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Jitendra Kumar Meena



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    EP1.11 - Screening and Early Detection (ID 201)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 2
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.11-05 - Integration of Low Dose Computed Tomography (LDCT) for Lung Cancer Screening in the National Cancer Program in India: A Feasibility Study (Now Available) (ID 783)

      08:00 - 18:00  |  Presenting Author(s): Jitendra Kumar Meena

      • Abstract
      • Slides

      Background

      Lung cancer is the commonest cause of cancer-specific mortality in India. It is difficult to screen and often misdiagnosed due to non-specific symptoms. However, improvement is likely with the advent of low-dose computed tomography (LDCT) screening recommendations by U.S. Preventive Services Task Force and American Cancer Society. Notably, specialists are concerned due to false-positive rate (up to 25%), radiation exposure and unnecessary invasive procedure, etc. Therefore it’s pertinent to study the feasibility of LDCT integration in the national cancer program.

      Method

      A descriptive online survey was developed for medical and surgical specialists using Google survey tool. Google platform was selected for its wide outreach and use by specialists in northern India. The survey period was 1 month and included items for lung cancer screening, LDCT awareness, the feasibility of its integration in the National cancer program, etc. The survey adopted a stratified sampling strategy for representation, and data collected were completely anonymous.

      Result

      A total of 530 completed responses were collected. Majority specialists (60.37%) were from the private sector, employed at academic institutions (64.15%). The mean work experience was 7.83±5.64 years with an average of 34.47±8.73 lung cancer patients attended. Most had specialized in internal medicine (26.41%), pulmonology (20.75%) and general surgery (18.86%). Although 71.69% practiced smoking cessation counselling and 25.47% counted it as a potential benefit of LDCT screening, only a few (6.98%) were formally trained in it. Most cited early detection (78.67%) and false positive results (50.94%) as potential benefit and harm of LDCT, respectively. Almost half (52.83%) erroneously suggested LDCT screening in the smoking history of 20 to 30 pack-years & age 40 to 55 years. Poor patient knowledge (55.28%) and denial of cancer risk (36.03%) were quoted as primary causes of refusal for screening. Only a few (24.33%) specialists were aware of the National cancer program, but many (80.75%) favored integration of LDCT screening for reducing lung cancer-related mortality. Poor finances and logistics (67.92%), and human resource (38.11%) were identified as potential barriers. Provision from health budget (39.62%) and social insurance (22.64%) were the preferred funding options.

      Conclusion

      In the present study a favorable attitude towards the inclusion of LDCT in national cancer program was observed among specialist doctors. However, the study also highlights potential barriers including financial and human resources to its integration warranting operational research. At the same time study also illustrate poor awareness of lung cancer screening protocols and inept smoking cessation counselling for which training should be formalized.

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      EP1.11-14 - Knowledge and Perspectives of Indian Medical Practitioners to Lung Cancer: A Regional Sample Survey (Now Available) (ID 2473)

      08:00 - 18:00  |  Presenting Author(s): Jitendra Kumar Meena

      • Abstract
      • Slides

      Background

      Lung cancer leads cancer-associated mortality figures in India. According to various cancer registries, It’s a pervasive problem with incidence expected to rise to 67,000 new cases per year by 2020. Especially concerning are limited health resources to tackle this problem in terms of specialty centers and trained staff. Adding to woes are poor knowledge, and practices among general practitioners (GPs) pertaining to lung cancer screening and referral. Thereby putting an additional burden on the constrained Indian health care system as a majority of cases are diagnosed at advanced stages leading to poorer prognosis and high treatment costs.

      Method

      A descriptive online survey was developed and pilot tested for GPs with Bachelor degree in Medicine & Surgery (MBBS) using Google survey forms. Google platform was selected for its wide outreach and use by GPs in northern India. The survey was done over 1 month period and included items related to etiopathology and diagnosis of Lung Cancer. The survey adopted a stratified sampling strategy for representation, and data collected were completely anonymous.

      Result

      A total of 2674 complete responses were collected. Majority of GPs were in the private sector (67.68%) with a mean work experience of 8.93±6.70 years. An average of 10 (10.45±7.10) Lung cancer cases were attended by GPs with majority presenting with non-resolving cough and/or hemoptysis (66%). Most common risk factors reported were cigarette smoking (93.27%) and exposure to chemicals (74.49%). Only a quarter of GPs identified lung cancer mortality being the highest (29.09%) with attribution to smoking (23.60%). Only 69.10% GPs advocated Lung cancer screening for current and past smokers. Only 30.89% GPs affirmed that a substantial reduction in mortality (95%) can be achieved by timely and proper screening. Only a quarter (25.46%) GPs reported low dose CT Scan (LDCT) as best modality lung cancer screening. 1943 (72.66%) GPs reported tissue sample biopsy as a method of diagnosis followed by CT scan (58.18%). Histopathology (85.48%) and molecular markers (74.49%) were frequently reported to guide therapeutic decision making.

      Conclusion

      Based on the survey, It can be concluded that knowledge of Indian GPs for Lung cancer is deficient in wake of high disease burden. Poor suspicion and detection of lung malignancy at early stages devoid patients of better prognosis and outcomes. Therefore it is recommended that sensitization workshops and training of GPs in opportunistic cancer screening and referral protocols be done.

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