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Biomedical subjects

R Sankaranarayanan

Publications and source records attributed to R Sankaranarayanan.

At least 91 records · Page 5Linked to original sources
PubMed1995

Survival in breast cancer: a population-based study in Bangalore, India.

Survival from cancer reflects the aggressiveness of the disease, the effectiveness of treatment and host factors such as age. While hospital-based survival rates are typically used to evaluate the care provided in a particular hospital, population-based survival reflects the effectiveness of the overall cancer control strategy in the region. Here, we report the survival experience of 1514 breast cancer patients registered by the Bangalore population-based registry during 1982-1989. There have been very few reports on survival from cancer in India, mainly because of poor patient follow-up and inadequate system of registration of death. This has been largely overcome in this study by means of active follow-up through visits of homes of patients. Scrutiny of medical records and matching with death certificates, was also carried out in a small proportion (12%) of cases. Thus, information on vital status (whether dead or alive) as on January 1, 1993 was available for 1334 (88%) subjects and partial follow up data were available for a further 34 (2%). The observed 5 year survival was 42.3% and the corresponding relative survival was 46.8%. The observed survival was 57.4% for localized disease, 45.8% for direct extension, 37% for those with regional node involvement, 14.2% for distant metastasis and 38.3% for those with unstaged disease. The clinical extent of disease and the educational status were independent predictors of survival.

Adult↗
PubMed1995

Evaluation of utilisation of health workers for secondary prevention of oral cancer in Kerala, India.

The utilisation of primary health workers (HWs) for cancer control in developing countries has often been suggested, based on the experience of feasibility studies in India and Sri Lanka. We initiated a project in 1988 to evaluate the long-term feasibility of using trained HWs in secondary prevention of oral cancer, to bring about earlier detection of oral cancer in the communities served by them. Two hundred and eighty-two HWs attached to 14 primary health centres (PHCs), serving approximately 0.92 million rural population in the northern half of Trivandrum district in Kerala, India, were trained in oral visual inspection to detect precancerous, malignant and other suspicious lesions of the oral cavity and refer them for confirmation and treatment. They were asked to examine subjects aged 35 years and above and to give person to person health education on tobacco in their target population. The HWs belonging to the PHCs serving approximately 1 million rural population in the southern half of Trivandrum district were not trained, and this region served as the control area. In addition to several process measures, stage distribution of oral cancer in subjects reporting from the intervention and control areas, as well as oral cancers referred by the HWs, as a proportion of total oral cancers from the intervention area, were the outcome measures evaluated. Only 9/282 (3.2%) trained HWs were motivated and they examined 17,812 eligible subjects in 3 years and referred 408 subjects with lesions; 258/408 (63.2%) referred subjects reported for further examination and ten oral cancers were detected among them.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Cervical cancer in Kerala: a hospital registry-based study on survival and prognostic factors.

The survival experience of 452 cervical cancer patients registered during 1984 by the hospital registry of the Regional Cancer Centre, Trivandrum, Kerala, India, is described in this paper. Eighty per cent of the patients completed the prescribed treatment, which was predominantly radiotherapy. The vital status of each patient was established by scrutiny of case records and by reply-paid postal enquiries. The observed survival rates were estimated by the Kaplan-Meier method and prognostic factors were assessed using Cox's proportional hazards regression analysis. The overall 5 year observed survival rate was 47.4% (95% CI, 41.6-52.9%). Socioeconomic status, performance status and the clinical stage of disease emerged as independent predictors of survival. Low survival was associated with advanced stages of disease, low socioeconomic status and poor performance status. The problems in studying survival from cancer in developing countries and the strategies used to improve follow-up rates in India are discussed. It is stressed that trends in survival rates may be used to evaluate cancer control programmes in developing countries in the absence of reliable mortality statistics and, even when mortality data are available, survival rates are valuable comparative statistics. Earlier detection by improving the awareness of the population and the physicians will improve survival rates, but a more effective and prudent approach would be to prevent invasive cervical cancer, and thereby reduce mortality, by implementing feasible and effective screening programmes in India.

Adult↗
PubMed1995

Evaluation of mouth self-examination in the control of oral cancer.

This study was planned to evaluate the feasibility of mouth self-examination (MSE). Some 450 college students distributed to 9000 households a brochure describing the risk factors of oral cancer, the appearance of premalignant and malignant lesions of the oral cavity and the methods of MSE with pictures. All subjects with tobacco habits and/or aged 30 years or over were asked to read the brochure carefully and to report to the clinic conducted in their locality on fixed days, if they suspected an abnormality while practising MSE. Out of the approximately 22,000 eligible subjects, 8028 (36%) practised MSE. Among the 247 subjects reporting to the clinics seven (3%) had oral cancer and 85 (34%) had oral precancerous lesions; the others had either benign lesions or normal anatomical variations. Six of the seven subjects with oral cancer had stage I disease, five of whom accepted treatment and were alive disease-free 5 years later. The detection rates of oral cancer compared favourably with the previously reported detection rates using trained health workers. Although this study demonstrated that MSE is feasible, larger studies are required to evaluate whether health education could result in a sustained practice of MSE resulting in reduction in incidence of and mortality from oral cancer.

Adult↗
PubMed1995

Evaluation of chemoprevention of oral cancer with Spirulina fusiformis.

The blue-green microalgae Spirulina, used in daily diets of natives in Africa and America, have been found to be a rich natural source of proteins, carotenoids, and other micronutrients. Experimental studies in animal models have demonstrated an inhibitory effect of Spirulina algae on oral carcinogenesis. Studies among preschool children in India have demonstrated Spirulina fusiformis (SF) to be an effective source of dietary vitamin A. We evaluated the chemopreventive activity of SF (1 g/day for 12 mos) in reversing oral leukoplakia in pan tobacco chewers in Kerala, India. Complete regression of lesions was observed in 20 of 44 (45%) evaluable subjects supplemented with SF, as opposed to 3 of 43 (7%) in the placebo arm (p < 0.0001). When stratified by type of leukoplakia, the response was more pronounced in homogeneous lesions: complete regression was seen in 16 of 28 (57%) subjects with homogeneous leukoplakia, 2 of 8 with erythroplakia, 2 of 4 with verrucous leukoplakia, and 0 of 4 with ulcerated and nodular lesions. Within one year of discontinuing supplements, 9 of 20 (45%) complete responders with SF developed recurrent lesions. Supplementation with SF did not result in increased serum concentration of retinol or beta-carotene, nor was it associated with toxicity. This is the first human study evaluating the chemopreventive potential of SF. More studies in different settings and different populations are needed for further evaluation.

Adult↗
PubMed1995

An evaluation of the oral cancer control program in Cuba.

The Cuban oral cancer screening program, functioning since 1984, requires all subjects of > or = 15 years to have an annual oral visual inspection by dentists. It covered 12-26% of the target population annually. Less than 30% of the subjects with suspect lesions complied with referral. The program identified 16% of the 4,412 incident oral cancers in Cuba during 1984-1990. The proportion of stage I cases increased from 24% in 1983 to 49% in 1990, although staging information was available only for half of the cases. There was no change in oral cancer incidence and mortality in Cuba over the last decade that could be ascribed to the screening program.

Adolescent↗
PubMed1994

A case-control study of diet and lung cancer in Kerala, south India.

A total of 281 male lung-cancer patients were identified from the hospital cancer registry in the Regional Cancer Centre in Trivandrum. The controls were selected from the visitors and patients' bystanders in the hospital. The recruitment of cases and controls started in 1990, and the present study used the cases registered in the first year. The questionnaire administered to cases and controls collected information on tobacco smoking and alcohol habits. Dietary data were collected using a food frequency questionnaire and were analyzed by multiple logistic regression producing odds ratio estimates of the relative risk and deviance chi-squared tests of significance. Analysis was done on the computer package, EGRET. All models included age, education, religion and smoking to adjust for the effect of confounding. Green vegetables and bananas were found to have a protective association with lung cancer. The odds ratio associated with the highest quartile of vegetable consumption compared with the lowest was 0.32 (95% confidence interval 0.13, 0.78). Forward stepwise regression analysis indicated pumpkins and onions as the most consistently significant protective factors. Animal protein foods and dairy products were found to have a predisposing effect on lung cancer in this study. The expected influence of smoking on lung cancer (a considerable increase in risk among smokers) provided evidence of the reliability of the data. In conclusion the results from this study show that diet has a role in lung cancer aetiology, although the association is weak compared to the effects of smoking.

Adult↗
PubMed1994

Adult Hodgkin's disease in Kerala.

BACKGROUND: Hodgkin's disease seen in the developing countries differs from that seen in developed countries. There are only a few reports from India regarding the epidemiologic and clinicopathologic features of Hodgkin's disease. METHODS: The records of 159 evaluable patients with Hodgkin's disease seen at the Regional Cancer Centre, Trivandrum, India, during the period 1983-1989 were reviewed for clinicoepidemiologic profile and survival analysis. The Kaplan-Meier product limit method was used to compute survival, and Cox proportional hazard regression analysis was used to study the factors affecting survival. RESULTS: The male-to-female ratio was 3.1:1. The mean age at presentation was 38 years in adults. Supradiaphragmatic presentation (44.7%) was more common, and mixed cellularity (50.3%) was the predominant histologic subtype. There were 9.4% patients with Stage I disease, 37.1% with Stage II, 33.4% with Stage III, and 20.1% with Stage IV disease. Of the patients, 57.9% were treated with chemotherapy, whereas 23.3% had radiation therapy alone, and 18.8% had a combination of radiation therapy and chemotherapy. Complete response was noted in 77.4% (n = 123) of patients, of whom 20.3% (n = 25) later experienced disease relapse. Second remission could be achieved in 8 of 25 patients with disease relapse. The overall 5-year survival rate was 55%. The stage-related survival rates were 89%, 69%, 53%, and 27% in Stage I-IV, respectively. On multivariate regression analysis, patient age and disease stage emerged as significant predictors of survival. CONCLUSION: Mixed cellularity was the most common histologic subtype. The inferior survival rate observed could be attributable to advanced stage of presentation, compromise on the drug and dose, and the lack of proper supportive measures. Patient age and disease stage were the important predictors of survival.

Adolescent↗
PubMed1994

Use of tobacco and alcoholic beverages by children and teenagers in a low-income coastal community in south India.

To plan and implement cancer control measures, information about the baseline habit patterns of the community is needed. A coastal village near Trivandrum, Kerala, Southern India, supported mainly by the fishing industry, was identified for this study with regard to establishing measures to control oral cancer there. Oral cancer is prevalent in Kerala. Smoking and chewing tobacco and drinking alcoholic beverages are the major risk factors for this cancer. The socioeconomic status of the fishermen of Kerala is low and their literacy rate is low. The adults in coastal Kerala have been found to have a habit pattern of very high levels of tobacco and alcohol use. A survey was conducted to study the tobacco and alcohol use habits of 146 children and teenagers in this village. The percentages of study subjects with pan-tobacco-chewing, smoking, and drinking habits were 29%, 2%, and 3%, respectively. The habit pattern correlated negatively with education and positively with number of children per family. This survey provides information that can be used to plan cancer education efforts, including redesigning the school curriculum and focusing on high-risk groups.

Adolescent↗
PubMed1994

Cancer deaths in India: is the model-based approach valid?

The model-based cancer mortality estimates for India (775,800) are nearly double the data-based estimates (433,000), and are higher than even the incidence estimates (612,300). The model-based approach is therefore, at least in the case of India, incorrect. Established practice is to use real data to validate theoretical models, not to reject the data if apparently the model does not fit.

Female↗
PubMed1993

Overall survival from breast cancer in Kerala, India, in relation to menstrual, reproductive, and clinical factors.

BACKGROUND: Breast cancer accounts for one-fourth of cancer cases seen in female patients in Kerala, India. Results of a retrospective analysis of breast cancer in Kerala are presented in this article. METHODS: Case records of 449 patients with breast carcinoma treated during 1983-1984 were reviewed. Survival analysis was done by the Kaplan-Meier product limit method. The survival curves were compared by the log-rank test. A forward stepwise procedure with the Cox proportional hazards regression analysis was performed to identify factors influencing survival. RESULTS: The overall 5-year survival rate was 40%. The 5-year survival rates were 85% for patients with T1, 63% for T2, 32% for T3, and 21% for T4 lesions. Those with N0 disease had a 68% 5-year survival rate. The survival rates were 90% for patients with Stage I, 65% for Stage II, 33% for Stage III, and 6% for Stage IV disease. On multivariate analysis, the following factors were found to significantly influence survival: response to treatment (P < 0.001), stage (P < 0.01), and regional nodal involvement (P < 0.05). CONCLUSIONS: Two-thirds of patients with advanced-stage disease on presentation seem to account for the poor overall survival. Early detection of breast cancer by breast self-examination and physician breast examination should be encouraged in developing countries to improve treatment results in breast cancer.

Adult↗
PubMed1993

Crystallization and preliminary X-ray studies of the basic lectin from winged bean (Psophocarpus tetragonolobus).

The basic lectin from winged bean (Psophocarpus tetragonolobus) could be crystallized using polyethyleneglycol (PEG) 4000 (I), PEG 8000 (II) and 2-methylpentane-2,4-diol (MPD) (III) as precipitants. Crystal forms I and II grew in the presence of methyl-alpha-D-galactopyranoside or N-acetylgalactosamine while III grew in the absence of sugar. The three forms have the same space group (P2(1)2(1)2) and similar unit cell dimensions with two dimeric molecules in the asymmetric unit. The unit cell dimensions are a = 156.8 A, b = 89.0 A, c = 73.3 A for I, a = 155.5 A, b = 92.3 A, c = 72.5 A for II and a = 148.3 A, b = 90.7 A, c = 73.8 A for III. The crystals, particularly those grown using PEG 8000, are suitable for high resolution X-ray analysis, which is in progress.

Crystallization↗
PubMed1993

Evaluation of symptomatology in planning palliative care.

Cross-sectional surveys are a useful tool in planning health care, both in the community and in hospitals. We found that a review of routine case records did not yield sufficient information for planning palliative care services in the hospital environment, and therefore decided to conduct a cross-sectional survey involving random patients attending the outpatient division of the Regional Cancer Centre, Trivandrum, India. Three hundred and twelve patients were interviewed, and pain and weight loss were found to be the most prominent symptoms (> 90%). This study indicates that symptomatology has to be addressed in detail while planning palliative care services in a hospital setting. Even with its selection bias, the study provides valuable clues for the adequate organization and continuation of palliative care services.

Adolescent↗
PubMed1993

Prevention and early detection of oral, breast and cervical cancers: a practical approach in Indian context.

Cancer has emerged as a major killer disease in India. One-third of the total cancer load is constituted by oral, breast and uterine cervix cancers. Considerable knowledge is available on control strategies on these 3 major cancers and this can be transformed into the community through the individual health care practitioners. Oral cancer is preventable and both the precancerous and invasive lesions can be picked up easily by examination of the oral cavity. The occurrence of breast cancer in the country is on the increase. The poor survival rate indicates the impact of the major proportion of advanced cancer. An effective strategy comprising breast self-examination, examination by a physician and a mammography test, is described. Cancer of the uterine cervix is the commonest malignancy among females in several regions in India. An effective and definitive method is available in the form of Pap smear for the control of cervical cancer. An organised community screening programme is not economically viable at present. However, routine per speculum examination should be undertaken and this can result in clinical downstaging of cancer. Women above the age of 40 years should undergo regular Pap smear screening. Broad guidelines are presented for an opportunistic screening.

Adult↗
PubMed1992

Independent predictors of response and disease-free survival in oral cancer treated with radical radiation therapy.

There have been no reports concerning the independent predictors of response and disease-free survival (DFS) in oral cancer in India, where the highest incidence is reported. The authors analyzed the outcome of radical radiation therapy of 378 patients with oral cancer and found that the complete response rate within 6 months of completion of treatment was 45% and the 5-year DFS was 34% (95% confidence interval 29% to 39%). Regional lymph node involvement (P less than 0.001), histologic type (P less than 0.01), and the intraoral site of lesion (P less than 0.025) were identified as independent predictors of response when adjusted in a forward stepwise logistic regression analysis. The Cox proportional hazards regression analysis revealed that regional lymph node involvement (P less than 0.001) and histologic type (P less than 0.05) were independent prognostic factors for DFS. Patients with fixed regional lymph node involvement demonstrated a relative risk (RR) of 2.4 compared with those with N0 disease. Patients with well-differentiated squamous carcinoma had an RR of 2, and those with other histologic types (other than verrucous carcinoma) had an RR of 1.5.

Adult↗
PubMed1992

Cancer control programme in India: opportunities for implementation and evaluation.

Cancer is now being appreciated in India as an emerging public health problem. Approximately 600,000 new cancer cases occur in India every year, and the absolute number of new cancer patients will increase considerably, due to growth in the size of the population and an increase in the proportion of elderly persons due to improved life expectancy following control of communicable diseases. This emerging problem has received the attention of the Government of India, and some state governments within the Indian Federation have formulated National and State Cancer Control Programmes to deal with the situation. In the event of these programmes being implemented, consideration should be given now to measures of evaluation of the activities, as many of the indices, used to monitor programmes in developed countries, such as 15% reduction from peak cancer mortality, or in peak mortality from specific cancers, are not applicable in developing countries like India. Factors such as the pattern of tobacco habits in the community, knowledge, attitude and practice (KAP) patterns regarding cancer in the general population, referral practices, and the national pattern of extent of disease at presentation, gain considerable importance from the evaluation point of view. Our article mainly deals with the sources and the quality of baseline data for such factors and the realistic quantitative goals which could be set for the above factors.

Humans↗