboratories. Data was collected on a standard form that included items on patient identification, site of the lesion and its histology, investigations, and treatment. The data was sent to the study statistical center at Kuantan where it was edited. The SAS software was used for data management and data analysis. Treatment modality was cross tabulated against stage at presentation.

 

RESULTS

A total of 1077 cancers were registered. A general pattern of late presentation and diagnosis was observed. Marked variation in stage at diagnosis was observed among the different districts and cancer sites. Regional lymph node involvement and distant metastases were high at diagnosis. Tables 1-3 show treatment modality by stage at presentation. Overall treatment distribution was as follows: single treatment 42.1%, treatment combination 18.9%, and missing data 38.9%. Single modality treatment was used more often than multi-modality treatment at all disease stages. This was true even for cases for which data on stage was not available. The order of preference for treatments was as follows: surgery 25.0%; radiotherapy 11.6%; chemotherapy + surgery 6.2%; surgery + radiotherapy 5.8%, chemotherapy 5.5%, chemotherapy + surgery + radiotherapy 3.5%, and chemotherapy + radiotherapy 3.4%.

 

DISCUSSION

The results show that cancer presents late and that single is preferred to combination therapy. Proper interpretation of the date requires consideration of biases due to the high proportion of missing information on stage and treatment. Further analysis of the data is being undertaken to see whether there are any systematic sources of bias.

 

 TABLE #1: TREATMENT MODALITY BY STAGE AT PRESENTATION

STAGE

No

Record

Chemo

Only

Surgery Only

Radio

Only

Chemo +

Surgery

Chemo  +

Radio

Surgery +

Radio

Chemo +

Surgery +

Radio

Other

Total

STAGE 0

 

4 (36.4%)

0 (0.0%)

7 (63.6%)

0 (0.0%)

0 (0.0%)

0 (0.0%)

0 (0.0%)

0 (0.0%)

0 (0.0%)

11

STAGE 1

 

12 (14.0%)

2 (2.3%)

50 (58.1%)

7 (8.1%)

8 (9.3%)

2 (2.3%)

5 (5.8%)

0 (0.0%)

0 0.0%)

86

STAGE 2

 

7 (7.8%)

0 (0.0%)

32 (36.0%)

15 (16.9%)

11 (12.4%)

2 (2.3%)

15 (16.9%)

7 (7.9%)

0 (0.0%)

89

STAGE 3

 

18 (14.5%)

6 (4.8%)

31 (25.0%)

26 (21.0%)

14 (11.3%)

6 (4.8%)

13 (10.5%)

10 (8.1%)

0 (0.0%)

124

STAGE 4

 

63 (33.7%)

16 (8.6%)

39 (20.9%)

24 (12.8%)

15 (8.0%)

 

10 (5.4%)

6 (3.2%)

14 (7.5%)

0 (0.0%)

187

No record

 

315 (54.3%)

35 (6.0%)

110 (19.0%)

53 (9.1%)

19 (3.3%)

17 (2.9%)

23 (4.0%)

7 (1.2%)

1 (0.2%)

580

TOTAL

 

419 (38.9%)

59 (5.5%)

269 (25.0%)

125 (11.6%)

67 (6.2%)

37 (3.4%)

62 (5.8%)

38 (3.5%)

1 (0.1)

1077

 

 

TABLE #2: COMPARING SINGLE-MODALITY WITH MULTI-MODALITY TREATMENT

STAGE

No

Record

Single

Modality

Multi

Modality

Other

Total

STAGE 0

 

4 (36.4%)

7 (63.6%)

0 (0.0%)

0 (0.0%)

11 (1.0%)

STAGE 1

 

12 (14.0%)

59 (68.6%)

15 (17.4%)

0 (0.0%)

86 (8.0%)

STAGE 2

 

7 (7.8%)

47 (52.8%)

35 (39.3%)

0 (0.0%)

89 (8.3%)

STAGE 3

 

18 (14.5%)

63 (50.8%)

43 (34.7%)

0 (0.0%)

124 (11.5%)

STAGE 4

 

63 (33.7%)

79 (42.2%)

45 (24.1%)

0 (0.0%)

187 (17.4%)

NO RECORD

 

315 (54.3%)

198 (34.1%)

66 (11.4%)

1 (0.2%)

580 (53.6%)

TOTAL

 

419 (38.9%)

453 (42.1%)

204 (18.9%)

1 (0.1)

1077 (100.0%)

 

 

TABLE #3: COMPARING SINGLE-MODALITY WITH MULTI-MODALITY TREATMENT

STAGE

Single

Modality

Multi

Modality

Other

Total

STAGE 0

 

7 (100.0%)

0 (0.0%)

0 (0.0%)

7 (1.80%)

STAGE 1

 

59 (79.7%)

15 (20.3%)

0 (0.0%)

74 (18.8%)

STAGE 2

 

47 (57.3%)

35 (42.7%)

0 (0.0%)

82 (20.9%)

STAGE 3

 

63 (59.4%)

43 (40.6%)

0 (0.0%)

106 (27.0%)

STAGE 4

 

79 (63.7%)

45 (36.6%)

0 (0.0%)

124 (31.6%)

TOTAL

 

255 (64.9%)

138 (35.1%)

1 (0.1)

393 (100.0%)

 

NB: Based only on cases with complete data on stage and treatment

Professor Omar Hasan Kasule Sr. November 2000