Cancer incidence and mortality in SSDM districts in 2018: Sarlai; Sirha; Dhanusha; Mohattari.

Research Report.

Summary: Background: Nepal Health Research Council (NHRC), an autonomous government body, is responsible to promote and conduct, coordinate and regulate all kinds of research activities to improve the health status of the people in the country. In the recent health developments of the country, cancer has become one of the major challenges for the government in terms of prevention, control and provision of necessary cancer care services to the patients. In this regard, NHRC, in close collaboration with Ministry of Health and Populations, has started Population Based Cancer Registry (PBCR) since January 2018 aiming to provide necessary evidences on cancer cases to the government in order to plan and implement cancer control policies and strategies. The registry is technically supported by the WHO and the International Agency for Research on Cancer (IARC) Regional Hub, Tata Memorial Centre, India. Three registries namely, Kathmandu Valley PBCR, Rukum PBCR and Siraha, Saptari, Dhanusha and Mohattari (SSDM) PBCR have been established covering 9 districts of the country representing urban, semi-urban and rural areas as well as the valley, hill, and terai regions in terms of geography. The objective of SSDM PBCR is to identify the cancer incidence, mortality and pattern of cancer in Siraha, Saptari, Dhanusha and Mohattari districts and to help in the development of cancer control strategies/activities to strengthen cancer care services in the areas. Population Covered: The SSDM PBCR covers four districts, Siraha, Saptari, Dhanusha and Mohattari with a total of 40 urban municipalities and 28 rural municipalities. The estimated population covered by the registry in 2018 is 2,846,035. Registration Method: The overall process of PBCR data collection is active method. There are two major approaches to collect the registry data. The first one is through the health facilities that include data collection from the cancer and/or the general hospitals having diagnostic and cancer treatment facilities, pathology laboratories and social security section. Due to the lack of cancer treatment facilities in SSDM districts, the neighboring healthcare facilities where the patients might visit for treatment have been considered for data collection. The data is collected from the records of the sources since January 2018 and recorded in the standard format. The second approach is through the trained data enumerators mobilized in the communities. They visit the health coordinators, health post in-charges, female community health volunteers (FCHVs), ward chairpersons and community leaders to identify the cancer cases and then visit the particular households to collect the information. The obtained data from all these sources are checked for the completeness and accuracy. Residence confirmation is done through individual phone call and the data are entered into the CanReg5 Software. Executive Summary: Cancer Incidence and Mortality in SSDM Districts in 2018 IX Findings: Over the year (2018), SSDM PBCR has registered 1106 new cancer cases (564 males and 542 females) and 286 death cases (155 males and 131 females). The Age Adjusted Incidence Rates (AAR) for male was 47.1 per 100,000 populations whereas the AAR for the female was 44.6 per 100,000 populations. Similarly, the Age Adjusted Mortality Rate for male was 13.1 per 100,000 populations and for females, 11.1 per 100,000 populations. The Mortality to Incidence ratio (M/I) in SSDM was 26 %, which is less as compared to the registries in neighboring countries like India and other registries within Nepal due to under reported death cases. Since the civil registration in Nepal is facing challenges to collect the death cases with actual cause of death registered,and the cases with cause of death as cancer is not recorded at all. All the other possible ways to identify the incident and death cases have been followed; however, some of the death cases might have been missed. The higher cancer incidence is found among the age group of 70-74 years in males and 65-69 years in females with an age specific rate of 212.5 and 188.8 per 100,000 populations respectively. In males, the top leading cancer site is mouth followed by lung, gallbladder, liver and stomach whereas in females, the most common site is breast followed by cervix uteri, gallbladder, lung and stomach. In 2018, 8% of primary site unknown cases in males and 4.4% in females have been registered, while these cases represent the diagnostic quality, availability and accessibility of the diagnostic centers and the improper documentation of medical records. As this is the first year report, there may be under registration of the cases. However, the community approach for PBCR by mobilizing field enumerators and other stakeholders within the community has reduced the under-reporting of the cases to a greater extent. Besides, there is a plan to have cross sectional survey of the 5% population to check the completeness of the cancer registry in the future registries. Because of the lack of cancer diagnostic and treatment facilities in SSDM districts, people have to travel 90 km to 2000 km for diagnosis and treatment of cancer. Hence, establishing the early detection centers in SSDM district is very important. For some cases, the date of diagnosis and primary site relied on the verbal information of the patient and their relatives. Due to lack of scientific way of data recording and reporting in health facilities, the cases obtained through community could not be traced back in the hospitals affecting the exact representation of the cases. It is recommended to have digital and uniformed medical recording system with some mandatory variables in all government and private health facilities. Similarly, MoHP, related provincial government and local authority are advised to develop cancer prevention and control policy and intervention based on the evidence given by the registry.