Lung Cancer Survival in Sri Lanka.

Nuradh JosephIntroduction Lung cancer is the second commonest cancer among males in Sri Lanka. Real-world survival data are scarce, and we conducted a retrospective survival analysis among patients treated for lung cancer. Methods All patients with primary lung cancer treated at three selected units during 2015-2016 were included in the study. Data on clinicopathological and treatment delivered were extracted from clinic records. Overall survival was considered the primary end-point. Results The study population comprised 349 patients. The median age was 61 years and majority of patients (74%) were males. Adenocarcinoma (56%) was the commonest histological subtype, followed by squamous cell carcinoma (26%), whereas 6% of patients had small cell lung cancer. Only 10% of patients with non-small cell lung cancer were treated with curative intent, whereas 67% presented with systemic metastases. The median overall survival was 12 months in patients treated with curative intent and there was no significant difference between radical surgery and radiotherapy. The median overall survival was 3 months in those treated palliatively. On multivariate analysis, female gender and first-line treatment with tyrosine kinase inhibitors was associated with superior survival. Conclusion More than 90% of lung cancer patients in Sri Lanka are treated with palliative intent. Further work is needed to identify patient and care pathway barriers to ensure diagnosis at an earlier stage.

Outcomes of patients with esophageal and gastric cancer in Sri Lanka: A retrospective survival analysis.

Introduction: Esophageal carcinoma is the fourth most common cancer among males and sixth most common cancer among females in Sri Lanka. Gastric cancer is less common, but its incidence is gradually rising. We conducted a retrospective analysis of survival of esophageal and gastric cancer patients treated at National Cancer Institute, Maharagama, Sri Lanka. Methodology: Patients with esophageal and gastric cancer treated in three selected oncology units of the National Cancer Institute, Maharagama during 2015 and 2016 were included in the study. Data on clinical and pathological factors were extracted from clinical records. Overall survival (OS), defined as time to death or loss to follow-up, was the primary endpoint. Univariate and multivariate analyses of survival were performed using the log-rank test and Cox proportional-hazard model, respectively. Results: The study population comprised 374 patients with a median age of 62 years (interquartile range 55-70). Majority (64%) were male and had squamous cell carcinoma (58%). In the sample, 20% were gastric cancers, while 71% were esophageal cancers, and 9% had gastro-esophageal junction tumors. The 2-year OS was 19% in patients treated with curative intent (95% confidence interval [CI] 14-26 months) with those receiving neoadjuvant chemotherapy, followed by radical surgery having the highest survival (P < 0.001, hazard ratio 0.25 [95% CI 0.11-0.56]). Median OS was 2 months (95% CI 1-2 months) in patients treated with palliative intent. Conclusion: Our results suggest that the outcome of patients with esophageal and gastric cancer is poor in Sri Lanka. Early detection and greater utilization of multimodality treatment could improve outcomes of these patients.

Predictors in breast cancer screening behaviors of South Asian women.

AIM: Screening is important in minimizing breast cancer-related morbidity. It is prudent to identify the factors that affect women's choice in participation in mammographic screening. Our objective was to identify the factors that influence the breast screening behaviors in Sri Lankan women. METHODS: Data on referral, sociodemographic factors and relevant personal history of all the women visiting a single mammography center were prospectively collected during a 4-year period. RESULTS: Of the 2695 participants, 1580 had sought mammographic services for screening purposes while 1115 were due to symptoms. A majority had Advanced Level (AL) or higher education (n = 1570, 58.3%) and were parous. Only a minority had past history (n = 221, 8.2%) or family history (n = 357, 13.3%) of breast cancer. Majority has normal mammographic findings with detection of 289 (10.7%) benign lesions. The mean age was 50.2 years in screening participants, 45.9 years in symptomatic women. Use of hormone replacement therapy, age >50 years, AL or higher education, having had undergone hysterectomy, past history of breast cancer, family history of breast cancer, family history of other cancer and self-referral were statistically significant contributors to mammography participation. In the logistic regression analysis age >50 years, AL or higher education, premenopausal status, having undergone hysterectomy and self-referral were significantly associated with screening participation and the model predicted 72.1% of the cases accurately. CONCLUSION: Five statistically significant predictors of mammographic screening among Sri Lankan women were identified. These suggest that higher health awareness and exposure to health care providers are important predictors.