The study's main aim was to investigate the prevailing cancer types and associated risk factors based on the geographical distribution of Hill and Terai of Nepal. Similarly, to identify the stage of cancer patients visiting the hospital and the contribution of other health care systems in cancer care and prevention.
Despite various cancer control efforts, cancer cases have been increasing in the developing world like Nepal due to low education, poverty, inadequate health services. Literature also showed that identification of risk factors of cancer, early disease diagnosis and treatment and preventive activity would help lower cancer morbidity and mortality.
This non-experimental, cross-sectional, descriptive and exploratory study was based on the pragmatic philosophy with concurrent mixed methods and Bio-psychosocial Model by George L. Engel. The primary quantitative data was collected from the samples of 200 admitted lung and oral cancer patients for a questionnaire survey along with qualitative data of 15 key informants of cancer and Ayurvedic hospitals along with 10 Focus Group Discussions and three case studies of cancer patients.
In the study, dependent variables include lung and oral cancer, and independent variables were controlled to the risk behaviour of tobacco smoking, tobacco chewing, including geographical area. Frequency tables and mean values were used to describe the necessary information for analysis, while qualitative data were manually interpreted and presented. Similarly, Regression and Pearson's Chi-square tests were performed to find variable's association and relationship.
The study showed more lung cancer patients than oral in Hill whereas more oral than lung cancer patients in Terai. Similarly, significantly high lung cancer cases among smokers and oral cancer in tobacco chewers. Due to less awareness of cancer risk factors, economic condition, geographical situation, health service availability, ignorance and fear of disease diagnosis, nearly 87% of patients visited the hospital at a late stage.
A significant number of the cancer patients visited or willing to visit shortly to Ayurvedic or other health systems. Respondents also suggested a research-based separate or integrated treatment approach of cancer Ayurvedic and other health care with conventional treatment. The finding suggests that commitment and services assurance at every level is necessary for cancer care.
Table of Contents
CHAPTER 1 14
INTRODUCTION 14
1.1 Background of the Study 15
1.1.1 Cancer Burden 15
1.1.2 Cancer Health Services in Nepal 16
1.1.3 Cancer in Past and Present 17
1.1.4 General Health Status in Nepal 18
1.1.5 Cancer Problem 21
1.2 Statement of Research Problem 24
1.3 Significance of Study 26
1.4 Research Questions 28
1.5 Research Objectives 29
1.5.1 General Objective 29
1.5.2 Specific Objective 29
1.6 Research Hypothesis 29
1.7 Philosophical Basis of the Study 30
1.8 Theoretical Framework of the Study 31
1.8.1 Bio-Psychosocial Model of Health and Diseases 32
1.9 Conceptual Framework of the Study 34
1.10 Limitation of the Study 35
1.11 Delimitations of Study 36
1.12 Ethical Consideration 37
1.13 Organization of the Thesis 37
1.14 Operational Definition of Key Words or Terms 40
1.15 Assumption of the Study 41
1.16 Chapter Summary 41
CHAPTER 2 43
LITERATURE REVIEW 43
2.1 Theories on Cancer Genesis 43
2.1.1 Humoral Theory 44
2.1.2 Lymph Theory 44
2.1.3 Blastema Theory 45
2.1.4 Chronic Irritation Theory 45
2.1.5 Infectious Disease Theory 45
2.2 Development of Modern Knowledge about Cancer Causes 46
2.2.1 Viral and Chemical Carcinogens 46
2.2.2 Cancer Types and Stages of Interest in Study 50
2.2.3 Cancer as a Leading Cause of Death in Developed and Developing Countries 52
2.3 Cancer in Nepal 52
2.4 Prevailing Cancers and Risk Factors in Asian Region and in Nepal 53
2.4.1 Factors Related with Prevailing Cancers in Nepal 55
2.4.2Factors associated with Increasing Cancer Risks 56
2.5 Cancer Acquiring Risk Group 64
2.6 Stage of Cancer Patients Visiting to Hospitals 65
2.6.1 History of Cancer Screening and Early Detection 65
2.6.2 Trend of Cancer Patient Visiting to Hospital at Different Stages of Disease 67
2.6.3 Delayed Diagnosis of Cancer 68
2.6.4 Cause of Cancer Patients’ Delay in Hospital Visit 69
2.7 Preventive Activities 70
2.8 Role of Preventive Clinic 71
2.8.1 Component of Preventive Clinic 74
2.8.2 Role of Nutrition and Food Habit 75
2.8.3 Role of Physical Activity and other Factors Causing Various Cancers 76
2.8.4 Awareness and Screening of Cancer 76
2.9 Cancer Care Service 77
2.9.1 Tobacco Control 78
2.9.2 Packaging and Labelling of Tobacco Products 78
2.10 Cancer Management Strategy 79
2.10.1 Other System of Medicine in Cancer Care and Treatment 79
2.10.2 Complementary and Alternative Medicine 83
2.10.3 Education, Communication, Training and Public Awareness 84
2.10.4 Early Diagnosis of Lung and Oral Cancer 85
2.10.5 Research Gap and Chapter Summary 86
CHAPTER 3 88
RESEARCH METHODOLOGY 88
3.1 Research Approach 88
3.2 Research Design 89
3.3 Research Method 89
3.4 Sampling Design 89
3.4.1 Universe and Sample Size 90
3.4.2 Sample Size 90
3.4.3 Study Unit 92
3.4.4 Rational of Selecting the Study Area 92
3.4.5 Qualitative Study 93
3.4.6 Selection of Respondents and its Justification 93
3.4.7 Sample Frame and Sampling Procedure 94
3.5 Data Collection Strategies 94
3.5.1 Types of Data Sources 94
3.5.2 Data Collection Process 95
3.6 Instruments Used for Data Collection: 96
3.6.1 Tools of Collecting Primary Data 96
3.6.2 Secondary Data Collection Tools 98
3.7 Formation of Questionnaires and Checklist 99
3.8 Research Variables 99
3.9 Validity and Reliability Test of Instrument 100
3.9.1 Language Translation-Back-Translation 100
3.9.2 Discussion with Experts (Panel Of Experts) 100
3.9.3 Pilot Test 100
3.10 Selection and Training of Research Assistants (Enumerators) 100
3.11 Ethical Consideration during the Study Period 101
3.12 Data Analysis and Interpretations 101
3.13 Chapter Summary 104
CHAPTER 4 105
FINDINGS AND DISCUSSION 105
4.1 Demographic Information of Cancer Patients 106
4.1.1 Lung and Oral Cancers Based On Geographical Distribution of Nepal 107
4.1.2 Patients Distribution by Sex 108
4.1.3 Patients Distribution Based on Caste 108
4.1.4 Patients’ Distribution Based on Religion 109
4.1.5 Patients’ Characteristics Based on Their Annual Income (Economic Status) 110
4.1.6 Cancer Types Based on Patients’ Education 111
4.1.7 Cancer Type Distribution Based on Respondents Marital Status 112
4.1.8 Patients Distribution of Based on Occupation 113
4.1.9 Distribution of Patients Based on Age Group 113
4.2 Prevailing Cancers and Related Risk in Hill and Terai Region of Nepal 114
4.2.1 Prevailing Major Cancers and Related Risk Factors 115
4.2.2 Patients Knowledge, Attitude and Practice (KAP) on Cancer Care and its Risk Factors 116
4.2.3 Distribution of Various Risk Factors of Lung and Oral Cancers 118
4.2.4 Perception of Health Service Providers on Risk Factors of Cancer 119
4.2.5 Perception of Patients and their Guardians on Lung and Oral Cancers Risk Factors 121
4.2.6 Associated Risk Factors of Tobacco Use With Lung and Oral Cancers 121
4.3 Stage of Patients Visiting to the Hospital 123
4.3.1 Cancer Stages Visiting to Hospital 123
4.3.2 Causes of Late Stage of Cancer Visiting to Hospital 124
4.3.3 Causes of Delay Reaching to Hospital 125
4.3.4 Cost Management for Cancer Diagnosis and Treatment 128
4.3.5 Duration to Make Final Diagnosis of Cancer 129
4.3.6 Service Quality for Early Diagnosis and Treatment 130
4.3.7 Perception of Health Service Provider on Stage of Cancer Visiting to Hospital 129
4.4 Contribution of Other Health System in Cancer Care 131
4.4.1 Patients who visited or Shortly Going to Visit other Health System for Cancer Care 132
4.4.2 Role of Ayurvedic and other Alternative Clinics in Cancer Care 134
4.4.3 Perception on Patients Visiting the Ayurvedic Clinics 135
4.4.4 Patients’ and Guardians’ Perception on Role of other Health Care System in Cancer Care 135
4.4.5 Patients Visiting for Ayurvedic Treatment: Case Studies 136
4.4.6 Overall Case Studies Findings in Role of Ayurvedic Clinic 147
4.4.7 Finding from Observations of the Cancer Patients 148
4.5 Role of Preventive Clinics in Prevention and Care of Cancer in Nepalese Context 151
4.5.1 Patients Perception on Counselling Service 152
4.5.2 Perception on Contribution of Ayurveda, Alternative and Preventive Clinics in Cancer Care 153
4.5.3 Perception of Patient and Guardian on Contribution of Ayurvedic and Preventive Clinics in Cancer Care 154
4.5.4 Chapter Summary 154
CHAPTER 5 156
SUMMARY, KEY FINDINGS, CONCLUSION AND RECOMMENDATION 156
5.1 Summary of the Study 156
5.2 Key Findings of the Study 158
5.2.1 Demographic Status of Respondents 158
5.2.2 Prevailing Cancers in Nepal and its Risk Factors 160
5.2.3 Knowledge, Attitude and Practice on Cancer and Associated Risk Factors 160
5.2.4 Cancer Stage Visiting to the Hospitals 164
5.2.5 Contribution of Other Health Care System in Cancer Care 166
5.2.6 Role of Ayurvedic, other Alternative and Preventive Clinic in Cancer Prevention and Care 171
5.3 Conclusion of Study 173
5.3.1 Hypothesis Test Results 179
5.3.2 Theory Testing 181
5.4 Recommendation 182
Research Goals and Key Topics
The primary research goal of this thesis is to identify the prevailing cancer types in Nepal, specifically lung and oral cancers, and to analyze their related risk factors based on geographical distribution (Hill vs. Terai). Furthermore, the study investigates the stage of disease at which patients present to hospitals, identifies barriers to accessing cancer care, and explores the role of alternative medical systems, such as Ayurvedic treatments, in the cancer care and prevention continuum.
- Prevalence and risk factors of lung and oral cancers in Nepal.
- Geographical variations in cancer distribution (Hill vs. Terai regions).
- Stages of cancer at hospital presentation and causes of delayed diagnosis.
- Role and perception of Ayurvedic and alternative health systems in cancer care.
- Sociocultural and economic factors influencing health-seeking behavior.
Excerpt from the Book
1.1.2 Cancer Health Services in Nepal
BPKMCH at Chitwan District is government hospital for cancer treatment in Nepal. Most of the cancer patients from all over Nepal, either referred or come to this hospital for cancer treatment. The hospital is also the centre for cancer registry. People from all over Nepal come to this central level cancer hospital. The study was concentrated on Terai and Hilly regions of Nepal. Bir hospital, Bhaktapur cancer hospital, Tribhuwan University Teaching Hospital, Manipal Medical Hospital, BP Koirala Memorial Cancer Hospital, BP Koirala Institute of health sciences and Other Medical Teaching Hospitals, Chitwan Medical College along with other private hospitals are providing cancer treatment services but not specific to cancer service. Similarly, some other private hospitals are providing cancer service for last few years. But there are still not sufficient health facilities to care cancer in Nepal.
Chapter Summaries
CHAPTER 1 INTRODUCTION: This chapter provides the background of the cancer burden in Nepal, sets the research problem, defines objectives and hypotheses, and introduces the Bio-psychosocial model used as a theoretical framework.
CHAPTER 2 LITERATURE REVIEW: This chapter explores theories of cancer genesis, the development of modern knowledge regarding causes, and reviews existing literature on risk factors, preventive measures, and cancer management strategies.
CHAPTER 3 RESEARCH METHODOLOGY: This chapter details the mixed-method research approach, including sampling design, data collection tools such as questionnaires and key informant interviews, and the analytical techniques used.
CHAPTER 4 FINDINGS AND DISCUSSION: This chapter presents the analyzed data regarding demographics, cancer risk factors, stages of presentation, and the role of alternative medical systems in cancer care.
CHAPTER 5 SUMMARY, KEY FINDINGS, CONCLUSION AND RECOMMENDATION: This chapter synthesizes the study's conclusions, tests the research hypotheses, and provides recommendations for future policy and research.
Keywords
Cancer, Nepal, Lung Cancer, Oral Cancer, Risk Factors, Tobacco, Ayurveda, Healthcare Access, Early Diagnosis, Bio-psychosocial Model, Health Policy, Preventive Clinic, Socioeconomic Status, Epidemiology, Public Health
Frequently Asked Questions
What is the primary focus of this research?
The research focuses on identifying the prevailing types of cancer in Nepal—specifically lung and oral cancers—and determining the associated risk factors, with an emphasis on how these factors differ between the Hill and Terai geographical regions.
What are the central themes of the work?
The central themes include the prevalence of tobacco use as a primary risk factor, the delayed stage of cancer presentation in hospitals, socioeconomic barriers to care, and the potential integrative role of Ayurvedic and alternative medicine in cancer treatment.
What is the primary research objective?
The general objective is to investigate the major risk factors for prevalent cancers in Nepal, while specific objectives include assessing the stage of cancer at initial hospital visits and identifying the contribution of non-conventional health systems.
Which scientific methodology is utilized?
The study employs a concurrent mixed-methods approach based on pragmatic philosophy, combining quantitative survey data from 200 cancer patients with qualitative data from key informant interviews, focus group discussions, and case studies.
What does the main body of the work cover?
The main body covers a comprehensive literature review of cancer theories, a detailed research methodology, a statistical analysis of demographic and risk data, and a qualitative exploration of patient and healthcare provider perceptions regarding cancer care.
Which keywords best characterize this thesis?
Keywords include Cancer, Nepal, Lung Cancer, Oral Cancer, Tobacco, Ayurveda, Healthcare Access, Socioeconomic Status, and Public Health.
How does geographical location influence cancer risk in this study?
The study correlates geographical regions—specifically the Hill and Terai regions—with distinct patterns of cancer, noting, for example, that lung cancer prevalence is higher in the Hill region while oral cancer is more common in the Terai region due to differing tobacco usage habits.
What role do case studies play in the findings?
Case studies provide in-depth insight into the lived experiences of patients who sought Ayurvedic treatment, highlighting how these treatments are perceived as supportive care, particularly for managing pain and improving quality of life in advanced-stage cancer.
- Quote paper
- Pramod Bhatta (Author), 2019, Study on Risk Factors Prevailing Cancers in Nepal, Munich, GRIN Verlag, https://www.grin.com/document/1169405
