Cancer patients' experience of oncology services in Assam, India.

BACKGROUND: Cancer patients' experience is dependent on the complex interaction between the patient, carer, healthcare practitioners and healthcare system. The aim of the study was to assess the experience of cancer patients in Assam in order to identify potential areas for improvement in delivering high quality cancer care. METHODS: A cross sectional patient experience survey was conducted in 400 patients using structured interviews and pre-tested questionnaires that collected patient-reported outcomes including access to cancer care, experience while availing cancer services across the pathway, waiting times, communication and counselling support, out-of-pocket expenditure and advice regarding available insurance schemes and financial support. RESULTS: The cancer patient's experience of accessing healthcare in Assam is variable with principal challenges being financial constraint and geographical distance to healthcare facilities. Overall, patients' experience during registration, first consultation, pre-treatment and during treatment was good with high satisfaction rates expressed in several of the areas assessed. Areas that were identified for improvement were better explanation of long-term side effects of treatment, enhanced guidance in choosing treatment options and greater support from healthcare professionals to help patients cope with the psychological, emotional and physical aspects of their cancer diagnosis, treatment and recovery. CONCLUSION: Understanding cancer patient experiences across their journey is critical to delivering accessible and affordable care. Effective, adaptive and responsive communication remains the anchor of excellent patient-centred care especially in resource constraint settings. POLICY STATEMENT: The paper provides an insight into critical areas focusing on diagnosis, treatment, continuum of care and communication during cancer patients' care in India. Healthcare policy needs to focus on developing a robust, holistic, healthcare system in terms of accessibility, affordability and psychosocial care, including counselling and financial support, to ensure better cancer outcomes.

Assessment of Knowledge and Screening in Oral, Breast, and Cervical Cancer in the Population of the Northeast Region of India.

PURPOSE: The burden of cancer is increasing globally, with poor outcomes in terms of morbidity and mortality in patients, especially in low- and middle-income countries. Lack of awareness of the risk factors, symptoms, and signs of common cancers in addition to inadequate cancer prevention programs at the community level are a major hindrance to the early detection of cancer. METHODS: A cross-sectional study was conducted in the North East Region (NER) of India, with a sample population of 1,400 participants from Assam (n = 1,000), Meghalaya (n = 200), and Nagaland (n = 200). The questionnaire developed for the study consisted of sociodemographic profile, knowledge about cancer (oral, breast, and cervical), its warning signs, risk factors, and attitude toward cancer screening. Statistical analysis was performed using STATA version 13.0. RESULTS: Among all the participants, 59% had heard about oral cancer, 50% about breast cancer, and 31% about cervical cancer. A limited understanding of risk factors, symptoms, and signs was reported for oral cancer (45%), breast cancer (54%), and cervical cancer (63%). A total of 34% of participants were aware of cancer screening. Among those who were aware of cancer screening, only six people had undergone any form of cancer screening, and 71% cited media as the major source of information. CONCLUSION: The level of cancer awareness is low in the NER. A multipronged approach is needed with assistance from government and nongovernment organizations for training, providing adequate human resources and equipment, and developing cancer screening infrastructure. This needs to be coupled with mass media communication and interpersonal communication through frontline health workers.

Increased prevalence of subclinical atherosclerosis in rheumatoid arthritis patients of Indian descent.

BACKGROUND: Studies have shown that rheumatoid arthritis (RA) patients are two to five times more likely to develop premature cardiovascular disease, thus shortening their life expectancy by five to 10 years. This risk has risen to approximately 12.6% in the urban population and 7.4% in the rural population of India. The Framingham risk score (FRS) identifies patients at increased cardiovascular risk and helps determine the need for preventive interventions. An investigation of the patients' coronary arteries and coronary artery calcification (CAC) - a measure of atherosclerotic plaque - has been found to be a strong predictor of cardiovascular disease. OBJECTIVE: To identify important biological markers for easy and non-invasive identification of cardiovascular disease in RA patients, and to investigate whether there is a relationship between the FRS and coronary artery atherosclerosis in RA patients. METHODS: The present study included 43 established RA patients and 50 healthy individuals (controls). Traditional and nontraditional risk factors were studied and compared with the control group. Insulin resistance was assessed using the homeostasis model of assessment of insulin resistance (HOMA-IR) and the homeostasis model of assessment of beta cell function. The FRS and the 10-year cardiovascular risk were compared between RA patients and controls. The presence of CAC was determined using electron-beam computed tomography, and the association between the FRS and CAC was examined. RESULTS: Significant differences in body mass index, waist circumference, rheumatoid factors (immunoglobulin [Ig]G, IgM and IgA) and inflammatory markers - C-reactive protein and erythrocyte sedimentation rate - were noted. There was significant correlation between HOMA-IR and body mass index, hypertension and C-reactive protein, but no correlation was seen with the homeostasis model of assessment of beta cell function. Significant differences were observed in the nontraditional biomarkers in RA patients, thus supporting their importance. Calcium deposition was observed in only seven RA patients. CONCLUSIONS: RA patients with increased C-reactive protein levels and erythrocyte sedimentation rates showed an increase in serum insulin levels and significant differences in HOMA-IR, thus indicating insulin resistance, which could lead to underlying progression of artherosclerosis. Significant differences were observed in the nontraditional risk factors, which could be chosen as biomarkers for endothelial dysfunction. There was a significant correlation between calcium score and the FRS in seven patients, suggestive of an underlying risk of atherosclerosis.