The ban on smokeless tobacco products is systematically violated in Chennai, India.

BACKGROUND: India is the world’s third largest consumer of tobacco. There are twice as many users of smokeless tobacco products (STPs) as cigarette smokers. The Government of Tamil Nadu has banned the sale of gutkha and pan masala in 2013. Our aim was to identify the varieties of illegal STP available in Chennai, India. METHODS: In systematically chosen zones and regions of Chennai city, we randomly identified three kinds of kiosks (n = 18) and asked for “gutkha” and “pan masala,” one of each product available. Details of each product were reviewed based on the information printed on the sachets. RESULTS: Totally 65 STPs were collected; 26 distinct products and 23 brands. All products were claimed to be “tobacco” by the shop keepers. Sixty‑five percent of the products informed to contain tobacco and 15.4% to contain pan masala. Five sachets did not inform about the content; 30.8% did not have a pictorial warning; a text warning was printed on 80.8%, but only two products had the messages in Tamil; 70% had promotional messages printed, and 57% had their registration numbers printed. CONCLUSION: The ban on STP is being systematically violated in Chennai. STP are cheap and easily available and due to promotional laudatory messages and lacking information about the content and warning of health damage, the consumers are left with the perception that they buy more or less harmless product. The Indian Government must introduce policies to control production, import, and sale of illicit STP but we also call for a coordinated international solution.

Validation of Cancer Institute Quality of Life Questionnaire Version II for cancer patients in India.

Background: The Quality of Life (QOL) questionnaire version I consisted of 38 items that were validated using 392 patients. The experiences gained through the interaction with the patients during the administration of the questionnaire provided a lot of inputs for the improvization of the tool. Aim: The current study is aimed at certain modifications of the QOL questionnaire version I and standardization of the same. Materials and Methods: The modifications of version I QOL scale included the change of verbatim, splitting, deleting, and adding of new items. Finally, version II included 42 items. It was administered to 183 cancer patients irrespective of their demographic details for further standardization. Statistics: The principal component method with varimax rotation was used. Spearman's product moment correlation and Cronbach's alpha coefficient were used for reliability analysis. Results: The data were subjected to factor analysis to explore the factors. Eleven factors emerged with the eigenvalue ranging from 8.03 to 1.10 and accounted for 66.7% variance. The first factor contributed maximally, 19.5%, and the remaining 10 factors contributed a total of 46.2% variance on QOL. They are general well-being, physical well-being, psychological well-being, familial relationship, sexual and personal ability, cognitive well-being, optimism and belief, economical well-being, information support, patient-physician relationship, and body image. The Cronbach alpha of 0.90 and split-half reliability of 0.80 indicated a high reliability of the tool. Conclusion: The factor structure showed that QOL is a multidimensional concept having different aspects. The Cancer Institute QOL Questionnaire version II for cancer patients is found to be a valid and reliable tool and feasible to administer at the clinical settings.

Quality of life among young women with breast cancer: Study from a tertiary cancer institute in south India.

Background : The incidence of breast cancer in young patients less than 35 years is less than 1%. The physical and psychosocial morbidity may affect their ability to successfully function in their social roles. Hence we studied the quality of life (QOL) issues in this subset. Materials and Methods :Younger women with age less than 35 years, diagnosed with non-metastatic breast cancer at our Institute, from 1995 to 2005, were included in the study. Quality of life issues were studied during the follow-up using EORTC QOL C30 and BR23. Descriptive and inferential statistics were used in order to analyze the data. Results : A total of 51 patients were included for the study. The mean age at diagnosis was 30 years. The effect of breast cancer on the occupation and marital status was minimal. The global health status and the functional scores were high, while the overall sexual function was lower. The global health status was higher in the mastectomy group. The arm symptoms (P = 0.027) and pain were higher in the Breast conservation surgery (BCS) group. The sexual symptoms appeared to be higher in the ovary ablated group when compared to the ovary preserved group. The sexual functional scores (P = 0.02) and sexual enjoyment scores (P = 0.003) were better in the mastectomy group. Conclusion : The overall QOL in younger patients with breast cancer appeared to be good. The QOL and sexual function were marginally worse in the breast conservation group when compared to mastectomy group.

Coping preferences of head and neck cancer patients - Indian context.

BACKGROUND: Cancer is a major health-related stress and demands adequate coping. Patients with head and neck carcinoma (HNC) often face exhaustive and debilitating treatment as well as physical and functional residual effects such as disfigurement, compromised speech, dry mouth and difficulty in swallowing. Understanding how patients cope with these challenges is important in comprehensive care of patients with HNC. OBJECTIVE: To assess and evaluate the coping preferences of head and neck cancer patients. MATERIALS AND METHODS: Towards this goal, a prospective study was conducted at the Cancer Institute (WIA), Chennai. 176 HNC patients participated in the study. The age group ranged from 19 to 87 years. The questionnaire used for assessing coping preferences was Jalowiec coping preference scale containing 40 items, with responses ranging on a 5-point scale. The variables chosen were treatment, site, education, survival, age and gender. Statistical analysis used: SPSS 9.0 version was used for both descriptive and multivariate analysis. RESULTS: No significant difference was observed in the preference of Emotion-Oriented Coping (EOC) in relation to age, treatment, site, education and survival. Treatment, site, education and gender showed significant differences in the preference of Problem-Oriented Coping (POC). There was, however, no difference in the preference of POC among the patients with different survival periods and age. CONCLUSION: In conclusion, HNC patients adapt both EOC and POC during the course of the illness. Literates, males and patients subjected to different modalities of treatment preferred more of POC compared to other groups.

Validation of quality of life questionnaire for patients with cancer--Indian scenario.

BACKGROUND: Quality of Life (QOL) is an important health outcome measure in oncology. Given the underlying pressure of individual geo-political entities, a universal solution may not be applicable and hence there is a need to develop a regional tool and standardize the same to address the linguistic and socio-cultural factors. OBJECTIVE: To standardize a tool to assess the QOL of patients with cancer to suit the Indian scenario. MATERIALS AND METHODS: The samples were collected from the Cancer Institute (WIA), Chennai. Samples comprise of 400 patients with all sites and stages of cancer. Period: January 2001 to January 2002. Patients were in the age range of 41-60 years. Thirty-eight items were pooled from existing tools, reviews, and the field trial, by which face and factorial validity were established. Reliability of the tool was also tested. Correlation analysis was done to find out the relation between the domains of QOL. STATISTICS USED: Principal component method with varimax rotation was used. Spearmen product moment correlation and Cronbach alpha coefficient were used for reliability analysis. RESULTS: Ten factors emerged with Eigen values ranging from 8.55 to 1.10 and accounted for 62.6% of variance. The first factor contributed maximally, 22% of variance. The remaining nine factors contributed totally to 40% of the variance on QOL. The ten factors that emerged were psychological well being, self-adequacy, physical well being, confidence in self-ability, external support, pain, mobility, optimism and belief, interpersonal relationship and self-sufficiency and independence. The internal consistency using Cronbach alpha test was 0.90 and split-half reliability was 0.74. CONCLUSION: The tool was found to be highly reliable and valid. It was feasible to administer it at clinical settings.