Cancer incidence and mortality in Rukum districts in 2018: east and west Rukum.

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 WHO and 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 Rukum PBCR is to identify the cancer incidence, mortality and pattern of cancer in Rukum districts and to help in the development of cancer control strategies/activities to strengthen cancer care services in the areas. Population Covered: The Rukum PBCR covers two districts, East and West Rukum with a total of 3 urban municipalities and 6 rural municipalities. The estimated population covered by the registry in 2018 is 2, 21,376. Registration Method The overall process of PBCR data collection is of 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 Rukum, the neighboring facilities where the patients from Rukum visit were taken. The data is collected from the records of the sources since January 2018 and recorded in the standard format. The second one is through the trained data enumerators mobilized in the communities. The enumerators personally visit the health coordinators, health post in-charges, FCHVs, ward chairpersons and community leaders to identify the cancer cases and 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. Findings: Over the year (2018), Rukum PBCR has registered 87 new cancer cases (44 males and 43 females) and 38 mortality cases (16 males and 22 females). The Age Adjusted incidence Rates (AAR) for male was 59.1 per 100,000 populations whereas the AAR for the females was 51.4 per 100,000 populations. Similarly, the age adjusted mortality rate for the males was 21.4 per 100,000 populations and for females, 25.1 per 100,000 populations. The Mortality to Incidence ratio (M/I) in Rukum district was 43.6%, which shows that the death case was under reported as compared to the registries in neighboring countries like India. Since the civil registration in Nepal is facing challenges to collect the death cases and for the death registered cases, the cause of death as cancer is not recorded at all. All the other possible ways to identify the Cancer Incidence and Mortality in Rukum Districts in 2018 X incident and death cases have been followed; however, we might have missed some of the death cases. The higher cancer incidence is found among the age group of 65-69 years in males and 55-59 years in females with an age specific rate of 372.4 and 254.5 per 100,000 populations respectively. In male, the top leading cancer site is lung followed by stomach, thyroid, prostate, gallbladder and liver. Among females, the most common site is cervix uteri followed by lung, uterus, ovary and breast. In 2018, 9% of primary unknown cases in males and 21% in females have been registered, that may be due to inadequate staging workup and documentation failing to establish the primary site of the cancer. Again, these kinds of cases represent the diagnostic quality, availability and accessibility of the diagnostic centers and the proper documentation of medical records. As this is the first year report, there may be under registration of the cases. However, the community based approach of 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 Rukum, people have to travel 170 km to 1200 km for diagnosis and treatment of cancer. Hence, establishing the early detection centers in Rukum 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 uniform 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 strategies and intervention based on the evidence given by the registry.