ISSN- 0301-1216 Indian J. Prev. Soc. Med. Vol. 43 No.4, 2012 KNOWLEDGE OF CANCER PATIENTS WITH REGARD TO DISEASE AND MEDICAL CARE Aparna Rai 1, CP Mishra 2, Anand Kumar 3, S Pradhan 4 ABSTRACT Backgrounds: Knowledge about the disease, types of available medical care and existence of health care facilities in the vicinity, is likely to have significant impact upon the utilization of health services by the cancer patients. Aim of Study: This aspect was explored by interviewing 264 breast cancer and 436 cervical cancer patients. Results: Only 2.3 percent subjects were aware about the causes of disease majority (86.3%) were knowledgeable about different systems of medicine. Only 289 (41.3%) subjects consulted doctor for any illness Maximum number of patients (56.1%) availed Allopathic treatment, 8.4% availed Homeopathy treatment and 35.4% patients availed none of them. There is a need and scope for enhancing awareness in the community about disease and the existing health facilities. Key Words: Health facility, Misconception, Awareness about cancer INTRODUCTION burden. 1 Worldwide, breast cancer is the most prevalent cancer among women, being responsible for 10.4% of the global Among Indian women, breast cancer is the second most common cancer after cancer of the Uterine cervix and is already the leading cancer in certain cities such as Mumbai, Delhi, Nagpur and Trivandrum. 2 In developed countries, breast cancer is the most common cancer in women, whereas cancer cervix occupies the top rank among cancer in women in developing countries. 3 Worldwide, cervical cancer is the second most common cancer and the major cause of cancer deaths among women. 4 Incidence and mortality rates in breast and cervix cancer vary widely from one region of the world to another. The variation is attributed to environmental factors and differences in diet and lifestyle. With its high incidence rates and relatively good prognosis (and a reducing mortality rate), breast cancer is the most prevalent caner in the world today with an estimated 4.4 million survivors up to five years following diagnosis compared with just 1.4 million survivors male or female from lung cancer. 5 Breast and cervix cancer can have an unbearable impact on a woman s felling of well being, wholeness, sexuality and attractiveness to varying degree. Thus, women s choice of treatment can be influenced by her age, her belief and cultural background, religion and faith as well as her hope and fears. Younger women appear to have more difficulties, especially suitor-marriage, childbearing issues or societal- expected issues. 1. Research Scholar, Departments of Radiotherapy and Radiation Medicine, IMS, BHU, Varanasi-5. 2. Professor & Head, Department of Community Medicine, IMS, BHU, Varanasi-5. 3. Professor, Department of Surgery, IMS, BHU, Varanasi-5. 4. Professor & Head, Departments of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi- 221 005 Indexed in : Index Medicus (IMSEAR), INSDOC, NCI Current Content, Database of Alcohol & Drug Abuse, National Database in TB & Allied Diseases, IndMED, Entered in WHO CD ROM for South East Asia.
The nature of breast and cervix cancer illness, the severity, the treatment and side-effects coupled with many other personal environmental factors like personality, finance, lifestyle prior to the illness and the access and level of social support, impact the ability to journey and adjust to the realities of this long term condition. Mental distress can occur in response to the uncertainty of recurrence of disease, leading to depression and complicated grief. They need to be given the message that breast and cervix cancer is highly prevalent and can affect anyone but at the same time can be treated. 6 AIMS AND OBJECTIVES The aim and objectives of the present study are: 1. Determine the level of knowledge regarding breast and cervix cancer in the study population. 2. Assess the level of awareness about medical care among women included in the study. METHODOLOGY The present study carried out in the Department of Radiotherapy & Radiation Medicine I.M.S B.H.U was conducted during the period July 2008 to July 2011. The design adopted for this study was that of a Hospital Based cross sectional study. The patients attending OPD of one consultant of Dept of Radiotherapy and Radiation Medicine and one consultant of Department of surgery were included in the study. Total numbers of breast cancer patients were 264 and cervix cancer patients were 436. The total study sample comprise of 700 patients A self structured interview proforma was prepared and patient interviews were taken accordingly. In addition to gathering demographic and financial information, the interview assessed a wide range of psychosocial and health-related variables. In this report, we focus on patients knowledge, care-seeking behaviors, and utilization and availability of medical care. Patients knowledge was assessed in two areas. First, patients were questioned about their own disease (e.g., site of the cancer) and its causes and treatment. The question was aimed at assessing participants health seeking behaviour. The interview schedule was subdivided (so as not to make it a lengthy and repetitive one) and was to be answered in yes or no format. The interview schedule measured the knowledge about breast and cervix cancer in general, its risk and protective factors. Secondly, they were asked in general regarding the medicine system and availability of medical care near to their residential area. RESULTS Demographic Data: The characteristics of the 700 patients interviewed, are shown in Table-1. An equal percentage of the respondents belonged to the age groups 41-50 years and 51-60 years. Together, they constituted 66.88%. Few respondents (2.3%) were in the age group below 30 years, 18.6% of them were in the age group 31-40 years and 11.6% were in the age group 61-70 years. The remaining 7% were in the age group 70 years and above. Majority of the respondents were Hindu. Muslims constituted 6.6% and patients from other religion were not found in the sample. Majority of the respondents (43.9%) belonged to OBC category, while general category patients constituted 33.3% and Scheduled caste and Scheduled tribe respondents constituted, 22.1% and 0.7% respectively. Majority of the respondents (59.7%) were illiterate and only 4.4% were graduates or postgraduates. A significant proportion of women included in our study were uneducated (59.7%). However, there were a few women who were from a well educated background with 4.4% being either graduates or post-graduates. Indian J. Prev. Soc. Med Vol. 43 No. 4 434
Majority of the patients (87.7%) were housewives. Only 3.6% respondents were employees in government and private sector and 8.3% were labourers doing agriculture and other types of work. In the present study, 83.3% respondents were married and 111(15.9%) were widows. Of 700 respondents, 36.1% were from nuclear families and 63.9% were from joint families. With regard to habitation, 77.9% were from rural area and 22.1% belonged to urban area (Table-1). Thus, with regard to various general characteristics, the study had a mixed group of women. Knowledge about the Disease and Medical Care: From among the respondents, 50.6% believed that there were no effective treatment for cancer and that cancer could not be cured and 49.4% were of the opinion that cancer was curable. Only 2.3% had an idea about the cause of the disease. A number of questions were asked regarding the availability of medical facilities near their place of living. Question was also asked regarding their knowledge of available medical systems. Their responses to these questions are shown in Table-2. The study suggests that 13.7% were not aware of the different systems of medicine that are available. However, a large number of subjects were aware of various systems of medicine. The next question was related to the availability of medical facility at native place. Only four hundred fifteen patients (59.4%) had treatment facility available near their native place and the majority of them (245 of 416 or 58.9%) had primary health center, and 157 of 415 (37.7%) had all types of facility (Primary Health Centre, Private Hospital, Government hospital), near the native place. Age in years Religion Caste Category Education Occupation Marital status Family Type Habitation Table-1: General characteristics of study subjects Patient Characteristics Socio-economic status No. (n=700) % 20-30 16 2.3 31-40 130 18.6 41-50 234 33.4 51-60 234 33.4 61-70 81 11.6 71-80 5 0.7 Hindu 655 93.4 Muslim 45 6.6 SC 155 22.1 ST 5 0.7 OBC 307 43.9 General 233 33.3 Nil 418 59.7 Primary 95 13.6 Secondary 61 8.7 High school 51 7.3 Inter 45 6.4 Graduate 21 3.0 Post Graduate 9 1.3 House wife 614 87.7 Govt./Pvt. job 25 3.6 Labourer 58 8.3 Student 3 0.4 Married 583 83.3 Unmarried 6 0.8 Widow 111 15.9 Nuclear 253 36.1 Joint 447 63.9 Rural 545 77.9 Urban 155 22.1 Very low 18 2.6 Low 75 10.7 Lower middle 131 18.7 Middle 227 32.4 Upper middle 163 23.3 High 86 12.3 Indian J. Prev. Soc. Med Vol. 43 No. 4 435
However, when taking into consideration all 700 patients, only 245 of 700 or 58.9% patients had Primary Health Centre and 157 of 700 (37.7%) had all the three type of facilities near their native place. Only 1.4% respondents had access to free medical facilities. DISCUSSION Knowledge about health and health care are important determinants of health behavior. When knowledge is based on incomplete or erroneous information, inappropriate health behaviors may follow. Thus, if the knowledge and beliefs people possess regarding the etiology of cancer and its treatment are inaccurate, we would expect inappropriate care-seeking behaviors. When erroneous beliefs lead to a delay in therapeutic intervention, they may contribute to inferior survival outcomes. Although knowledge is not a sufficient condition for appropriate careseeking, it is certainly a necessary one. 7 Chaudhury and Srivasatava found that majority (54%) said that they did not know much about breast cancer. 8 Stephanie et al conducted a research on Screening for Breast Cancer and Cervical Cancer in Germany. Table-2: Patient s knowledge about cancer, systems of medicine and use of health care facilities Parameters No. % Type of Disease Breast cancer 264 37.7 Cervix cancer 436 62.3 Knowledge about disease Yes 16 2.3 No 684 97.7 Consider disease curable Yes 346 49.4 No 354 50.6 Knowledge about different systems of medicine Type of treatment facility available at native place Type of medical system respondent prefer most Treatment patients avail Consultation of doctor for illness If No for Consultation of doctor for illness, why Yes 604 86.3 No 96 13.7 Primary health center 244 58.9 Private hospital 8 1.9 Government hospital 6 1.4 All the above types 157 37.7 No available facilities 284 40.6 Allopathy 558 79.7 Ayurveda 2 0.3 Homeopathy 138 19.7 None of them 2 0.3 Allopathy 393 56.1 Homeopathy 59 8.4 None of them 248 35.4 Yes 411 58.7 No 289 41.3 Auto recovery 4 0.6 Home remedy 103 14.7 Self use of medicine 61 8.7 Expensive 15 2.1 Any other 106 15.1 Free medical facilities Yes 10 1.4 No 690 98.6 They noted that knowledge about available procedures for early detection of breast cancer was good and rates of BSE were high (43%). 9 In the present study, with Indian women, 97.9% of sample had less than adequate knowledge about breast and cervix cancer. Our study included mainly middle aged and older women (40-60 years) and only 2.3% women knew about the cause of the disease and 49.9% considered that disease is curable. Wardle et al. involved young women between 17 to 30 years of age in their study and evaluated the attitudes to BSE and their results showed that 54% of women reported as never having practiced BSE. 10 Bener et al. conducted a survey to evaluate knowledge, attitudes and practices related to breast cancer screening among 1750 Arabic women aged 40 to 65 years, and reported that knowledge about breast cancer screening was low and only 12.7% of the study population practices BSE. 11 In our study, 97.7% women had no adequate knowledge about the disease and overall awareness was present in only 2.3%. Indian J. Prev. Soc. Med Vol. 43 No. 4 436
Sanchez et al. found no statistically significant correlation between knowledge and early detection practice and also noted that a higher socio-economic status correlated positively with BSE performance, as did age. 12 In our study too, we found that women belonging to a higher social class were more aware than those who were economically challenged, and younger women were more aware than older ones. CONCLUSIONS This study revealed that the respondents lacked knowledge of vital issues related to breast and cervix cancer. Breast and cervix cancer awareness was found to be very faint in our study (2.3%) which substantiates the fact that it is important to educate the middle aged, average Indian woman about this disease. Knowing facts about breast cancer will help us move together to reach the common goal- prevention. Knowledge must be spread via mass media since this avenue is available to a large number of people and was stated as an important source of information. Spreading awareness amongst the general public is the need of the hour and should be advocated by means of effective educational programmes. REFERENCES 1. Stewart BW, Kleihues P. (Eds.). World Cancer Report, Lyon, IARC Press, 2003:188-93. 2. Chopra R. The Indian Scene. Journal of Clinical Oncology 2001, 19 No. 18S (Sept. 15 Supplement): 160S. 3. WHO/IARC (2001). Biennial Report (2000-2001). Published by Lyon, France, IARC, 2001. 4. WHO/IARC (2000). Biennial Report (1998-1999). Published by Lyon, France. 5. Parkin DM, Bray F, Ferlay J et al. Global Cancer Statistics, 2002. CA Cancer J Clin 2005, 55 (2):74-108. 6. Loh SY, Packer T Yip CH et al. Perceived barriers to self management in Malaysian women. Asia Pac J Public Health 2007, 19(3): 52-7. 7. Loehrer PJ, Sr. HA Greger et al. Knowledge and beliefs about cancer in a socio-economically disadvantaged population. Cancer, 1991, 68: 1665-71. 8. Chaudhury UK, Srivastava R, Fitch MI. Breast cancer detection practices of south Asian women: knowledge, attitudes and beliefs; Oncology Nursing Forum 1998, 25(10): 1693-701. 9. Stephanie J. Klug, Melanie Hetzer, Maria Blettner; Screening for breast and cervical cancer in a large German city: participation, motivation and knowledge of risk factors. European Journal of Public Health 2005, 15(1): 70-77. 10. Wardle J, Steptoe A, Smith H, Groll- Knapp E, Koller M, Smith D, Brodziak A. Breast self examination: attitudes and practice among young women in Europe. European Journal of Cancer Prevention 1995, 4(1): 61-8. 11. Abdulbadri Bener, Rafie Alwash, Campbell J Miller et al. Knowledge, attitudes, and practices related to breast cancer screening: a survey of Arabic women. Journal of cancer education 2001, 16(4): 215-20. 12. Sanchez Ayender M, Suarez Perez E, Vazquez MO, Velez- Almodovar H, Nazario CM. Knowledge and beliefs of breast cancer among elderly women in Puerto Rico; P R Health Science Journal; 2001, 20(4): 351-9. ---- Indian J. Prev. Soc. Med Vol. 43 No. 4 437