PROFORMA FOR REGISTRATION
OF
SUBJECT FOR DISSERTATION
SUBMITTED BY:
Ms. CHAITRA.G.N.
1st year M.Sc Nursing
COMMUNITY HEALTH NURSING,
2010-2012BATCH,
ORIENTAL COLLEGE OF NURSING,
BANGALORE -560044.
1 / NAME OF THE CANDIDATE AND ADDRESS / Ms.Chaitra.G.N1st year MSc nursing Oriental college of nursing
#43/52,2nd main, Industrial town
West of chord Road, Rajajinagar
Bengaluru-560044.
2 / NAME OF THE INSTITUTION / Oriental College of Nursing.
3. / COURSE OF THE STUDY AND SUBJECT / I st year M.Sc. Nursing.
[Community Health Nursing]
4. / DATE OF ADMISSION OF COURSE / 07.07.2010
5. / TITLE OF THE STUDY / “A Study to evaluate the effectiveness of Mass awareness Program on knowledge and attitude regarding oral cancer among adults in selected community ,Bengaluru.”
6 / BRIEF RESUME OF THE INTENDED WORK
6.0 INTRODUCTION
6.1 NEED FOR THE STUDY
6.2 REVIEW OF LITERATURE
6.2.1STATEMENT OF THE PROBLEM
6.3OBJECTIVES
6..3.1OPERATIONAL DEFNITIONS
6.3.2 ASSUMPTIONS
6.3.3HYPOTHESIS
6.3.4SAMPLING / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7 / MATERIALS AND METHODS
7.1 Source of data-Data will be collected from the adults aged 20-40years.
7.2 Method of data collection: Interview method.
7.3 Does the study require and investigation or interventions to be conducted
on the patients or other human being or animals ? Yes.
7.4 Has ethical clearance been obtained from your institutions?
Yes, ethical committee's report is here with enclosed.
KARNATAKA, RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANIDATE AND ADDRESS / MS.Chaitra.G.NI st year M.Sc. Nursing
Oriental College of Nursing
#43/52,2nd Main
Industrial town, West of
Chord Road, Rajajinagar,
Banaglore – 560 044..
2 / NAME OF THE INSTITUTION / Oriental College of Nursing
Banaglore – 560 044.
3 / COURSE OF THE STUDY AND SUBJECT / I st year M.Sc. Nursing
Community Health Nursing
4 / DATE OF ADMISSION / 07.07.2010
5 / TITLE OF THE STUDY / “A study to evaluate the effectiveness of Mass awareness program on Knowledge and attitude regarding oral cancer among adults in selected community, Bengaluru
6. BRIEF RESUME OF THE INTEDNDED WORK
6.0 INTRODUCTION
“Why should society feel responsible only for the education of children, and not for the
education of all adults of every age?”
Erich formm
Oral cancer or oral cavity cancer, a subtype of head and neck cancer, is any cancerous tissue growth located in the oral cavity. It may arise as a primary lesion originating in any of the oral tissues, by metastasis from a distant site of origin, or by extension from a neighboring anatomic structure, such as the nasal cavity or the maxillary sinus. oral cancer is part of a group of cancer called head and neck cancers. Oral cancer begin in tongue and floor of the mouth. Almost all of oral cancers begin in the flat cells squamous cells that cover the surface of the mouth , tongue and lips.1
The most common site for oral cancer in the older age group was the buccal mucosa (37%), Followed by tongue (21%) and gingiva (20%)2. It is among the most common cancers seen in both Indian men and women as can be gauged from the records of the National CancerRegistry Programme.
Tobaccouse is associated with about 75 percent of oral cancer cases, caused by irritation of the mucous membranes of the mouth from smoke and heat of cigarettes, cigars, and pipes. Tobacco contains over 60 known carcinogens, and the combustion of it, and by products from this process, is the primary mode of involvement. Use of chewing tobacco or snuff causes irritation from direct contact with the mucous membranes3.
Cancers in all forms are causing about 12% of deaths throughout the World. In the developed countries cancer is the second leading cause of death accounting for
21%(2.5million) of all mortality . There is a significant difference in the incidence of oral
cancer in different regions of the world4.
90% of the patients with the oral cavity and the oropharyngeal cancer use tobacco and the of developing these cancer increases with the amount smoked or chewed and
duration of the habit.
An estimated 36,540 new cases of oral cancer are expected to diagnosed in the united states in 2010 and an estimated 7,880 people will die of the diseases. This form of cancer accounts for about 3% of cancer in men and 2% of cancers in women. Oral
cancer occurs more frequently in blacks than in whites. In 2008, in the US alone, about
34,000 individuals were diagnosed with oral cancer. 66% of the time these will be found as late
stage three and four disease. Low public awareness of the disease is a significant factor, but these
cancers could be found at early highly survivable stages through a simple, painless, 5 minute
examination by a trained medical or dental professional5.
More than 90% of cancers occur in patient older than 40 years. The incidence increases steadily until age 65 years. Reports have noted a substantial increase in the adults younger than 40 years in the united states between 1973 and 1997. Primary factor for oral cancer in American men and women are tobacco and alcohol use.
India has one of the highest incidence of oral cancer in the world. The highest incidence of oral cancer and precancerous lesions in India has long been linked with the habit of betel quid chewing incorporating tobacco. In India it is estimated that 63.5% of
population is under the age group of 15-64 years. Males are found 349,785,804 and
females 326,289,402. Oral cancer is well known to occur in the age group 40 and
above6.
In comparison with the U.S. population, where oral cavity cancer represents only about 3% of malignancies, it accounts for over 30% of all cancers in India.
In Karnataka in 2010, it was found that nearly 10,000 of the 36,000 fresh cases of cancers reported every year were that of oral cancer. Over the last five years oral
cancers among youngsters has gone up , with six per hundred thousand population
between 20 and 44 years affected.
Bengaluru has the highest (incidence) number of cab drivers, among them habit of
chewing tobacco among them is very high and are at high risk for oral cancer
.
Oral cancer ranks number one among man and number three among women in India. Oral cancer constitutes 12% of all cancers among in men and 8% of all cancers among women. In India it is estimated that among the 400 million individuals aged 15 years and over 47% use tobacco in one form or the other. Annual incidence rate is estimated to be 64,640.
Oral cancer has been found to be more prevalent among men compared to women; the
associated sex ratio was 2.5:1. This ratio seems to be vary from one study to the other in India
for example Sankaranarayanan et al. (1990) has reported almost the e ratio (2:1) and Mehrotra.
(2003) has shown higher ratio (3.27); while lower ratios have been reported by Chattopadhyay
(1989) . It may be due to the more exposure to risk factors such as tobacco and alcohol by men
compare to women. According to Subramanian et al. (2004), in India men are considerably
more likely to smoke as well as chew tobacco than women7.
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 It is the sixth most common cancer reported globally with an annual incidence of over 300,000 cases, of which 62% arise in developing countries8.
Survival rates for oral cancer depend on the precise site, and the stage of the cancer at diagnosis. Overall, survival is around 50% at five years when all stages of initial diagnosis are considered. Survival rates for stage 1 cancers are 90%9, hence the emphasis on early detection to increase survival outcome for patients.
Improvements in knowledge regarding tobacco and alcohol use are needed. Future interventions might include educational programs and increased tobacco and alcohol cessation education in adults. Oral cancer awareness need to be increased, particularly among tobacco smokers.
6.1 Need For The study
Oral cancer is part of a group of cancers called head and neck cancers. Oral cancer can
develop in any part of the oral cavity or oropharynx. Most oral cancers begin in the tongue and
in the floor of the mouth. Almost all oral cancers begin in the flat cells (squamous cells) that
cover the surfaces of the mouth, tongue, and lips. These cancers are called squamous cell
carcinomas.
An adult is a human being or livingorganism that is of relatively mature age, typically
associated with sexual maturity and the attainment of reproductive age. a high incidence of oral
cancer among young2.
WHO has estimated that 91 per cent of oral cancers in South-East Asia are directly
attributable to the use of tobacco and this is the leading cause of oral cavity and lung cancer in
India The World Health Organisation considers adult to be the periods between 20-65
years. In India 15 to 65 years 63.5% male 349,785,804; female 326,289,402.
More than 90% of oral cancers occur in patients older than 40 years. The incidence
increases steadily until age 65 years, when the rate levels off. For the last 22 years, there have
been slight decreases in incidence and mortality rates. Reports have noted a substantial increase
in the incidence of oral cancer (particularly of the tongue) among adults younger than 40 years.
Oral cancer has been found to be more prevalent among men compared to women the
associated sex ratio was 2.5:1.
There is a significant difference in the incidence of oral cancer in different regions of
the world. The age-adjusted rates of oral cancer vary from over 20 per 100,000 population in
prevalence of oral cancer in South Asia has been linked to tobacco use particularly in
conjunction with chewing betel quid or 'pan'8.
In comparison with the U.S. population, where oral cavity cancer represents only about
3% of malignancies, it accounts for over 30% of all cancers in India. The variation in incidence
and pattern of oral cancer is due to regional differences in the prevalence of risk factors. But as
oral cancer has well-defined risk factors, these may be modified – giving real hope for primary
prevention8.
A retrospective study was conducted to study an incidence of oral cancer in
young adults it was a retrospective study. Data of oral cancer cases reported between 2002
and 2007 were retrieved from the records. The cases in patients below 40 years of age formed
a separate study group. The data obtained was tabulated and comparisons drawn on the observed
variables between the two groups. Results showed a high incidence of OSCC among young
adults. data revealed high incidence of oral cancer among young adults,the tongue is
the most common site of these cancers.
Thus, when the researcher was posted in community, researcher identified most
of the adults had the habit of tobacoo chewing both men and women. The tobacco
users were found to be having lack of knowledge and awareness regarding oral
cancer,signs and symptoms, all this created an interest for researcher and also felt that
there is an urgent need for creating awareness about oral cancer among tobacco chewers.
Public awareness about the risk factors and methods of early detection of oral cancer
are quite low. Those who consumed more 'pans' daily were significantly older, less literate, had a
lower educational attainment, and were more likely to believe that chewing tobacco was
beneficial
Hence the gap in the knowledge and attitude are growing risks and other sides
necessitate the need to systematically investigate the knowledge and attitude of adults
regarding oral cancer. It is also anticipated that this study may increase awareness among
adults regarding oral cancer and motivated the researcher to do this study.
6.2 REVIEWOF LITERATURE
The literaturefor present study is organized under the following headings.
1.Review of Literature related to knowledge regarding oral cancer.
2. Review of Literature related to Attitude regarding oral cancer.
3. Review of Literature related to Mass awareness program regarding oral cancer.
- Studies related to knowledge regarding oral cancer
A study on a population-based case–control investigation on cancers of the oral cavity in
Bangalore, India. A case-control study on cancers of the oral cavity was conducted by utilising
data from the population based cancer registry. Bangalore, India. Three hundred and forty-eight
cases of cancers of the oral cavity (excluding base tongue) were age and sex matched with
controls from the same residential area but with no evidence of cancer. The relative risk due to
pan tobacco chewing was elevated in both males and females, being appreciably higher in the
latter (relative risk 25.3%; 95% confidence interval 11.2-57.3). A statistically significant (linear
test for trend P less than 0.001) dose response based on years, times per day and period of time
chewed was seen. Thus it was concluded that tobacco chewing has highest risk for
developing oral cancer10.
A study conducted Changing trends in oral cancer, Calicut, India. Aim of the study the
cases of OSCC reported at our institution, with emphasis on the clinicopathologic variables in
young adults. This was a retrospective study of OSCC cases reported from 2002 to 2007. Data
of oral cancer cases reported between 2002 and 2007 were retrieved from the records. The cases
in patients below 40 years of age formed a separate study group Results showed a high
incidence of OSCC among young adults.The findings of our study indicate a high incidence of
oral cancer among young adults in our region. The tongue is the most common site in these cases
with a significant number showing no possible etiological factors11.
A study conducted by European School of Oncology Advisory Group has reviewed current
knowledge on the epidemiology, treatment and prevention of cancer of the oral cavity. While the
major factors in the aetiology of such cancers are thought to be well understood, i.e. tobacco and
alcohol consumption, current increases in the occurrence of the disease, especially in young
adults throughout Europe, are cause for concern. The reasons for such increases are not clearly
evident and the Advisory Group has suggested further work which is required to be carried out to
understand the aetiology. In treatment of the disease there have been no major improvements in
survival for patients in recent decades and the importance of examining new radiotherapy
modalities and defining the role of chemotherapy is emphasized. Primary prevention of oral
cancer could be achieved by stopping smoking tobacco, limiting alcohol consumption to a
minimum (2–3 drinks per day) and increasing intake of fruits and vegetables. To supplement
these actions, while neither population screening programmes nor screening trials could be
recommended by the Advisory Group, initial chemoprevention trials have produced some
promising results and this represents an interesting area which is the focus of much current
research12.
A study conducted on the effect of joint exposure to alcohol and tobacco on risk of cancer of
the mouth and pharynx The effect of joint exposure to smoking and alcohol on risk of
development of oral cancer was evaluated from a case-control study. Although a simple 2 × 2
relative risk table suggests almost complete synergy of the two exposures, regression analysis
and a more detailed relative risk table which reduces confounding demonstrate the definite
individual effects of the two exposures in addition to the synergistic effect. If smoking and
drinking both are causes of oral cancer—as the data suggest—then the removal of both will be
necessary to prevent a large proportion of the disease in males13.
A study on assessing knowledge of oral cancer risk factors, clinical signs, and oral
cancer examination experience among adults digitall dial and computer assisted interview
was conducted . Data from 1096 respondents revealed knowledge of one sign of oral
cancer, 4 on factors of oral cancer examination. Fourteen (95% confidence interval [CI] +/-
2) percent of adults had never heard of oral or mouth cancer. Risk factor knowledge was high for
56 percent (95% CI+/-3) and associated in a logistic regression model with younger age, feeling
personal factors cause cancer, and nonuse of snuff. One sign of oral cancer (sore/lesion, red or
white patch in mouth, and bleeding in the mouth) was correctly identified by 53 percent (95%
CI+/-3) with significantly more correct responses from younger people, nonsmokers, and some
college education. Only 29 percent (95% CI+/-3) reported ever having had an oral cancer
examination when this procedure was described. Most respondents reported exams performed by
dentists. In a weighted logistic regression model, older age, being dentate, nonsmokers, alcohol
users, and those with some college education were significantly more likely to report having ever
had an oral cancer examination. Then the study reveals there is moderate knowledge of risk
factors of oral cancers, knowledge deficit remain14
- Studies related to Attitude regarding oral cancer
A study conducted in Bangladesh on The use of tobacco and betel quid ('pan') among
Bangladeshi women by Summers RM, Williams SA, Curzon ME. The high prevalence of oral
cancer in South Asia has been linked to tobacco use particularly in conjunction with chewing
betel quid or 'pan'. However, it is not known whether and to what extent these habits are
practised by Asian people in the United Kingdom. Home based interviews using semi-structured
questionnaires were undertaken among 296 first generation Bangladeshi women 'Pan' was
reportedly chewed by 282 (95 per cent) of the women, of whom 174 (62 per cent) added tobacco
in leaf form, and 75 (27 per cent) as a component of zarda. Those who consumed more 'pans'
daily were significantly older, less literate, had a lower educational attainment, and were more
likely to believe that chewing betel quid was beneficial. Cigarette smoking was practised by 9
per cent, this group being older and having lived in the UK longer. Burnt tobacco leaves were
used as an oral hygiene aid by 20 per cent. Over half (58 per cent) of the sample had never