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Prof Dr Mohd Tahir Azhar, Prof Dr Omar Hasan Kasule, Sr., Prof Dr Syed Hassan Al-Mashor, Dr Aziz Baba, Dr Gerard Lim, Dr Fuad Ismail, Dr Hooi Lai Ngoh, Dr Zarihah Md. Zain. Presented at the Annual Scientific Meeting of the Malaysian Oncological Society held at the Legend Hotel, Kuala Lumpur on 3-5 November 2000 by Prof Omar Hasan Kasule MB ChB (MUK), MPH, DrPH (Harvard), Deputy Dean, Kulliyah of Medicine, International Islamic University, PO Box 141 Kuantan, MALAYSIA
ABSTRACT
This paper explores the relation between stage at cancer presentation and the modality of treatment chosen. It is based on data collected in the course of a nation-wide pilot cancer registration project. A total of 1077 cancers were registered. A general pattern of advanced stage at presentation was observed. Single modality treatment was used more often that multi-modality treatment at all stages of disease presentation. The most popular method of treatment reported was surgery followed by radiotherapy.
INTRODUCTION
This is a preliminary report from a nation-wide cancer registration project which was undertaken with 4 objectives in mind: assessment of the feasibility of district-level cancer registration, baseline epidemiological description of cancer, description of cancer management practices, and survival of cancer patients.
METHODS
Newly diagnosed cancer cases in the study period January 1 1997 – December 31, 1997 in the study area were identified by active surveillance in hospitals and pathology laboratories. Data was collected on a standard form that included items on patient identification, site of the lesion and its histology, investigations, and treatment. The data was sent to the study statistical center at Kuantan where it was edited. The SAS software was used for data management and data analysis. Treatment modality was cross tabulated against stage at presentation.
RESULTS
A total of 1077 cancers were registered. A general pattern of late presentation and diagnosis was observed. Marked variation in stage at diagnosis was observed among the different districts and cancer sites. Regional lymph node involvement and distant metastases were high at diagnosis. Tables 1-3 show treatment modality by stage at presentation. Overall treatment distribution was as follows: single treatment 42.1%, treatment combination 18.9%, and missing data 38.9%. Single modality treatment was used more often than multi-modality treatment at all disease stages. This was true even for cases for which data on stage was not available. The order of preference for treatments was as follows: surgery 25.0%; radiotherapy 11.6%; chemotherapy + surgery 6.2%; surgery + radiotherapy 5.8%, chemotherapy 5.5%, chemotherapy + surgery + radiotherapy 3.5%, and chemotherapy + radiotherapy 3.4%.
DISCUSSION
The results show that cancer presents late and that single is preferred to combination therapy. Proper interpretation of the date requires consideration of biases due to the high proportion of missing information on stage and treatment. Further analysis of the data is being undertaken to see whether there are any systematic sources of bias.
TABLE #1: TREATMENT MODALITY BY STAGE AT PRESENTATION
STAGE | No Record | Chemo Only | Surgery Only | Radio Only | Chemo + Surgery | Chemo + Radio | Surgery + Radio | Chemo + Surgery + Radio | Other | Total |
STAGE 0 | 4 (36.4%) | 0 (0.0%) | 7 (63.6%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | 11 |
STAGE 1 | 12 (14.0%) | 2 (2.3%) | 50 (58.1%) | 7 (8.1%) | 8 (9.3%) | 2 (2.3%) | 5 (5.8%) | 0 (0.0%) | 0 0.0%) | 86 |
STAGE 2 | 7 (7.8%) | 0 (0.0%) | 32 (36.0%) | 15 (16.9%) | 11 (12.4%) | 2 (2.3%) | 15 (16.9%) | 7 (7.9%) | 0 (0.0%) | 89 |
STAGE 3 | 18 (14.5%) | 6 (4.8%) | 31 (25.0%) | 26 (21.0%) | 14 (11.3%) | 6 (4.8%) | 13 (10.5%) | 10 (8.1%) | 0 (0.0%) | 124 |
STAGE 4 | 63 (33.7%) | 16 (8.6%) | 39 (20.9%) | 24 (12.8%) | 15 (8.0%) | 10 (5.4%) | 6 (3.2%) | 14 (7.5%) | 0 (0.0%) | 187 |
No record | 315 (54.3%) | 35 (6.0%) | 110 (19.0%) | 53 (9.1%) | 19 (3.3%) | 17 (2.9%) | 23 (4.0%) | 7 (1.2%) | 1 (0.2%) | 580 |
TOTAL | 419 (38.9%) | 59 (5.5%) | 269 (25.0%) | 125 (11.6%) | 67 (6.2%) | 37 (3.4%) | 62 (5.8%) | 38 (3.5%) | 1 (0.1) | 1077 |
TABLE #2: COMPARING SINGLE-MODALITY WITH MULTI-MODALITY TREATMENT
STAGE | No Record | Single Modality | Multi Modality | Other | Total |
STAGE 0 | 4 (36.4%) | 7 (63.6%) | 0 (0.0%) | 0 (0.0%) | 11 (1.0%) |
STAGE 1 | 12 (14.0%) | 59 (68.6%) | 15 (17.4%) | 0 (0.0%) | 86 (8.0%) |
STAGE 2 | 7 (7.8%) | 47 (52.8%) | 35 (39.3%) | 0 (0.0%) | 89 (8.3%) |
STAGE 3 | 18 (14.5%) | 63 (50.8%) | 43 (34.7%) | 0 (0.0%) | 124 (11.5%) |
STAGE 4 | 63 (33.7%) | 79 (42.2%) | 45 (24.1%) | 0 (0.0%) | 187 (17.4%) |
NO RECORD | 315 (54.3%) | 198 (34.1%) | 66 (11.4%) | 1 (0.2%) | 580 (53.6%) |
TOTAL | 419 (38.9%) | 453 (42.1%) | 204 (18.9%) | 1 (0.1) | 1077 (100.0%) |
TABLE #3: COMPARING SINGLE-MODALITY WITH MULTI-MODALITY TREATMENT
STAGE | Single Modality | Multi Modality | Other | Total |
STAGE 0 | 7 (100.0%) | 0 (0.0%) | 0 (0.0%) | 7 (1.80%) |
STAGE 1 | 59 (79.7%) | 15 (20.3%) | 0 (0.0%) | 74 (18.8%) |
STAGE 2 | 47 (57.3%) | 35 (42.7%) | 0 (0.0%) | 82 (20.9%) |
STAGE 3 | 63 (59.4%) | 43 (40.6%) | 0 (0.0%) | 106 (27.0%) |
STAGE 4 | 79 (63.7%) | 45 (36.6%) | 0 (0.0%) | 124 (31.6%) |
TOTAL | 255 (64.9%) | 138 (35.1%) | 1 (0.1) | 393 (100.0%) |
NB: Based only on cases with complete data on stage and treatment.