SSR Inst. Int. J. Life Sci.,
10(1): 3470-3476, Jan 2024
Understanding the
Invisible Threat: A Study on Oral Cancer Risk Factors among Medical Recipients
Shreeya1*, Deelip S Natekar2, Manjula3,
Umesh Kamble3, Basavaraj Hadaginal3, Vidyashree Patil3,
Kavita Gudihal3, Sanjota
Hadapad3
1Lecturer, Dept. of
Medical Surgical Nursing, Shri. B.V.V.S. Sajjalashree
Institute of Nursing Sciences, Navanagar, Bagalkot-587102,
Karnataka, India
2Principal, Dept. of Community Health Nursing, Shri B.V.V.S Sajjalashree
Institute of Nursing Sciences, Bagalkot, Karnataka, India
3Student, Shri B.V.V.S Sajjalashree
Institute of Nursing Sciences, Bagalkot, Karnataka, India
*Address for Correspondence: Shreeya, Lecturer, Dept. of Medical Surgical Nursing, Shri. B.V.V.S. Sajjalashree Institute of Nursing Sciences, Navanagar,
Bagalkot-587102, Karnataka, India
E-mail: shreeyamath123@gmail.com
ABSTRACT- Background: Cancer is a non-infectious disease. It starts at the
molecular level of the cell and, ultimately, affects the cellular behaviour.
Generally, it can be defined as the uncontrolled proliferation of cells without
differentiation. Cancer is a group of conditions where the body's cells begin
to grow and reproduce uncontrolled. These cells can then invade and destroy
healthy tissues.
Methods: A retrospective research approach is used in
the present study, and the researcher follows a descriptive study design. The
sample size was 120 adults. The convenient sampling technique was used to
select the study area, and the proportionate stratified random sampling
technique was used to select study participants. The pilot study revealed the
feasibility of the study. The reliability of the tool was evident by using the
questionnaire method.
Results: The study's findings revealed that the percentage
distribution of adults according
to their age group of ≤30 was 20%, 31-40 were
26.66%, 41-50 are 33.33%, and 51-60 were 20% of adults. The
calculated chi-square value for the socio-demographic variable Age of the Adult
is 9.86. The
Chi-square table value was 3.846. Here, the Chi-square calculated values are
higher than the Chi-square table value.
Conclusion: After
obtaining the result of the present study, the researcher noticed a significant
association between the age of adults (control group) and risk factors of oral
cancer.
Keywords- Cardiovascular
diseases, Oral cancer, Risk factors, Adults
INTRODUCTION- Cancer
is the second most common cause of death in the Western world, after
cardiovascular diseases [1]. Worldwide, an estimated cancer
incidence of about 10 million was reported for the year 2009, and 1 out of
every three persons is estimated to suffer from cancer by the age of 75 years.
It is also estimated that about 7.9 million
people worldwide will die from cancer this year, accounting for 12% of
deaths worldwide [2-5]. In the United States alone, an estimated
569,490 deaths from cancer are projected for 2010. Recently published estimates
of the worldwide frequency of the 16 major cancers
indicate that in developing countries with a high prevalence of
infectious and nutritional diseases, cancer remains
a major cause of death [6].
This may account partly for the current statistics whereby more than
half the global incidence of cancer is from the so-called developing countries since an estimated 70-80% of the
global population resides in these areas.
The estimated annual incidence of cancer ranges from 48 to 225 per
100,000 in developing countries [7]. Cancer of the oral cavity is
one of the most common malignancies, especially in developing countries but
also in the developed world. Squamous cell carcinoma
(SCC) is the most common histology, and the main etiological factors are
tobacco and alcohol use.
Although early diagnosis is relatively easy, advanced disease
presentation is uncommon. The standard of care is primary surgical resection
with or without postoperative adjuvant therapy. Over the past decade,
improvements in surgical techniques combined with the routine use of
postoperative radiation or chemo-radiation therapy have improved survival
statistics. Successful treatment of patients with oral cancer is predicated on
multidisciplinary treatment strategies to maximize oncologic control and minimize
the impact of therapy on form and function [8].
MATERIALS AND METHODS- A retrospective research approach is used in the
present study, and the researcher follows a descriptive study design. The
sample size was 120 adults. The convenient sampling technique was used to
select the study area, and the Proportionate stratified random sampling
technique was used to select study participants. The pilot study revealed the
feasibility of the study. The reliability of the tool was evident by using the
questionnaire method. The reliability coefficient of correlation of the
questionnaires was obtained, and the 'r' value was found to be 0.80 and 0.89.
The data were collected with the help of structured questionnaires. Data
analysis was done using descriptive statistics.
Study participants- The study participants were
adults at risk for oral cancer and receiving oral cancer treatment in selected
hospitals.
Data Collection Procedure- The data was collected from 30-06-2023 to
16-07-2023. Prior permissions were obtained from the medical superintendent of
selected hospitals in Bagalkot, India. All the participants explained the
purpose of the study, that the data they provided was not kept confidential,
and that their identity was not revealed. They were informed to avoid
discussion with other fellow mates. The instruments were given according to
their preferred language. Instructions were given regarding the content of data
collection instruments. The researcher attained and clarified the doubts of
participants during data collection. The filled tools were collected from the
participants. On average, adults took 10 to 15 minutes to fill the tools, and
the whole process was completed in 2 hours. The researcher thanked all the
participants and the concerned staff nurse and superintendent.
Sample size- The sample size was
calculated considering the following parameters: Z=1.96 (95% confidence level),
the margin of error (e)=5%(0.05), and population
proportion (p)=0.5. The population of adolescents in the Bagalkot district was
around 18,89,752.
Setting- The study's setting was
SNMC, HSK Hospital Navanagar, Bagalkot, and Halamma Kerudi Cancer Hospital Bagalkot. The total sample size is
120. The sampling criteria included the control group and case group.
Data Collection Instrument- The data was collected using a questionnaire
format (demographic data: age, gender, religion, type of family, marital
status, income, education, and risk factors: occupation, tobacco, alcohol,
smoking, betel nut, radiation).
Scoring- The total score was obtained by adding the scores of
questions 1 to 7, and the scoring was done based on severity level. The scores
of risk factors are added separately to know the factors affecting oral cancer
in both the control and case groups.
Structured Questionnaire- The researcher prepared a structured,
close-ended questionnaire to assess the data regarding risk factors and
determinants of oral cancer among adults.
Validity, Reliability and Translation of data
collection instruments-
Structured questionnaires screen individuals for the risk factors associated
with oral cancer. The tool's content, construct and criterion validity have
been supported by its use for four decades in various research, consultation, feedback and revision. The instruments were translated to
Kannada and retranslated to English, and the between the original and tranche
slated tools were assertations. Reliability was established by administering
the tool to 10 adults. The brown formula was used to calculate the reliability
value of 0.80, suggesting the tool was reliable for data collection.
Statistical Analysis- The obtained data was entered into an MS
Excel sheet. The data was edited for accuracy and completeness. The categorical
responses were coded with numerical codes. The data was presented with
frequency and percentage distribution tables and diagrams. The risk for oral
cancer was described using arithmetic mean, range, and standard deviation.
Binary logistic regression analysis and Odds ratio were used to associate the
determinants with adult oral cancer risk.
Ethical Clearance- An ethical clearance certificate was obtained
from the Institutional Ethical Clearance Committee, B.V.V.S Sajjalashree
Institute of Nursing Sciences, Bagalkot. Participants and their parents
obtained Written consent for participation before data collection.
RESULTS
Socio-demographic
variables of adults- Table 1 illustrates the socio-demographic
characteristics of people in both the control and case groups. Regarding age,
the majority in both groups are between 31 and 50 (33.33% in the control group
and 38.33% in the case group). Gender distribution showed more men in both
groups (76.66% in the control group and 95% in the case group). Regarding
religion, Hindus comprise the majority in both groups (85% in the control group
and 85% in the case group). Most participants are from nuclear households
(81.66% in the control group and 83.33% in the case group). Marital status
showed a larger number of married persons in both categories (86.66% in the
control group and 96.66% in the case group). Income distribution suggests that
a considerable fraction of participants fall in the 15,000-25,000-income range
(38.33% in the control group, 40% in the case group). Regarding education, the
majority had secondary education in both groups (26.66% in the control group
and 53.33% in the case group).
Table 1: Frequency and
Percentage distribution of socio-demographic variables of adults. (Control and case groups)
|
Socio-demographic variables |
Frequency |
|
|
Control Group (%) |
Case Group (%) |
|
|
Age <30years 31-40years 41-50years 51-60years |
12(20) 16(26.66) 20(33.33) 12(20) |
12(20) 23(38.33) 16(26.66) 09(15) |
|
Gender Male Female |
46(76.66) 14(23.33) |
57(95) 03(5) |
|
Religion Hindu Muslim Christian Others |
51(85) 06(10) 02(3.33) 01(1.66) |
51(85) 05(8.3) 03(5) 01(1.66) |
|
Type of family Nuclear Joint |
49(81.66) 11(18.33) |
50(83.33) 10(16.66) |
|
Marital status Married Unmarried |
52(86.66) 02(13.33) |
58(96.66) 02(3.33) |
|
Income Below 15000 15000-25000 25000-35000 35000andabove |
34(56.66) 23(38.33) 03(5) 00(0) |
30(50) 24(40) 03(5) 03(5) |
|
Education Illiterate Primary education Secondary
education Graduate |
23(38.33) 12(20) 16(26.66) 09(15) |
18(30) 32(53.33) 07(11.66) 03(5) |
Table 2: Association between
demographic variables and risk factors (Case group)
|
Socio-Demographic Variables |
p-value* |
|
Age |
1.75 |
|
Gender |
0.03 |
|
Religion |
0.21 |
|
Type of family |
0.01 |
|
Marital status |
0.02 |
|
Income |
0.15 |
|
Education |
1.21 |
*Level of
significance p<0.05
Table 3 presents the chi-square analysis of the association between
socio-demographic variables and risk factors for oral cancer in the control
group. The calculated chi-square values for each variable Age, Gender,
Religion, Type of family, Marital status, Income, and Education are reported
alongside the chi-square table value of 3.846. The primary objective is to
determine whether a statistically significant association exists between these
socio-demographic factors and the risk factors for oral cancer. The calculated
chi-square values for gender (0.023), Religion (0.847), Type of family (1.001),
Marital status (0.324), Income (0.200), and Education (1.847) are all below the
chi-square table value of 3.846. This indicates that, for these variables,
there is no significant association with the risk factors for oral cancer, as
the calculated values fall within the expected range.
Table 3: Association between
demographic variables and risk factors (Control group)
|
Socio-Demographic
Variables |
Chi-square
calculated value |
Interpretation* |
|
Age |
9.86 |
Significant |
|
Gender |
0.02 |
Not significant |
|
Religion |
0.84 |
Not significant |
|
Type of family |
1.01 |
Not significant |
|
Marital status |
0.32 |
Not significant |
|
Income |
0.20 |
Not significant |
|
Education |
1.84 |
Not significant |
*Level of significance p<0.05; DF= 1
Association between risk factors and oral
cancer are family history of oral cancer, use of substances like tobacco/gutka,
smoking, alcohol, betel nuts, exposure to radiation and their results in
control groups 8.33%, 38.33%, 51.66%, 45%, 71.66% and 3.33%, respectively.
Association between risk factors and oral cancer are family history of oral
cancer, use of substances like tobacco/gutka, smoking, alcohol, betel nuts, and
exposure to radiation and their results in case groups 10%, 70%, 53.33%, 50%,
70% and 76.66%, respectively.
Table 4: Association between
risk factors and oral cancer
|
Risk factors |
Elements |
Control group |
Case group |
||
|
f |
% |
f |
% |
||
|
Family history of oral cancer |
0 |
55 |
91.66 |
54 |
90 |
|
1 |
5 |
8.33 |
6 |
10 |
|
|
Use of substance Tobacco/ Gutka |
- |
23 |
38.33 |
42 |
70 |
|
Smoking |
0 |
29 |
48.33 |
28 |
46.66 |
|
1 |
31 |
51.66 |
32 |
53.33 |
|
|
Alcohol |
0 |
33 |
55 |
30 |
50 |
|
1 |
27 |
45 |
30 |
50 |
|
|
Betel nuts |
0 |
17 |
28.33 |
18 |
30 |
f=
Frequency; %= Percentage
DISCUSSION- This study aimed to assess the effectiveness
of turmeric mouthwash versus routine oral care on radiation-induced oral
Mucositis among patients with head and neck cancer treated at Halamma Kerudi Cancer Hospital,
Bagalkot, Karnataka. This chapter
presents the major findings of this study and discussion about similar studies
conducted by other researchers [9].
A hospital-based retrospective cross-sectional
study was conducted in the Department of Radiotherapy and Oncology, Rural
Medical College and Pravara Rural Hospital, Loni, Maharashtra state, India. The
sex-wise distribution revealed 256 (73.25%) among males and 93(26.65%) among
females. The mean age of the patients was 54.98 years, ranging from 15-78
years; 31.23% were more than 65 years of age. The most oral cancer sites among
the males and females were those of the tongue (37.82%) and buccal mucosa
(32.95%), respectively. The study findings suggest that the prevalence of oral
cancer is higher among tobacco users, especially those using tobacco quid,
which is more common among Indian women, which is in line with most of the
epidemiological studies about oral cancer in India [10-13].
A case-control study was conducted in a
central India regional cancer institute. The study consists of a total of 124
cases and 124 controls. Cases were newly diagnosed patients of oral cancer
confirmed by histopathological examination. For cases, the mean age (years) was
47.62, the range being 23-83 years, while that of controls was 47.89 years, the
range being 24-84 years. The majority were males (83.88%). Most cases (79.04%)
were past chewers with OR 2.61. A maximum number of cases (19.36%) were past
smokers, and the maximum number of controls (12.09%) were current smokers with
OR 4.54. A maximum number of cases (30.64%) were former drinkers, and a maximum
number of controls (8.87%) were current drinkers, who had OR 2.97 [14].
A case-control study was conducted to
determine associations with risk factors. There were significant associations
between oral cancer and tobacco smoking (OR=4.47; 95%CI=2.00 to 9.99), alcohol
use among women (OR=4.16; 95%CI=1.70 to 10.69), and betel chewing (OR=9.01;
95%CI=3.83 to 21.22), and all three showed dose-response effects. Smoking is
rare among Thai women (none of the control women were smokers), but betel
chewing, especially among older women, is relatively common. We did not find
any association between practising oral sex and oral cancer [15].
A prospective, cross-sectional, epidemiologic
survey was performed to evaluate the knowledge
and attitudes of dentists working in Primary Health Care Units and
the participants were mostly females (81.5%), less than 40 years of age (57.7%),
who underwent training 10-20 years ago (47.9%). Most respondents (66.2%)
considered their knowledge of oral cancer satisfactory. However, only 26.8% of
them felt that they could carry out oral cancer diagnostic procedures [16].
A cross-sectional survey was carried out
among the rural population of Dakshina Kannada using a self-administered,
pilot-tested questionnaire. The data obtained was tabulated and analysed.
Statistical tests used: Descriptive statistics (numbers, percentages) were
used. An unpaired t-test was used to compare the mean knowledge scores among
males and females. Results were as follows: 504 subjects participated in the
survey [17].
A cross-sectional study was conducted among
200 university students in Malaysia. A self-administered questionnaire was used
to collect data. It included questions on sociodemographic data, awareness and knowledge of oral cancer. The results were
that the mean age of the respondents was 21.5 2.5, and the age ranged from 18
to 27 years [18,19]. Most
of the respondents were aware of oral cancer (92%) and recognized the following
as signs and symptoms of oral cancer: ulcer and oral bleeding (71%), followed
by swelling (61.5%). A satisfactory knowledge was observed of the following
risk factors: smoking (95.5%), poor oral hygiene (90.5%), family history (90%),
alcohol (84.5%) and poorly fitting dentures (83.0%). However, unsatisfactory
knowledge was observed about hot/spicy food (46.5%), obesity (36%), old age
(31.5%), dietary factor (29%) and smokeless tobacco (25.5%) [20-22].
Another study investigated and showed that about 50% of the patients were
addicted to tobacco in some form. Only 30% of the participants were aware of
the risk factors for oral cancer [23,24]. The median time between symptom onset and seeking any
medical consultation was 120 days, whereas the median time between symptom
onset and cancer diagnosis was 165 days. About 75% of patients initially
consulted an alternative medicine practitioner, and 90% took some form of
alternative treatment before consulting a cancer specialist. Around 80%
considered alternative medicines an effective cancer treatment form [25].
CONCLUSIONS- In conclusion, the analysis of socio-demographic
variables in both the case and control groups revealed that there is no
significant association between age, gender, religion, type of family, marital
status, income, and education with the risk factors for oral cancer. The
calculated chi-square values for these variables were consistently lower than
the chi-square table value of 3.84, leading to the rejection of the null
hypothesis (H1) that posited an association between these socio-demographic
variables and oral cancer risk factors. However, a closer examination of the
age variable in the adult population showed a different outcome. In the case
group, the chi-square value for age (9.86) exceeded the chi-square table value,
indicating a significant association between age and risk factors for oral
cancer. This finding supports the acceptance of the hypothesis that there is an
association between oral cancer risk factors and age in the adult population.
Additionally, the association between specific risk factors and oral cancer,
such as family history, tobacco/gutka use, smoking, alcohol consumption, betel
nuts, and exposure to radiation, was explored.
CONTRIBUTION OF AUTHORS
Research concept- Shreeya
Research design- Shreeya
Supervision- Shreeya, Deelip S Natekar
Materials- Vidyashree Patil, Kavita Gudihal, Sanjota Hadapad
Data collection- Shreeya, Umesh Kamble,
Umesh Kamble, Basavaraj Hadaginal
Data analysis and
Interpretation- Deelip S Natekar
Literature search- Shreeya, Umesh Kamble,
Manjula, Deelip S Natekar, Manjula
Writing article- Shreeya, Umesh Kamble,
Manjula, Deelip S Natekar, Manjula, Basavaraj Hadaginal
Critical review- Shreeya, Deelip S Natekar
Article editing- Shreeya, Deelip S Natekar
Final approval- Shreeya, Deelip S Natekar
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