RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Miss. JERIN M.P,1ST YEAR MSc. NURSING STUDENT
RAJEEV COLLEGE OF NURSING,HASSAN
KARNATAKA.
2 / NAME OF THE INSTITUTION / RAJEEV COLLEGE OF NURSING HASSAN, KARNATAKA.
3 / COURSE OF THE STUDY
AND SUBJECT / MASTER OF SCIENCE IN NURSING,
MEDICAL SURGICAL NURSING
4 / DATE OF ADMISSION TO COURSE / 26-10-2010
5 / TITLE OF THE STUDY / “EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE REGARDING PREVENTION AND EARLY DETECTION OFCOLON CANCER ”
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE (SIM) ON KNOWLEDGE REGARDING PREVENTION AND EARLY DETECTION OFCOLON CANCER AMONG BANK EMPLOYEES WORKING IN SELECTED BANKS AT HASSAN CITY, KARNATAKA.”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Cancer is potentially the most preventable and the major chronic life threatening disease. Unfortunately, it is still increasing as a leading killer across the globe, especially in the developing world. In 2008 there were an estimated 10.5 million new cancer cases and 6.5 million cancer deaths throughout the world. Without action the number of new cancer cases will be more than double to over 12 million by 2020.1
The Cancer is a group of diseases characterized by uncontrolled cell division leading to growth of abnormal tissue.2 The colon is the part of the digestive system where the waste materials are stored. Colon cancer is defined as a malignancy from the inner lining of the colon3.
The colon which includes large intestine, rectum, and anus is the end portion of the human gastrointestinal tract which extends from the mouth to the anus. It is a muscular tube approximately 5 to 5 ½ feet in length and has an average diameter of approximately 2 ½ inches. The main functions of the colon are absorption of water and minerals, and the formation and elimination of feces ... The colon contains nearly 60 varieties of micro flora or bacteria to aid digestion, promote vital nutrient production, to maintain pH (acid-base) balance, and to prevent proliferation of harmful bacteria.4
The exact cause of the colon cancer is unknown, but the risk factors are increasing with age above 50, years family history of colon cancer or polyps, previous colon cancer, history of inflammatory bowel disease, high fat diet, high protein, low fibre diet, life style practices etc.5
The signs and symptoms of colon cancer includes a change in bowel habits, diarrhoea, constipation or feeling that bowel does not empty completely, blood, either bright red or dark in the stool, stools that are very narrow than usual, general abdominal discomfort such as frequent gas pains, bloating etc, weight loss with no known reason, vomiting etc .6
Colon cancer is highly curable form of cancer if found early. Regular check up and screening is very important. The important diagnostic procedures are fecal occult blood test, double contrast barium enema, colonoscopy, endoscopy, CT-colonography, x-ray, flexible sigmoidoscopy, fecal immune chemical test, stool DNA test etc. Flexible sigmoidoscopy and colonoscopy are more invasive than other tests, but only these two test can identify colon cancer without the need for more tests.7
Colon cancer is one of the most common, and yet preventable, cancers more than 90 percent of people diagnosed with colon cancer are 50 or older and the average age of diagnosis is 64. Research indicates that by age 50, one in four people has polyps. Getting screened is a excellent colon cancer prevention method. Avoid high fat diet, maintain a healthy weight because obese men seem to be more at risk for colon cancer than obese women, maintain an active life style, consider genetic counselling, avoid smoking, and reduce radiation exposure.82
Colon cancer is often found after symptoms appear; most people with early colon cancer have no symptoms of the disease. Symptoms usually appear only with more advanced disease. This is why getting the recommended screening tests before any symptoms develop is so important. Regular screening can often find colon cancer early, when it is most likely to be curable. In many cases, screening can also prevent colon cancer altogether. This is because some polyps, or growths, can be found and removed before they have the chance to turn into cancer9. Improved screening strategies have helped to reduce the number of deaths in recent years. Of more than 148,000 people diagnosed each year fewer than half that number dies annually. Early diagnosis and prompt treatment could save almost three of every four people with colon cancer. If the disease is detected and treated at an early stage, the 5-year survival rate is 90%.but only 34% of colon cancers are found at an early stage. Prevention and early screening are key to detection and reduction of mortality rates.1o
In Karnataka a state in the southern part of India, it is estimated that annually there are about 35,000 incidence of cancers whereas, the prevalent cancer accounts to about 1,50,00011
6.1 NEED FOR THE STUDY
A malignancy that arises from the inner lining of the colon most of these cancers develop from colonic polyps. Removal of these precancerous polyps can prevent colon cancer.12
Globally cancer of the colon is the third leading cause of cancer in males and the fourth leading cause of cancer in females. The frequency of cancer varies around the world. It is common in the western world and rare in Asia and Africa and countries where the people have adopted western diets, the incidence of colon cancer is increasing13.
Colon cancer rates increasing worldwide. A new study finds colon cancer incidence rates for both males and females increased in 27% of 51 countries worldwide according to statistics between 1983 to 2002,and points to increasing westernalization as being a likely culprit14.
The substantial regional and ethnic variations in colon cancer incidence trends within countries such as Japan, Israel and Singapore, The United State was the only country where colon cancer incidence rates declined in both males and females. 15
Early epidemiological research suggested that diets high in fat, and low in fruit, vegetable and cereal fibre promoted colon cancer. The dietary pattern associated with the greatest increase in risk is the one which typifies a western style diet.16
India is a developing country with one of the most diverse populations and different diets in the world. Indias rapid urbanization is characteristics of a country changing status from a “developing” to a “developed” country. Dietary changes, reduction in physical activity and increasing obesity generally follow this transition, especially as urbanization occurs. Diet in India associated with risk of colon cancer.17
The median age and death for colon cancer for 2000-2003 was 75 years of age.18 American Cancer Society ranks colon cancer second in the US and projects 106,000 new cases and 49,290 death in 2009.19
In India the incidence rates of colon cancer in eight population registries vary from 3.7 to 0.7/100,000 among men and 3 to 0.4/100,000 among women.20
Colon Cancer Incidence and Mortality Worldwide in 2008
The statistics says that21
Cases Death / WOMEN
Cases Death / BOTH SEX
Cases Death
USA / 79 / 24 / 74 / 26 / 153 / 50
CHINA / 125 / 61 / 95 / 48 / 220 / 109
INDIA / 50 / 14 / 16 / 11 / 36 / 25
EUROPEAN UNION [EU-27] / 182 / 80 / 151 / 68 / 333 / 148
A study was conducted by Javid G, et al to evaluate the incidence of colon cancer in Kashmir Valley, India, and the present population-based study was undertaken to determine the incidence of colon cancer in Kashmiri population which is non-migratory and ethnically homogeneous having stable food habits. The result of the study was that total of 212 cases of colon cancers were registered; of them 113 originated in the colon . Male to female ratio was 1.2:1. The age-specific rate for colon carcinoma was highest in the age group 55-59years followed by 65-69years and the reviewers concluded that the incidence of colon cancer in Kashmir valley is similar to that reported in the rest of India.22
A study on colorectal cancer was conducted by Deo SV et al:, experience at a regional cancer in India, about the incidence of colorectal cancer shows a wide geographic variation and India along with other Asian and African countries has a low incidence and result of the study shows that the mean age of patients was 45.3 years (18-90 years) and there was a predominance of rectal cancer patients Rectal vs Colon = 76% vs 24%. Seventy nine percent of patients had adenocarcinoma and 90% of colorectal cancer patients belonged to Astler-Collers stage B2 and C. A total of 37 patients also received adjuvant radiotherapy and only 39 out of 60 patients planned for adjuvant chemotherapy could complete the treatment and the operative mortality was 2.2% and morbidity was 18%. A total of 13 (14%) patients had relapse of disease local 5, regional 3, distant 5.The reviewers concluded that a significant number of colorectal cancer patients in India present with advanced stage of disease and probably due to referral bias majority had low rectal cancers and by advocating multimodality protocols a good locoregional and systemic control can be achieved despite the advanced stage of presentation.23
A new report from the American Cancer Society says a large proportion of the 141,000 cases and 49,000deaths from colon cancer expected in the United States this year could be prevented by increasing the use of established screening tests and by applying existing knowledge about colon cancer prevention.24
The life time risk of being diagnosed with cancer of colon is about 5% for both men and women in the US. Modifiable risk factors that have been associated with an increased risk of colon cancer in epidemiologic studies include physical inactivity, obesity, high consumption of red or processed meats, smoking and moderate to heavy alcohol consumption.24
Astudy conducted by Runder EH, Laiyeno AO et:al, on non – steroidal anti inflammatory drugs and cancer risk and found that use of NSAIDS reduced colon cancer risk.25
A study conducted by Winzer BM, White Man DC, et:al , On physical activity and cancer prevention and found that there is some evidence to support the role of exercise in modulating various cancer pathways.26
Markers of risk and markers of early detection share the same outcome. Namely the incidence of disease, Markers of risk and markers for early detection differ in the degree of certainty they convey regarding the existence of cancer. A risk factor confers significantly less than 100% certainty of cancer within a specified time interval, where as early detection markers confer close to 100% certainty of cancer.27
A study conducted by Hudt.S, Haugu, Brunner H,2007on Blood markers for early detection of colon cancer and the main purpose of this review to give an overview of published studies on blood markers aimed at early detection of colon cancer and summarize their performance characteristics and found that promising results were reported for some noval assays and also for some genetic assays, but evidence thus far is restricted to single studies with limited sample size and without further external validation.28
Decreased physical activity, life style, exercise, dietary factors etc are the some of the risk factors of the colon cancer. Incidence rate increases with age, so early detection and prevention one of the important aspect.5
Higher levels of physical activity have been consistently associated with a lower risk of colon cancer in epidemiological studies. Bank employees are sedentary workers and colon cancer is commonly seen in sedentary employees.29
Since the sedentary workers are living with decreased physical activities, changes the dietary habits, obesity, decreased leisure activities, increased stress at the working environment can affect their health. And also due to these factors sedentary workers are suffering from some chronic diseases like haemorrhoids, diabetes mellitus, hypertension, cancer and chronic constipation So it is necessary to provide information and education on preventive measures and early detective measures of colon cancer, so that we can reduce the risk of colon cancer among the sedentary bank employees.
6.2 REVIEW OF LITERATURE
Review of literature is a key step for research process. It refers to an extensive exhaustive and systematic examination of the publications relevant to the research project.
In this study the Review of literature is classified under four categories i.e.
6.2.1 Studies related to risk factors and causes of colon cancer.
6.2.2 Studies related to prevention of colon cancer.
6.2.3 Studies related to early detection of colon cancer.
6.2.4 Multimedia based educational interventions related to improving colon cancer literacy in screening colonoscopy patients.
6.2.1 STUDIES RELATED TO RISK FACTORS AND CAUSES OF COLON CANCER
A Clinico –epidemiologic study was conducted to clarify risk factors and to promote colon cancer screening and they investigated lifestyle factors, biochemical data, and pathological features of 727 individuals who underwent colonoscopy and the data were subjected to statistical analysis using software and the results of the study was low-grade adenoma was more frequent among the elderly men and 87.5% of the women with high-grade adenoma or adenocarcinoma were aged≥45 and≥50 years and also a larger waist circumference of women (80 cm) increased the odds ratio for colon adenoma or adenocarcinoma . Metabolic syndrome significantly increased the odds ratio of colon tumors in men, but not in women and also Cigarette smoking, drinking alcohol, and increased physical activity were significant risk factors for colon tumors in men and the researchers concluded that Colon tumors have a high prevalence in the elderly and a larger waist circumference in women and metabolic syndrome in both men and women elevate the risk of colon tumors and also smoking, drinking, and excessive physical activity are risk factors for adenoma and adenocarcinoma in men and the early detection of colon cancer, men older than 45 years and women older than 50 years with these risk factors are recommended to undergo colonoscopy.30