RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MISS RAJANI DARAI
1st YEAR MSc. NURSING
CHRISTIAN COLLEGE OF NURSING No.150/6, HORAMAVU- AGARA HENNUR MAIN ROAD K.R. PURAM HOBLI, BANGALORE-560043
2. / NAME OF THE INSTITUTION / CHRISTIAN COLLEGE OF NURSING No.150/6, HORAMAVU- AGARA HENNUR MAIN ROAD K.R. PURAM HOBLI, BANGALORE-560043
3. / COURSE OF THE STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING MEDICAL AND SURGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 7-5-2012
5. / TITLE OF TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON PREVENTION AND EARLY SYMPTOMS OF UTERINE AND BREAST CANCER AMONG WOMEN AT SELECTED RURAL AREA OF BANGALORE

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“Health is not mainly an issue of doctor’s social services and hospitals. It is an issue of social justice”

According to World Health Organization (1948), “Health is a state of complete physical, mental and social wellbeing and not merely an absence of disease or infirmity”. The state of positive health implies the nation of “perfect functioning” of the body and mind. Health promotion is the process of fostering awareness influencing attitudes and identifying alternatives so that people can make informed choices and change behaviors to achieve an optimum level of physical and mental health and this is the primary responsibility of the health care professions.

In countries with a westernized lifestyle about half of all deaths are caused by circulatory disease and a quarter by cancer. Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA. Cancer is an important problem in both public health and political terms worldwide, irrespective of a country’s development. The most recent estimates of the global cancer burden suggest that there were 8.1 million new cases, excluding non-melanoma skin cancer, worldwide in 1990. About10 million new cases are now diagnosed each year.

In India it is estimated that there are 2 to 2.5 million cancer patients at any given point of time with about 0.7 million new cases coming every year and nearly half die every year. Two-third of the new cancers is presented in advance and incurable stage at the time of diagnosis. More than 60% of these affected patients are in the prime of their life between the ages of 35 and 65 years. With increasing life expectancy and changing life styles concomitant with development, the number of cancer cases will be almost three times the current number. It has long been realized that cancers of the head and neck in both sexes and of the uterine cervix in women are the most common malignancies seen in the country. The age adjusted incidence rate per 100,000 for all types in India in urban areas range from 106-130 for men and 100-140 for women but still lower than USA, UK and Japan rates. 50% of all male cancers are tobacco related and 25% in female (total 34% of all cancers are tobacco related). There are predictions of incidence of 7 fold increase in tobacco related cancer morbidity in between 1995-2025. To control this problem the Govt. of India has launched a National Cancer Control Programme in 1975 and revised its strategies in 1984-85 stressing on primary prevention and early detection of cancer.

Cancer of the uterine endometrium (fundus or corpus) is the fourth most common cancer in women. Most uterine cancers are endometrioid (ie, originating in the lining of the uterus). Type 1, which accounts for the majority of cases, is estrogen related and occurs in younger, obese, and perimenopausal women. It is usually low grade and endometriod. Type 2, which occurs in about 10% of cases, in high grade and usually serous cell or clear cell. It affects older women and African American women. Type 3, which also occurs in about 10% of cases, is the hereditary or genetic types, some of which are related to the Lynch II syndrome. (This syndrome is associated with the occurrence of breast, ovarian, colon, endometrial, and other cancers throughout a family). Cumulative exposure to estrogen is considered the major risk factor. Other risk factors include age above 55years, obesity, early menarche, late menopause, nulliparity, anovulation, infertility, and diabetes, as well as use of tamoxifen.

Cancer of breast is a pathologic entry that starts with a genetic alteration in a single cell and may take several years to become palpable. The most common histological type of breast cancer is infiltrating ductal carcinoma (80% of cases), whereby tumors arise from the duct system and invade the surrounding tissues. Infiltrating ductal and lobular carcinomas usually spread to bone, lung, liver, adrenals, pleura, skin or brain. Several less common invasive cancers, such as medullary carcinoma (5% of cases), muninous carcinoma (3% cases), and tubular ductal carcinoma (2% cases) have very favorable prognosis. Inflammatory carcinoma and Paget’s disease are less common forms of breast cancer, but if left untreated, there is an increased likelihood that it will progress to invasive cancer. There is no one specific cause of breast cancer; rather, a combination of genetic, hormonal, and possible environmental events may contribute to its development. If lymph nodes are unaffected, the prognosis is better. The key to improved cure rates is early diagnosis, before metastasis.

6.2 NEED FOR THE STUDY

Every country in the world is focusing towards the Destiny of “Health for all”. We are also confronted by various challenging health problems, thus making the journey a moment task. Besides the existing problems, the emerging problems have possessed a great threat to the health care delivery system. Cancer diseases remain a major public health problem in developed countries due to industrialization, changes in lifestyles, population growth and increase in the proportion of elderly persons, despite advances for diagnosis and treatment. It was reported that approximately over 10 million new cases of cancer (5.3 million men and 4.7 million women) occurred in 2000 and over 6 million people died from cancer in the world (Parkin et al, 2001). According to the National Center for Health Statistics there will be approximately 1,334,000 new cases of cancer in 2003 and about 556,500 deaths due to the disease in the United States

Uterine cancer is the most common cancer of the female reproductive organs, affecting 1 in every 41 American women. The good news is that it's highly curable, with a survival rate of up to 95%. When doctors use the term endometrial cancer, they are typically referring to what's known as a carcinoma that begins in the endometrium, or the inner lining of the uterus. The cells in these cancers fall in to one of two categories: 1) Those that are near-normal in appearance, slow-growing and less likely to spread or 2) those that tend to grow and spread quickly. Another form of uterine cancer, accounting for only 5% of diagnoses, is called a "sarcoma," which starts in the uterine muscle wall and may spread to the endometrium. It is generally considered a separate condition and has a five-year survival rate of 50% when diagnosed in its earliest stage.

According to the American Cancer Society, some 40,000 women are diagnosed with endometrial cancer each year, most of them post-menopausal. Pelvic pain and weight loss usually indicate a more advanced stage of the disease. Vaginal bleeding is a symptom of 90% of patients; therefore, immediately report any unusual bleeding to your gynecologist to ensure the best chances of early diagnosis. The balance of estrogen and progesterone between menstrual periods protects women from endometrial cancer until menopause.

Breast is the important organs for each woman as these are the symbols of motherhood and women hood. Breast cancer is probably the most feared cancer in women because its frequency and psychosocial impact. It affects the perception of sexuality and self image to a degree great than any other cancer. Breast cancer is also the most common malignancy in women, accounting for 27% of all female cancers; it accounts for < 1% of all cancer cases in men. Breast cancer also is responsible for 15% of cancer deaths in women, making it the number-two cause of cancer death. An estimated 230,480 new breast cancer cases will be diagnosed in women and 2,140 new cases will be diagnosed in men in the United States in 2011, and 39,970 women and 450 men will die of this cancer. As of 2011, there are approximately 2.9 million breast cancer survivors in the United States.

Worldwide, breast cancer is the most common invasive cancer in women. Breast cancer is more than 100 times more common in women than in men, although men tend to have poorer outcomes due to delays in diagnosis. In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women and 6.0% of all cancer deaths for men and women together). The World Cancer Research Fund indicated that women can reduce their risk of breast cancer by maintaining a healthy weight, drinking less alcohol, being physically active and breastfeeding their children. These modifications might prevent 38% of breast cancers in the US, 42% in the UK, 28% in Brazil and 20% in China. The benefits with moderate exercise such as brisk walking are seen at all age groups including postmenopausal women.

As the researcher I have noticed that one of the neighbor women got suffering from breast cancer for past three years, while communicating with the women the researcher understand that, the women had lack of knowledge regarding early identification and prevention of breast abnormalities. She started taking treatment for the same in reputed hospital with all symptomatic treatment, she died, and this incidence motivated the researcher to select this topic for women’s.

6.3 REVIEW OF LITERATURE

Review of Literature is organized under the following headings.

6.3.1 Studies related to knowledge on Uterine and Breast Cancer

6.3.2 Studies related to prevention and early symptoms of Uterine and breast Cancer

6.3.3 Studies related to effectiveness of Planned Teaching Programme

6.3.1 Studies related to knowledge on Uterine and Breast Cancer

Study of ovarian and endometrial cancer was conducted among female residents of Warsaw and Lodz (Poland) between 2001 and 2003. We identified all women with histologically-confirmed ovarian and endometrial carcinoma through a rapid ascertainment system in participating hospitals and cancer registries. The collection of biological specimens includes blood, urine, and paraffin embedded tumor tissue. Control women were randomly selected from complete population lists and were frequency matched to cases on age and study site. A personal interview and blood/mouthwash sample was collected. A total of 347 women with invasive ovarian cancer and 555 women with endometrial cancer were enrolled. We share 2,798 controls between breast, ovarian, and endometrial cancer cases. We have recently constructed tissue microarrays including tumor samples from approximately 200 ovarian cancer cases and 300 endometrial cancer cases for immunohistochemical analyses. We are currently extracting nucleic acids from tissue cores to create a resource for DNA-based studies.

A study conducted to assess the knowledge of breast cancer detection practices of 57 South Asian women aged 40 years and over, residing in Toronto, Canada, Chaudhury and Srivasatava who’s paper was published in Oncology Nursing Forum in November 1998 and founded that only 12% of the participants practiced BSE monthly and a majority (i.e. 54%) said that they did not know much about breast cancer. Our study revealed a similar percentage of BSE performers (12% claimed they were regular while 23% were irregular performers) and overall awareness level about breast cancer of 52%. The investigators used an interview guide designed specifically for their study. Our study too incorporated a similar self designed interview. Whereas Chaudhury and Srivasatava’s interview additionally contained questions assessing the variables of the Health Belief Model and also health motivators, ours did not include this aspect. The data were obtained during face to face interviews in the primary language of the participants similar to the manner in which we collected our data.

A study was conducted to determine the effectiveness of a STP on the knowledge, attitude & practice of breast cancer & breast self examination to women admitted to Gynecological ward of Christian medical college & hospital Vellore using simple random sampling 40 subjects were selected through an interview. The selected sample was given a pretest after STP on breast cancer & demonstration on breast self examination was given. The post test was conducted on the 3rd day to assess the effectiveness of the structured teaching. It was found that there was a gross inadequacy (98%) in the patients knowledge regarding breast self examination in the pre test. The STP showed a significant improvement (P<0.001) in the knowledge regarding breast self examination.

6.3.2 Studies related to prevention and early symptoms of Uterine and breast Cancer

Continued advances study in cancer research related to detection, and treatment have resulted in a decline in both incidence and death rates for all cancers. Among people who develop cancer, more than half will be alive in 5 years. Yet, cancer remains a leading cause of death in the United States, second only to heart disease. The cancer objectives for Healthy People 2020 support monitoring trends in cancer incidence, mortality, and survival to better assess the progress made toward decreasing the burden of cancer in the United States. The objectives reflect the importance of promoting evidence-based screening for cervical, colorectal, and breast cancer by measuring the use of screening tests identified in the U.S. Preventive Services Task Force (USPSTF) recommendations. The objectives for 2020 also highlight the importance of monitoring the incidence of invasive cancer (cervical and colorectal) and late-stage breast cancer, which are intermediate markers of cancer screening success. In the coming decade, as the number of cancer survivors approaches 12 million, understanding survivors’ health status and behaviors will become increasingly important.