|MINI SYMPOSIUM: HEAD NECK CANCER
|Year : 2013 | Volume
| Issue : 1 | Page : 9-13
Socio demographic profile of oral cancer patients residing in Tamil Nadu - A hospital based study
R Ganesh, J John, S Saravanan
Department of Public Health Dentistry, Saveetha Dental College and Hospital, 162, Poonamalee High Road, Chennai, Tamil Nadu, India
|Date of Web Publication||20-May-2013|
Department of Public Health Dentistry, Saveetha Dental College and Hospital, 162, Poonamalee High Road, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Introduction: In developing countries, a high proportion of patients with oral cancer are from lower socioeconomic classes. This high proportion is clearly associated with difficulties in accessing the health care system. Hence, the aim of this study is to assess the socio-demographic profile of oral cancer patients at Tamil Nadu, India. Objective: To determine the socio-demographic profile of study subjects. Materials and Methods: This study was a cross sectional study done at a cancer hospital in Chennai. The study population were subjects with oral cancer who reported for treatment. A pretested interviewer administered questionnaire was used to assess the socioeconomic status of oral cancer patients. Pareek's scale of classification was used for rural population and Kuppuswamy's classification was used in urban population to assess the socioeconomic status. Results: A total of 266 oral cancer patients aged 21-60 years and above comprised the study population. Most of the study subjects belonged to the lower socio economic classes. About 48.5% of rural subjects had agriculture as a source of occupation and 28.6% of urban subjects were unskilled labourers. In both rural and urban subjects, majority, 94.9% and 71.9% had family income below Rs 5000. The percentage of illiterates was high in both rural and urban class (i.e.) 55.8% and 21.9% respectively. The difference in the prevalence of oral cancer among different levels of literacy and occupation was found to be significant statistically. Conclusion: Identifying occupation, income and education specific disparities in tobacco use can provide a useful "signspot" indicating inequalities that need to be addressed by policy makers and broader community through allocation of resources.
Keywords: Oral cancer, rural, socioeconomic status, and urban
|How to cite this article:|
Ganesh R, John J, Saravanan S. Socio demographic profile of oral cancer patients residing in Tamil Nadu - A hospital based study. Indian J Cancer 2013;50:9-13
|How to cite this URL:|
Ganesh R, John J, Saravanan S. Socio demographic profile of oral cancer patients residing in Tamil Nadu - A hospital based study. Indian J Cancer [serial online] 2013 [cited 2018 Dec 13];50:9-13. Available from: http://www.indianjcancer.com/text.asp?2013/50/1/9/112270
| » Introduction|| |
World is heading towards various types of non-communicable diseases, which are also known as modern epidemics. Among these modern epidemics cancer is the second commonest cause of mortality in developed countries. In developing countries, oral cancer is among the ten commonest cause of mortality. 
India has one of the highest rates of oral cancer in the world; accounting for one third of the total cancers and unfortunately this figures continue to rise. According to World Health Organisation, 40% of the oral cancers which were diagnosed worldwide occurs in India, Pakistan, Bangladesh and Srilanka. 
The incidence of oral and pharyngeal cancers has shown an increasing trend worldwide. The mortality rates of patients with these malignancies also continues to increase.  Oral cancer is one of the ten most frequent cancers occurring globally.  In India, approximately 30-40% of all cancer cases are oral cancers, which are much higher as compared to Western world.  As estimated by WHO, 90% of oral cancer cases among Indian men are attributable to tobacco consumption. 
There is uncertainty and limited recognition of the relationship between socio-demographic inequalities and oral cancer. Despite a wealth of literature on the effects of poverty and inequality on health,  the effect of socio-demographic circumstances on oral cancer is given little recognition in a predominant medical model approach to research and prevention on the risks of the disease. 
Recent published work on the relationship between socio-demographic factors and oral cancer has mainly been in the form of descriptive epidemiology studies linking routine registry data to census data. From such studies, increased risk of oral cancer appears associated with high levels of area based socio-economic deprivation. ,
In developing countries, a high proportion of patients with oral cancer are from lower socioeconomic classes. This high proportion is clearly associated with difficulties in accessing the health care system, with most cases eventually diagnosed at advanced clinical stages. Consequently, more aggressive, multimodal, time consuming and costly staging workups and treatments are needed to treat these patients.  The risk of complications, sequelae and disabilities is also increased.
Cancer is a public health problem and has been ranked among the most frequent diseases associated with workday losses and work-related disabilities. Head and neck cancer treatment sequelae are related not only to cosmesis but also mainly to the patient's ability to communicate and to vital functions such as chewing and swallowing. Consequently, this causes potentially devastating socioeconomic effects for the patients and their families. 
Socioeconomic inequalities are consistently reported for total mortality and for many causes of death.  This includes higher cancer mortality rates among men of lower socioeconomic status. 
Earlier studies reported that socio-economic status is one of the most important variables affecting health related quality of life and an important predictor of disease morbidity and mortality. Low socio-economic status is significantly associated with oral cancer risk in developed and developing countries, across the world. 
Many epidemiological studies conducted over the last three decades in America, Europe and Asia have provided strong evidence of an association between alcohol and tobacco use and an increased risk of oral and pharyngeal cancer. One published Indian study has reported socio demographic factors as an independent risk for oral cancer. 
Epidemiological data indicate that ethnic and racial groups differ significantly in terms of cancer incidence and mortality.  The variations in the incidence and mortality rates among the ethnic and racial groups were due to the differences in the demographic, socio-educational and occupational factors or due to food and tobacco consumption habits.
However, there are not many studies about the socio-demographic profile of patients as independent risk for oral cancer in India. Hence, the aim of this study is to assess the socio-demographic profile of oral cancer patients at Tamil Nadu, India.
| » Materials and Methods|| |
This study was a cross sectional study done at a Cancer hospital in Chennai. The study population were subjects with oral cancer who reported for treatment at the hospital. The sample size consisted of 266 individuals. All oral cancer patients who reported during the month of March, 2011 formed the study group and were included in the study. The subjects who were not willing to participate in the study were excluded.
Prior to the start of the study ethical clearance was obtained from the Institutional Ethics Committee of the concerned University. Written informed consent was obtained from the study participants. The procedures followed were in accordance with the Helsinki Declaration of 1975. Prior to the start of the study, permission to conduct the study was obtained from the concerned Cancer hospital in Chennai. A pretested interviewer administered questionnaire was used to assess the socioeconomic status of oral cancer patients. Data collection was scheduled for a period of one month. Socioeconomic status was assessed using Pareek's scale  for rural population and Kuppuswamy's scale  for urban population.
Pareek's Scale is based on nine Characteristics
The reliability of the scale was found to be very high (r = 0.93). After filling the information, and scoring the individual items, the total score is summed up.
- Occupation of the head of the family
- Education of the head of the family
- Level of social participation
- Land holding
- Farm power (Bullocks, Tractors, Ox, Sheep, Horse etc.)
- Material possession
- Type of family
Socioeconomic Status Scale of Kuppuswamy:
This classification uses per capita income derived by calculating total income of all members of the family and dividing it by the number of family members. The income categories are based on the All India Consumer Price Index for industrial workers. The scale is based on three variables- education, occupation and income. A weightage is assigned to each variable according to a seven point pre-defined scale. The total of the three weightages gives the socioeconomic status score which is graded to indicate five classes.
Data was entered in Microsoft Excel spreadsheet and analysed using SPSS software (version 15). Chi square test was used to test the statistical significance in difference in prevalence of oral cancer among different occupations and different levels of literacy and it was found to be highly significant (P = 0.000).
| » Results|| |
The study sample consisted of 266 study subjects with oral cancer. Both the rural and urban population were included in the study and it had almost equal representation. [Table 1] shows the distribution of study subjects according to the age groups and gender.
Among the study subjects, 181 (68%) were males and 85 (32%) were females. The age group of the study subjects ranged from 20 to 83 years. 31.9% of the males belonged to the 51 - 60 years age group. 33% of the females belonged to the 60 years and above age group.
Based on location, 138 (51.87%) study subjects were residing in rural areas and 128 (48.12%) study subjects were residing in urban areas. Based on religion, 212 (79.7%), 35 (13.20%), 19 (7.10%) were Hindus, Christians and Muslims respectively. Based on marital status, 253 (95.10%) were married, 12 (4.50%) were single and 1 (0.40%) study subject was a widow.
[Figure 1] shows the distribution of study subjects based on age group and level of literacy residing in rural areas. Among the 138 study subjects, 77 (55.8%) were illiterates and 61 (44.2%) were literates. 18.1% of illiterates belonged to the age groups of 41-50 and 51-60 years. 13.76% of literates belonged to the age group of 51-60 years.
|Figure 1: Distribution of study subjects based on level of literacy (Rural)|
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[Figure 2] shows the distribution of study subjects based on age group and level of literacy residing in urban areas. Among the 128 study subjects, 28 (21.9%) were illiterates and 100 (78.1%) were literates. 9.4% of illiterates belonged to the age group of 51-60 years. 24.2% of literates belonged to the age group of 60 years and above.
|Figure 2: Distribution of study subjects according to level of literacy (Urban)|
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Among the 138 rural study subjects, unemployed study subjects constituted 40 (28.9%), unskilled workers constituted 23 (16.7%), semiskilled workers constituted 3 (2.22%), skilled workers constituted 2 (1.4%), clerical workers, shopkeepers or farmers constituted 67 (48.5%) and semi-professionals constituted 3 (2.2%). The difference in prevalence of oral cancer among different occupations (Pareek's scale) was found to be significant statistically (P = 0.000).
Among the 128 urban study subjects, unemployed study subjects constituted 33 (25.7%), unskilled workers constituted 34 (26.56%), semiskilled workers constituted 7 (5.46%), skilled workers constituted 13 (10.15%), clerical workers, shopkeepers or farmers constituted 24 (18.8%), semi-professionals constituted 8 (6.25%) and professionals constituted 9 (7%). The difference in prevalence of oral cancer among different occupations (Kuppuswamy's scale) was found to be significant statistically (P = 0.000).
[Figure 3] shows the distribution of study subjects based on family income and location. Among the 266 study subjects, 131 (94.9%) from rural areas and 92 (71.9%) from urban areas had family income below Rs.5000.
|Figure 3: Distribution of study subjects based on family income and location|
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The socio economic status based on Pareek's classification in rural areas showed that 68 (49.3%) of the study subjects belonged to the lower class, 57 (41.3%) belonged to the lower middle class, 8 (5.8%) belonged to the middle class and 5 (3.6%) were below poverty line.
The socio economic status based on Kuppuswamy's classification in urban areas showed that 67 (52.3%) study subjects belonged to the upper lower class, 25 (19.5%) study subjects belonged to the lower middle class, 15 (11.7%) study subjects belonged to the upper middle class, 12 (9.4%) study subjects belonged to the lower class and 9 (7%) study subjects belonged to the upper class.
| » Discussion|| |
Given that not many studies of this nature have been conducted formally in the study setting, the present cross sectional study was done to obtain baseline information on the socio demographic profile among the oral cancer patients and to ascertain its validity as a risk factor in the occurrence of oral and pharyngeal cancer.
In the current study, majority of oral cancer patients belonged to the 51-60 years age group. Males had higher prevalence of oral cancer in the all the age groups when compared to females. This was in accordance with the study by Khandekar et al.  High proportion of cancer among males may be due to high prevalence of tobacco consumption habits among males. ,
Most of the study subjects belonged to lower middle and upper lower socio economic scale (urban) and to the lower and lower middle class (rural). This was similar to findings of the same study by Khandekar et al. The lower socioeconomic status may be a risk factor for poor oral hygiene thereby further increasing the risk of oral cancer in tobacco consumers.  Since tobacco consumption was not considered in this study, further associations cannot be made in this regard.
The risk of oral cancer is inversely proportional to increasing level of education, income and occupation. True to this statement, about 48.5% rural subjects had agriculture as a source of occupation and 26.6% urban subjects were unskilled workers. The difference in prevalence of oral cancer among different occupations was found to be significant statistically. In both rural and urban subjects, majority (i.e.) 94.9% and 71.9% had family income below Rs.5000. The percentage of illiterates was high both in rural and urban class (i.e.) 55.8% and 21.9% respectively. The difference in prevalence of oral cancer among different levels of literacy was found to be significant statistically. These findings are consistent with similar study conducted by Abdoul et al.  in cancer institute at Pune, which concluded low education, occupation and low monthly household income as significant independent risk factors for oral cancer.
In terms of religion majority (79.7%) belonged to Hindu religion followed by 13.2% Christians and 7.10% Muslims. While marital status has shown that the category of married was 95.10% and others constituted 4.9%. Similar results in terms of distribution according to religion was found in study by Abdoul et al.  It was found that religion and marital status did not show any association with the development of oral cancer independently and neither of them appeared to increase the risk, either in males or females.
The limitations of this study includes that tobacco use pattern was not recorded. Cross sectional nature of the study precludes any causal relationship. The education and occupation data were based on self reports. In addition the complexities of obtaining, recording and coding occupational data can lead to misclassification. Data was collected on individual level and not the household level and thus the data on socio economic position may have been incomplete in case of women. Case and control comparisons were not possible.
| » Conclusion|| |
The present data will serve as a part of initial data collection effort. Though the study is hospital based and is representative, it represents only people obtaining treatment during the duration of the study. Moreover, extrapolation of results to the varied general population is not possible in this study. Identifying occupation and education specific disparities in tobacco use can provide useful 'signspot' indicating inequalities that need to be addressed by policy makers and broader community through allocation of resources.
| » Acknowledgments|| |
We would like to thank our department Bio-statistician, Mr. Jayapal for helping us in statistical analysis of the study.
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[Figure 1], [Figure 2], [Figure 3]
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