Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 122623

AbstractMaterial and MethodsResultsDiscussionConclusionKey MessageAcknowledgementReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2010 | Month : June | Volume : 4 | Issue : 3 | Page : 2378 - 2383 Full Version

Forecasting Breast Cancer Cases requiring Radiotherapy at a Teaching Hospital in Nepal.


Published: June 1, 2010 | DOI: https://doi.org/10.7860/JCDR/2010/.741
SATHIAN B, SREEDHARAN J , SHARAN K*, SURESH B N , NINAN J , JOY T, ABHILASH E S

*(Lecturer)[Ph.D(Biostatistics) Scholar],DeptofCommunityMedicine,Manipal CollegeofMedicalSciences,**(Ph.D)Biostatistics,Asst. Director Research Division,Gulf Medical UniversityAjman, (UAE),***(MD)Asst Prof,Deptof radiotherapy,ManipalUniversity,Udupi,Karnataka,(India).****(MD,DNB,MNAMS, FaeMS, FIMSA, FCCP)Professor, Dept of Physiology,****** (MSc)Lecturer, Dept of Anatomy,ManipalCollegeofMedical Sciences,(Nepal)*****(MSc)Lecturer, Dept ofradiotherapy,Manipal Teaching Hosp,Pokhara(Nepal)

Correspondence Address :
Dr. Brijesh Sathian. MD(AM), M.Sc, PGDCA, Ph.D (Biostatistics) Scholar, Lecturer, Department of Community Medicine, Manipal College of Medical Sciences, Deep Height 16, PO BOX 155, Pokhara, (Nepal0.Phone No: 9804180332 Email:brijeshstat@gmail.com

Abstract

Objective: The aim of this study was to determine the trends and to estimate the future load of patients with breast cancer requiring radiotherapy at Manipal Teaching Hospital, Pokhara, Nepal.
Materials and Methods: A retrospective study was carried out on the data collected from the treatment records of patients who were treated with radiotherapy at the department of Radiation Oncology at Manipal Teaching Hospital (MTH), Pokhara, between September 2000 and December 2008. Descriptive statistics and statistical modelling were used for the analysis and the forecasting of data.
Results: Seventy patients were found to have been treated with radiotherapy for breast cancer during the study period. The patients’ mean age was 49.9 years (95% CI: 47.6, 52.3). Curative treatment was given to 80% and palliative treatment to the remaining 20% of the patients. Patients from the age group of 45-64 years were more likely to receive curative 76.2% radiotherapy. The compliance to treatment was 100% among the age group of 25-44 years and 90.5% among the group of 45-64 years, as compared to only 66% among patients older than 65 years. (p = 0.03). The number of patients receiving radiotherapy for breast cancer showed a pattern of increasing trend. Excluding the constant term from the equation, the cubic model was the best fitted with R2 = 0.95, p = 0.001 for the forecasting of breast cancer cases. Using this model, the number of breast cancer cases treated with radiotherapy at the hospital by the year 2015 was estimated to be 194.
Conclusion: Breast cancer cases in Nepal show an increasing trend and treatment facilities are bound to be hard pressed in providing the necessary health care to the public. Nepal should adopt better strategies for the early detection of the disease and improvise on the resources required for the treatment of this malady.

Keywords

Breast cancer, radiotherapy, future trend, incidence

Introduction
Breast cancer is the most common cancer and the leading cause of cancer deaths among women worldwide (1).Although the causes and the natural history of breast cancer remain unclear, epidemiological research has uncovered genetic, biological, environmental and lifestyle risk factors for the disease. Over the past several decades, the risk of breast cancer in developed countries has increased by one to two percent annually (2) .While the data for developing countries are limited, cancer registries suggest that age-standardized incidence rates are rising even more rapidly in low-incidence regions such as Africa and Asia (3). Radiotherapy is an integral treatment component in the multimodal treatment approach for many patients with breast cancer. Perez and colleagues estimate that breast cancers constitute 25% of the patients visiting the radiotherapy OPD. Radiotherapy is used to reduce the loco-regional recurrence and the possible improvement in survival among these patients. Radiotherapy is also used with a palliative intent to achieve symptom relief. The aim of this study was to determine the trends and to estimate the future load of patients with breast cancer requiring radiotherapy at Manipal Teaching Hospital, Pokhara, Nepal.

Material and Methods

This hospital based study was conducted with the data available at the Department of Radiotherapy and Oncology, Manipal Teaching Hospital, Pokhara (MTH). Pokhara is a major town in the Western development region of Nepal and MTH is the only cancer treatment centre in this region. The data of breast cancer cases treated by external radiotherapy between September 2000 and December 2008 was collected from the department archives. The age of the patient, the date of presentation, the intent to treat (curative vs. palliative) and whether or not the patient completed the prescribed treatment, were recorded. The data was analysed using Excel 2003, R 2.8.0 Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. The chi-square test was used to examine the association between different variables. A p-value of < 0.05 (two-tailed) was used to establish statistical significance. The annual numbers of patients visiting the centre for radiotherapy was then plotted against the corresponding year in the x-axis. Curve fitting, also known as regression analysis, was used to find the "best fit" line or curve for a series of data points. Linear, Logarithmic, Inverse, Quadratic, Cubic, Compound, Power, Exponential and Growth models were chosen to fit to the obtained curve. The F-test was used for selecting the best fitting curve for the testing of hypothesis. P-value was taken as significant when < 0.05 (two-tailed). R2 values > 0.80 were taken as significantly better for prediction (4). Prior approval for the study was obtained from the institutional research ethical committee.

The decision regarding the selection of a suitable approach for prediction is governed by the relative performance of the models for monitoring and prediction. It should also adequately interpret the phenomenon under study. The cubic model selected here could closely fit curves for estimated and observed breast cancer cases (Table/Fig 1). While building models, the extremities (maximums and minimums) play a great role. If the points are scattered more, the curve tries to adjust with maximum number of observed points. The cubic model is a third degree polynomial, represented by the equation y = m0 + m1 * x + m2 * x2 + m3 * x3, where m0 is the constant term and m1, m2, m3 are coefficient terms 5,6. Without the constant term, the equation of this model is y = m1 * x + m2 * x2 + m3 * x3. This equation was the best fit equation in the forecasting of cancer cases from our data and the equation for predicting the total number of breast cancer cases receiving radiotherapy at our centre is Y= 7.171X - 1.837X2 + 0.134X3, where Y is the number of breast cancer cases presenting annually and X is the corresponding year (1=2000, 2=2001, 3=2002, 4=2003 and so on).

Results

A total of 70 breast cancer patients treated by radiotherapy in the aforementioned period were analyzed. The patients’ ages ranged from 25 to 69 years, the mean age being 49.9 years (95% CI: 47.6, 52.3). (Table/Fig 2)depicts the annual numbers of patients with breast cancer receiving radiotherapy from the year 2000 onwards. The numbers of the cases had an increasing trend that reached a peak in 2006, showing a sharp decline in the years 2004, 2005 and in 2007 before recovering back in 2008.



(Table/Fig 3) displays compliance to treatment in various age categories. It can be noted that the younger age group of 25-44 years had 100% compliance to treatment, while the age groups of 45-64 and 65-74 years had a 90.5 and a 66.7% completion rate, respectively. The difference was found to be statistically significant (p = 0.03). (Table/Fig 4) shows the age group and the intent to treat. Patients from the age group of 25-44 years were more likely to receive curative radiotherapy (86.4%), while the patients between 45 and 64 years of age were more likely to receive palliative radiotherapy.



The data were modelled using the curve fitting method. (Table/Fig 5) depicts the model summary and the parameter estimates including the constant term for different models. When the constant term was included, the p values were >0.05 in all the models and none of the models were best fitted. After excluding the constant term, all curves (except for inverse curve) fitted well with the data. (Table/Fig 6) displays the model summary and the parameter estimates excluding the constant term for different models and (Table/Fig 1) shows the fitted curves for observed breast cancer cases. However, with the highest R2 value, the cubic model is the best fit, with R2 = 0.83, p = 0.001 and shape of the curve also conforming well to the observed data, as compared to other curves.


(Table/Fig 7) depicts the observed number of cases until 2008 and the estimated number of cases along with confidence intervals up to 2015. The observed and the estimated number of cases have a fair degree of coincidence up to 2008. This model can thus be considered to be able to project the data with reasonable precision. The projected numbers of breast cancer patients visiting the centre for radiotherapy using this model hint at an increasing trend from 2009 onwards. One hundred and ninety four patients are expected to visit the centre for radiotherapy for breast cancer by the year 2015.

Discussion

The cancer prevalence rate in Nepal is unknown due to the lack of a population based national cancer registry. However, every year, at least 17,000 new cancer cases are estimated and the figure is expected to go up considerably in the future (1). The increasing rates of newly diagnosed cases of breast cancer in developing countries are bound to put a stress on their limited resources available for treatment. Moreover, establishing a radiotherapy centre is a very expensive undertaking. Nepal has only 4 centres which are equipped to treat patients with radiotherapy, to date. In our study, using the curve fitting method, we tried to estimate the number of breast cancer cases that are expected to undergo radiotherapy in this region of Nepal in the near future.

As seen in the (Table/Fig 6), from the year 2009 onwards, the cases show an increasing trend. From (Table/Fig 1) it is clear that breast cancer patients from the age group of 45-64 years presented the most to our department. In many countries where the incidence of breast cancer is great enough to pose a public health problem, the government, medical professionals, and the public may not recognize its importance. Advocacy directed to government officials and policy makers can place breast cancer on the national agenda, encourage the development of systematic health policies and service protocols and increase women’s access to the detection and treatment services (7). From this study, it was found that 17% of patients in the age group of 65-74 years, 24% patients in the age group of 45-64 years and 14% patients in the age group of 25-44 years were not likely to receive curative radiotherapy. In other studies, elderly patients have been observed to be more likely to receive palliative rather than curative radiotherapy (8). Considering the compliance to treatment, the age group of 25-44 years had 100% completion, the age group of 45-64 years had 90.5 completion and the age group of 65-74 years had 66.7% completion. There is a statistical relationship between the age group and completion (p = 0.03) in breast cancer radiotherapy treatment. The issue of patient access is a significant factor in many published reports that consider the development of radiation oncology services (9),(10),(11),(12),(13).

Using the curve fitting method, we estimated the number and the trend of breast cancer cases which had to receive radiotherapy at MTH from the years 2002 to 2015. The cubic model provided closely fitted curves for estimated and observed cancer cases (Table/Fig 1). While building models, the extremities (maximums and minimums) play a great role. If the points are scattered more, the curve tries to adjust with maximum number of observed points. Therefore, it might give over-and under-estimation inevitably, but that is not the case in all the situations. A sudden annual decrease and increase in the trend is possible, as the curve cannot exactly connect these data points because of its shape. For adjusting the over-and under-estimation, the model gave wide confidence intervals in the cases of some years (Table/Fig 7). In our study, the future annual estimated breast cancer-cases (Table/Fig 6) showed an increasing trend of the disease after the year 2010. Such an increase might be convincing as the cancer incidence in developing countries is expected to rise principally due to the possible decline of mortality from infectious diseases, population growth and increasing life expectancy(14). Our study hereby establishes the applicability of statistical modelling in predicting the cancer incidence in the Nepalese context. (Table/Fig 8)

Conclusion

Considering that the projections of our hospital data show a continuously increasing trend, it can be appreciated that breast cancer is on rise in Nepal. Thus, in the near future, there might be a discrepancy between the necessity and the delivery of health care for these patients. The Nepal Government must now be geared up to promote better strategies for health promotion, prevention, the earlier diagnosis and the treatment of breast cancer cases in the coming years.

Key Message

1. Introduction
Breast cancer is the most common cancer and the leading cause of cancer deaths among women worldwide.
2. Discussion
a. Without the constant term, the equation of this model is y = m1 * x + m2 * x2 + m3 * x3. This equation was the best fit equation in the forecasting of cancer cases from our data.
b. In many countries where the incidence of breast cancer is great enough to pose a public health problem, the government, medical professionals and the public may not recognize it’s importance.
c. Considering the compliance to treatment, the age group of 25-44 years had 100% completion, the group of 45-64 years had 90.5% completion and the age group of 65-74 years had 66.7% completion.
3. Conclusion
In the near future, there might be a discrepancy between the necessity and the delivery of health care for breast cancer patients.

Acknowledgement

Dr. B M Nagpal, CEO Manipal Education and Medical group Dean, Manipal College of Medical Sciences, P O Box No 155, Deep Heights Pokhara (Nepal), for permitting the authors to use the hospital documents for the study.

References

1.
CR Bhatt, K Sharan, J Ninan, B Sathian,et al. Cancer Treatment by Radiotherapy in Western Nepal. A Hospital-based Study Asian Pacific Journal of Cancer Prevention. 2009; 10: 205-08.
2.
Forbes, J.F. The incidence of breast cancer: the global burden, public health considerations. Seminars in Oncology. 1997; 24(1, suppl 1):S1-20–S1-35.
3.
Sasco AJ. Epidemiology of breast cancer: an environmental disease? APMIS. 2001 ;109(5):321-32.
4.
Aviva Petrie, Caroline Sabin, Medical Statistics at a glance. I Ed, London, Blackwell Science. 2000. pp 71-74.
5.
BeyerW H. Standard Mathematical Tables. Cleveland, CRC Press. 1976.
6.
ChambersJ M, Cleveland WS, Kleiner B., et al. Graphical Methods for Data Analysis. Boston, Duxbury Press. 1983.
7.
Ngoma, T. Organization of cancer services in low resource environments—the Tanzania experience. (Abst). Cancer Strategies for the New Millennium. 1998: (10): 19-20,
8.
Olmi P, Ausili-Cefaro G. Radiotherapy in the elderly: a multicentric prospective study on 2060 patients referred to 37 Italian radiation therapy centers. Rays. 1997; 22(1 Suppl):53-6.
9.
Wigg DR, Morgan GW. Radiation oncology in Australia: workforce, workloads and equipment 1986-1999. Australas Radiol. 2001;45(2):146-69.
10.
Burrell JE. Radiation therapy at the crossroads. Adm Radiol J. 1999 ;19(2-3):22-4.
11.
Pitchforth E, Russell E, Van der Pol M. Access to specialist cancer care: is it equitable? Br J Cancer. 2002; 87(11):1221-6.
12.
Roberts GH, Dunscombe PB, Samant RS. Geographic delivery models for radiotherapy services. Australas Radiol. 2002; 46(3):290-4.
13.
Mackillop WJ, Groome PA, Zhang-Solomons J, et al. Does a centralized radiotherapy system provide adequate access to care? BJ.J Clin Oncol. 1997; 15(3):1261-71.
14.
Magrath I. The International Network for Cancer Treatment and Research: helping poorer nations confront a growing problem. Cancer Futures. 2004; 3: 55-8.

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com