Assignment On Mortality and Morbidity

Introduction:
Oral cancer and head and neck cancer (HNC) has become one of the most
common cause of cancer related mortality and morbidity globally. Head and
neck cancer affects 6, 50, 000 people globally and it has resulted in 3, 30, 000
deaths annually (Stenson, Brockstein & Ross, 2014). It is the most common
cancer in the world and the incidence is highest in the South and Southeast Asia
region (Argirion et al., 2019). Hence, considering the highest prevalence of oral
and HNC in Asian countries, investigation about the cause behind such incidence
and high risk of occurrence of this type of cancer is necessary. Research
evidence shows that tobacco and alcohol consumption are two factors that
interact and increase the likelihood of developing such condition. The issue is
aggravated in South Asian countries because of over indulgence in smoking of
bidis, chewing betal quid and chewing tobacco (Jayalekshmi et al., 2011). Hence,
the main purpose of this research is to critically analyse the association between
tobacco chewing, alcohol or smoking on neck cancer and oral cancer risk in Asia.
This research aims to find three papers which reveals this association and
develops understanding regarding the reason for high incidence of oral cancers
in Asia.
Methodology:Search strategy:
To find and retrieve relevant search articles for the systematic review, the
search for papers was done in PubMed. The main rational for taking PubMed was
that it publishes millions of biomedical and life sciences journal and there is high
likelihood of getting high quality papers from this journal. The search terms
during literature searching was developed after reviewing the research aim and
objective. Some relevant key words that were used included ‘tobacco chewing’,
‘tobacco consumption’, ‘alcohol use or consumption’, ‘smoking’, ‘oral cancer’,
‘head and neck cancer’ and ‘Asia’. To further increase the chance of getting
more number of papers relevant to the research objective, the key words were
combined with Boolean operators in the following ways:
 Tobacco consumption OR tobacco chewing AND oral cancer AND Asia
 Alcohol consumption AND head and neck cancer AND Asia
 Smoking AND oral cancer AND Asia
 Alcohol use AND oral cancer and Asia
This strategy of combining key words with research question helped to
retrieve many articles and the final selection of papers were done based on
inclusion and exclusion criteria which has been discussed belowInclusion and exclusion criteria:
The inclusion criteria for article selection were as follows:
Research population: It must include only those individuals who live in Asian
countries and those who are diagnosed with oral cancer or HNCPublication: Articles published from 2001 to 2019 were included
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Type of research papers: Research papers with mainly primary research designs
such as cohort study, case control study and cross sectional study must be taken
in the reviewLanguage: All selected research papers must be published in EnglishCountry or setting: Only those articles to be taken which conducts research in an
Asian countriesResearch topic: All research articles must discuss about smoking and drinking on
oral cancer or HNC.
The exclusion criteria for article selection were as follows:Publication: Articles published before 2001 was excludedType of research papers: Literature review and systematic review papers were
excludedLanguage: Studies published in language other than English were excludedResearch topic: Studies which reported about interventions related to oral cancer
and HNC and not risk factors were excluded.Country: All those studies were excluded which evaluated research done in
countries other than Asian countries
.
Data analysis:
After the selection of articles based on inclusion and exclusion criteria, the
title and abstract of articles were reviewed. The full text review was also done to
find articles most relevant to the research objective. Finally, the quality and
validity of research papers were one by doing critical appraisal using the CASP
tool and the JBI critical appraisal tool
Results:
Table 1 Cross-sectional study: (Risk factor profiles of head and neck
cancer patients of Andhra Pradesh, India.)
Critical appraisal questions Underline your answer
Were the criteria for inclusion in the
sample clearly defined?
Yes/No/Unclear
Evidence:
justification, compare and contrasting or/and providing solution
The criteria for inclusion of study sample included new patients with
histologically confirmed diagnosis of squamous cell carcinoma of the head and
neck, who reported during the period from 2002 through 2006 in two hospital
based cancer registries. This defines how the samples were included in the
study.
Critical appraisal questions Underline your answer
Were the study subjects and the Yes/No/Unclear
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setting described in detail?
Evidence:
justification, compare and contrasting or/and providing solution
Yes, the study subjects were clearly defined by giving evidence regarding
number of subjects selected and those with diagnosis of HNC. Furthermore, the
setting for the setuy included Mehdi Nawaj Jung (MNJ) Institute of Oncology and
Regional Cancer Center, Hyderabad, and Indo American Cancer Institute and
Research Hospital, Hyderabad, Andhra Pradesh, India.
Critical appraisal questions Underline your answer
Was the exposure measured in a
valid and reliable way?
Yes/No/Unclear
Evidence:
justification, compare and contrasting or/and providing solution
The exposure was measured in a reliable way as stages of cancer were defined
based on the American Joint Committee on Cancer and the site of cancer was
defined by the International Classification of Disease for oncology (ICD-02).
Both these are reliable and standard classification system according to time of
publication of research. Hence, use of these classification systems validates
the measurements of exposures.
Critical appraisal questions Underline your answer
Were objective, standard criteria
used for measurement of the
condition?
Yes/No/Unclear
Evidence:
justification, compare and contrasting or/and providing solution
Yes, standard criteria were used as measurement of the condition was done by
the use of ICD-02 criteria and the American Joint Committee on Cancer.
Critical appraisal questions Underline your answer
Were confounding factors identified? Yes/No/Unclear
Evidence:
justification, compare and contrasting or/and providing solution
Although the study used ICD system of classification, however the
researcher did not identified confounding factors in relation to recording
about HNC cases in cancer registries. However, this limitation was
discussed in the conclusion.
Critical appraisal questions Underline your answer
Were strategies to deal with
confounding factors stated?
Yes/No/Unclear
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Evidence:
justification, compare and contrasting or/and providing solution
Strategies to deal with confounding factors were stated in the conclusion part
where it was mentioned that cancer registries should use standardized format
so that appropriate details related to smoking habits, frequency, duration,
socioeconomic status and other risk factors were recorded. This is necessary to
understand geographical, cultural and histological variations in HNC
prevalence.
Critical appraisal questions Underline your answer
Were the outcomes measured in a
valid and reliable way?
Yes/No/Unclear
Evidence:
justification, compare and contrasting or/and providing solution
No, use of cancer registries to measure outcome of HNC and risk habits
is not reliable as appropriate reporting system was not discussed. It
contributes to biases.
Underline your answer
Was appropriate statistical analysis
used?
Yes/No/Unclear
Evidence:
justification, compare and contrasting or/and providing solution
The data was analyzed using the SPSS version and chi square test. Use of chi
square test is appropriate as it helps to predict whether the outcomes obtained
are statistically significant or not. The researcher was able to identify
association between gender, habits, site and stage of cancer using the chi
square test.
Add additional pages if needed
Reference: Addala, L., Pentapati, C. K., Thavanati, P. R., Anjaneyulu, V., &
Sadhnani, M. D. (2012). Risk factor profiles of head and neck cancer patients of
Andhra Pradesh, India.
Indian journal of cancer,
49(2), 215.
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