Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION Ms. MERCY SAMPOORNA.P NAME OF THECANDIDATE 1 I YEAR M. Sc NURSING E.T.C.M COLLEGE OF NURSING AND ADDRESS P.O. BOX No. 4, KOLAR – 563 101 KARNATAKA NAME OF THE E.T.C.M COLLEGE OF NURSING, INSTITUTION P.O. BOX No. 4, KOLAR – 563101 COURSE OF STUDY AND MASTER OF SCIENCE IN NURSING, SUBJECT PSYCHIATRIC NURSING 2 3 DATE OF ADMISSION TO 15-6-2012 4 COURSE “A STUDY PSYCHOSOCIAL CANCER 5 TO ASSESS NEEDS PATIENTS IN OF THE ORAL SELECTED TITLE OF THE TOPIC CANCER HOSPITALS AT BANGALORE IN A VIEW TO DEVELOP INFORMATION BOOKLET”. 1 AN 6. BRIEF RESUME OF THE INTENDED WORK “Health is a large word. It embraces not the body only, but the mind and spirit as well... and not today's pain or pleasure alone, but the whole being and outlook of a man”. - James H. West According to WHO, health is state of complete physical, mental, social and spiritual well being, not merely an absence of disease or infirmity1. The state of positive health implies the notion of ‘perfect functioning’ of the body and mind. It conceptualizes health biologically, as a state in which every cell and every organ is functioning at optimum capacity and in a perfect harmony with the rest of the body; psychologically as a state in which the individual feels a sense of perfect wellbeing and of mastery over his environment and socially, as a state in which the individuals capacities for participation in the social system are optimal1. Cancer is the Latin word for crab because of the crab-like tenacity a malignant tumor sometimes seems to show in grasping the tissues it invades. The word cancer often abbreviated as ”Ca” is a term often frightens most people it is otherwise known as malignant neoplasm. It includes tumor, malignancy, carcinoma etc. Cancer is a collective term describing a large group of disease characterized by uncontrolled growth and / or spread of abnormal cells2. Cancer is a generic term for a large group of diseases that can affect any part of the body. One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries, and which can then invade adjoining parts of the body and 2 spread to other, a process referred to as metastasis. Metastasis is the major cause of death from cancer3. Cancer is the second largest cause of disease worldwide, representing about 13% of all deaths (7.6 million deaths) 4. Cancer is the second most common disease in India5. The data from Hospital Based Cancer Registry [HBCR] of India has shown that Cancer of Cervix (28%) and Breast (16%) in women are most common and cancer of Head and Neck region constitute about 30 % of all cancer in males and females6. Oral cancer is part of a cancer group called head and neck cancers, and is defined as an uncontrollable growth of cancerous cells that invades the mouth (called oral cavity) and the part of the throat behind the mouth (called oropharynx)7. The Commonest cancers among Males and Females seen at Kidwai Memorial Institute of Oncology [KMIO] 2004-05 are as below6. MALE Pharynx Oral cavity Leukemia Esophagus Lung Lymphoma Stomach Brain & Nervous system Larynx Liver FEMALE Cervix Breast Oral cavity Esophagus Ovary Leukemia Thyroid Stomach Lymphoma Pharynx The leading Sites of Cancer in Males are as follows - Pharyngeal cancers (excluding cancer of nasopharynx) accounts for (14.1%), Oral cavity (11.2%), Leukaemias (8.4%), Oesophagus (8.3%) and Lung (6.8%). Leading Sites of Cancer in 3 Females are Cancer of the cervix uteri accounted for (26.7%), Cancer of the breast (16.6%), oral cavity (11%), Oesophagus (5.7%) and ovary (5%) 6. The risk factors for mouth cancer include: Smoking; Chewing tobacco; Heavy smoking, heavy drinking; Too much sun exposure on the lips; people who consume lots of red meat, processed meat and fried foods; Gastro esophageal reflux disease; HPV (human papillomavirus) infection; Prior radiation treatment (radiotherapy) in the head and/or neck area; Regularly chewing betel nuts; Exposure to certain chemicals especially asbestos, sulphuric acid and formaldehyde; Cancer starts when the structure of the DNA (deoxyribonucleic acid) alters - a genetic mutation8. The impact of cancer on patients brought psychosocial problems like difficulties in the family, smoking, alcohol abuse, work and leisure, social isolation, dependency, financial crisis. The psychosocial problems are leading for major psychiatric problems in oncologic clients9. Each year on 4 February is celebrated as World Cancer Day."Together it is possible" is the 2012 theme for World Cancer Day10. World No Tobacco Day (WNTD) is observed around the world every year on May 31. It is meant to encourage a 24-hour period of abstinence from all forms of tobacco consumption across the globe11. 4 6.1 NEED FOR THE STUDY "Cancer is not a death sentence, but rather it is a life sentence; it pushes one to live." - Marcia Smith According to the WHO, Oral health is defined as ‘being free of chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects and other diseases and disorders that affect the mouth and oral cavity. Having a good oral health enables individuals to communicate effectively, to enjoy food, to speak well, to enjoy a higher quality of life, and to have both a higher self-esteem and social confidence. However, despite considerable improvement in the field of oral health throughout the world, oral health problems still persist both in developed and developing country12. Oral cancer is an important public health matter which is responsible for 3% to 10% of cancer mortality worldwide. Oral or oropharyngeal cancer is the eleventh most common cancer worldwide with over 3, 00,000 new cases13. Oral cancer is the third most common cancer in India after cervical and breast cancer amongst women14. In India alone over 1, 00,000 cases are registered every year. In Karnataka 75% of people are using tobacco or alcohol and 40% of people are in risk15. A study was conducted in Italy to assess the functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer. 36 of 153 consecutive patients surgically treated for carcinoma of the oral cavity. 50% of the cases examined, moderate to severe late toxicity was observed, regarding subcutaneous tissues, salivary function, dysphagia, and taste impairment. Patients with severe dysphagia showed higher levels of depression and anxiety. Finally they concluded that dysphagia and taste impairment are associated with quality of life and depression16. 5 A study to assess the functional status and coping in patients with oral and pharyngeal cancer before and after surgery. These psychosocial and physical functioning as well as the functions of recreation/pastimes, sleep/rest, home management, work, and eating were rated as being impaired 2-4 months and also 12 months after treatment. This study reveals that there is a need of individualized rehabilitation for these patients, and that the Sickness impact profile (SIP), and coping, measured by the Sense of coherence (SOC) scale may serve as evaluation tools in a rehabilitation programme17. Oncology patients have various psychological problems such as emotional liability, changes in future perspectives, feelings of solitude, abandonment, marginalization, stigmatisation, interpersonal problems, and all these problems can occur during different disease stages and during treatment with variety of psychological consequences18. Psychosocial issues facing the head and neck cancer patient are numerous and include coping with the initial cancer diagnosis, adjustment to living with cancer and the treatments involved (including difficulties with speech, eating and drinking, and sexual adjustment), depression and anxiety. The patient must also often confront issues with a spouse and family, facial disfigurement, rehabilitation, and for the terminal cancer patient, accepting death. It is recommended that additional psychosocial research and patient education efforts continue in order to assist head and neck cancer patients19. Oral cancer is the most common cancer in India and according to Dr Geoff Craig “People are dying of oral cancer because of ignorance”. So Sangeeta Darvekar Charitable Trust thought of a mass awareness program about oral cancer, its causes, its treatment and resultant problems and the way of preventing this cancer20. 6 “India has the highest number of oral cancers in the world with 75,000 to 80,000 new cases every year. The government should ban gutka under the Food Safety and Standard Authority of India rules that came in effect on August 2011,” says Bhavna Mukhopadhyay, executive director, Voluntary Health Association of India, a non-profit organization20. The Mouth Cancer Foundation in June 2004 to be a professional support organization solely dedicated to helping people with mouth, throat and other head and neck cancers deal with the crisis of cancer. Through a variety of ways the charity gives resources, information and contact with people in a similar situation at a difficult time21. Additionally worrisome, the remarkable advances in biomedical care for cancer have not been matched by achievements in providing high-quality care for the psychological and social effects of cancer. Numerous cancer survivors report that cancer care providers did not understand their psychosocial needs, failed to recognize and adequately address depression and other symptoms of stress, were unaware of or did not refer them to available resources, and generally did not consider psychosocial support to be an integral part of quality cancer care22. Psychosocial health needs encompass the mental, emotional, social, and spiritual aspects of health and the actions necessary to attain optimal well-being21. Cancer patients also experience other physical, informational, and practical needs that may influence psychosocial health. The supportive care framework is inclusive of the psychosocial as well as the physical, informational, and practical needs that are important to address in cancer care23. 7 Many studies have suggested that unmet psychosocial needs of oral cancer patients can affect treatment and put patients at risk of illness later in life. Yet, that psychosocial need are often not acknowledged or addressed in cancer care. Oral cancer remains a major health problem in India, and only dedicated, sustained efforts towards early detection, prevention and helping the oral cancer patients to meet psychosocial needs will reduce the burden of this disease and also the above need for the study and reviews of literature clearly suggests that less studies has been conducted on psychosocial needs of oral cancer patients. So the investigator found it relevant to assess the psychosocial needs of oral cancer patients in a view to develop an information booklet. 6.2 REVIEW OF LITERATURE The review of literature is arranged under the following categories: 6.2.1 Review of literature related to incidence and prevalence of oral cancer 6.2.2 Review of literature related to psychosocial needs of patients 6.2.3 Review of literature related to information booklet to patient 6.2.1 Review of literature related to incidence and prevalence of oral cancer A retrospective study was conducted to determine whether the incidence of oral cancer is continuing to rise in the United Kingdom. There were 32,852 oral cancer cases registered and had significant increases in incidence of 18% and 30% were seen in males and females respectively. The trend was observed in younger (<45 years) and older (45+ years) age groups with 3.5% and 2.4% average annual increases respectively. These increases were consistent for the majority of regions in the older group. For the younger 8 group the increases in incidence were more rapid and differed geographically. Incidence remains higher in men than women24. A population-based study was conducted among oral cancer patients in Taiwan during the period 1979- 2003, the incidence of oral cavity cancers is increasing rapidly in South-East Asia, which may be attributable to tobacco smoking, alcohol and betel-nut chewing. 26,166 cases were seen having an initial diagnosis of oral cavity cancers. 3.11 fold increase in risk for second cancer at all sites was observed after oral cavity cancers compared with the general population (standardized incidence ratio = 3.11, 95% confidence interval: 2.97-3.25). Of nine sites with excess risks of developing a second cancer, the frequency was highest in the oral/pharynx (60%), followed by lung (7.2%) and esophagus (5.5%). Second esophageal and lung cancers had a greater impact on survival compared with other types of second cancer. Notably, the risk excess was more prominent for patients with a follow-up interval of <=1 year and a first primary cancer diagnosed at age of <=40. Finally they concluded that oral cavity cancers are associated with an increased risk of nine second malignancies, which had a negative impact on survival25. A study conducted by Lizzy Sunny et al (2004) on 9670 oral cancer patients in Mumbai of which 6,577 were men and 3,093 were women was done to provide a population based incidence trend and cumulative risk of oral cancers. This study found that 1 out of every 57 men and 1 out of every 95 women will contract oral cancer at some time in their whole life and 97% of the chances are after they complete the age of 4026. A case control study of 348 cases of cancers of the oral cavity with equal number of controls was conducted by A. Nandakumar et al (1990) in Bangalore, India. It showed 9 an elevated relative risk (25.3%) of oral cancer due to chewing of pan tobacco, any smoking (cigarette or bidi or both) had only slightly elevated risk of developing oral cancer, whereas a history of alcohol drinking or inhalation of snuff did not influence the risk. A new finding of study was the markedly elevated risk of oral cancer in persons consuming ragi (Eleusine coracana, family graminae) in comparison to those not consuming ragi as staple cereal in their diet. There also appeared to be some interaction between ragi consumption and tobacco chewing with substantially higher relative risks in those who pursued both habits compared to those who gave a history of either27. 6.2.2 Review of literature related to psychosocial needs A study was conducted to identify the prevalence of psychosocial need, and the contributory factors to need, among cancer patients, using a descriptive cross-sectional questionnaire survey of adult cancer patients. The participants were 1,000 patients from four hospitals in the north west of England with the following characteristics: tumor type (breast, colorectal, lymphoma, lung), being 1 month from a 'critical moment' in the cancer journey (i.e. (i) diagnosis, (ii) end of first treatment, (iii) recurrence, (iv) move from active treatment to palliative care), and aged over 18 years. The main outcome measure was a psychosocial needs inventory comprising seven needs categories (48 need items). A sample of 402 was achieved (40% response rate). Psychosocial needs relating to the need categories 'health professionals', 'information' and 'support networks' are commonly expressed and strongly felt by cancer patients. Needs relating to 'identity', 'emotional and spiritual' issues and 'practical' issues are less commonly expressed but are also strongly felt. Particular needs are related to tumor type, illness 'critical moment', age, gender, 10 health status, socioeconomic and other social factors. This information should increase awareness among cancer care professionals about a range of psychosocial needs and may help them target particular patient groups for particular support interventions28. A study was conducted to evaluate the psychosocial support needs of teenage young adult cancer patients undergoing radiotherapy in Wales. A focus group interview was utilized to encourage dialogue and collect rich data. Transcripts were analyzed through open coding and content analysis. Emergent themes in terms of psychosocial tensions were identified and categorized as external stressors and intrinsic anxieties. All participants indicated a desire to maintain their identity as individuals and resume as normal life as possible throughout the treatment process and beyond. Peer support was deemed as vital to achieving this goal. Participants demonstrated a distinct sense of unity and group cohesion throughout the session with suggestions that they considered themselves to be very different from what they thought of as usual cancer patients. A range of information was offered prior to radiotherapy however there was variation in the efficacy of this provision between centers. At variance with literature, issues related to body image were not overtly demonstrated as significant. Support services provided by external organizations were not being signposted. Psychosocial support is vital to the psychological recovery and wellbeing of young adult cancer patients. Findings suggest that issues related to peer support and age appropriate services and information are not being addressed within current service provision29. A study was conducted on routine assessment of psychosocial and supportive care needs. A total of nine clinical practice guidelines, three systematic reviews, and 14 primary studies were included in the review. Overall, this body of literature suggested 11 that routine collection of psychosocial health care data has an influence on communication with oncologists and other study specific outcomes, but the evidence was limited by heterogeneity and methodological limitations. Given the limitations in the current body of evidence, there remains a need for rigorous empirical research regarding the optimal approach to psychosocial needs assessment, including the specific characteristics that influence effectiveness on patient outcomes. This guideline fills an important gap in psychosocial care, regarding the routine assessment of psychosocial health care needs such as mental, emotional, social, spiritual and other actions to attain optimum health30. A study was conducted on psychosocial needs of patients with leprosy in South Africa. 30 leprosy patients (15 males, 15 females; 41-60 years old) underwent interviews. Intense grief was the most common general reaction on hearing the diagnosis of leprosy. All responses experienced anxiety while admitted at a hospital and the majority felt that lengthy institutionalization had more disadvantages that advantages. 11 subjects first consulted a traditional healer before visiting a doctor because of belief that a spell had been cast on them, family influences and traditional beliefs. In general, the subjects were very satisfied with the treatment that they received from the Leprosy Mission and a West fort Hospital. Of 23 married subjects, 9 men and 7 women had been deserted by their marriage partners because of leprosy. It is concluded that the psychosocial need of leprosy sufferers in South Africa are similar to those of leprosy sufferers in other parts of the world in the need for self acceptance, social acceptance and acceptance by the community31. 12 6.2.3. Review of literature related to information booklet to patients An exploratory study investigated factors influencing patient satisfaction with and utilization of information booklets. The research was conducted in two stages. In stage 1, five commonly used cancer information booklets were reviewed by 36 Australian patients who were either receiving chemotherapy or had just completed treatment. Data were collected on patient satisfaction with, preference for and utilization of information booklets. A high level of satisfaction was found for all five information booklets, although a clear preference for one particular booklet emerged. Stage 2 focused on the side effects of patient information preference style on their satisfaction and recall of information presented in two booklets in the course of their treatment. No differences were found between patients who seek information and those who avoid it. The findings of this study suggest that patients' information needs may be better met if information booklets are written in plain English, and presented to patients prior to treatment. Future studies incorporating a larger sample of patients and greater selection and variety of information booklets are required to further determine if patient characteristics and features of booklet presentation influence patient satisfaction and preference32. A study was conducted to evaluate the level of understanding and the impact of the information booklet "For a better understanding of radiotherapy" for radiotherapy patients. One hundred booklets with a questionnaire and a postage-paid envelope were sent to the oncologists of these ten radiotherapy centers. The information given in the booklet was considered clear for 57.4% of the patients; 74.2% did not require explanations of the vocabulary, whereas 14.8% wanted explanations and 13.0% did not state an opinion. In the qualitative analysis, the booklet was found to be well received and 13 understood even if technical explanations were sometimes needed. This booklet was judged to be useful by the patients and thought to "answer the questions which the patient may ask". It seems important to define the right moment for its distribution (the first visit, the first sequence of treatment, for example, would be more appropriate). Lastly, certain passages, especially in the introduction, could be modified so as to improve the legibility (in particular for the elderly). In addition, the informative content, largely well understood, could be extended with a glossary, using simple technical and always clear explanations33. A study was conducted to determine the need for information among survivors of childhood cancer, to assess the acceptability of an information booklet, and to investigate the effectiveness of the booklet in increasing knowledge and influencing health related behaviors. The booklet was developed for young people aged 14 years and above by the United Kingdom Children's Cancer Study Group Late Effects Group. Included is information about treatment of cancer, general advice about a healthy lifestyle, the rationale for long term follow up, and information about employment and life insurance problems. Survivors were interviewed at the follow up clinic, offered the booklet, and contacted approximately one week later for a telephone interview. The clinic interview assessed survivor's understanding of their illness and treatment and its impact on their lives, and their preferences for further information. The telephone interview determined survivors' general reaction to the booklet, whether it increased knowledge and influenced health related behaviors. After reading the booklet there was an increased awareness of the risk from sun bathing (p < 0.05), and greater appreciation of the importance of follow up (p < 0.05). These results suggest that written information is likely to be an acceptable 14 and effective supplement to discussions with medical professionals and may readily be incorporated into long term follow up clinics34. A study was conducted to develop an information based booklet for patients with hip or knee osteoarthritis, offering information and advice on maintaining activity. Six information based guidelines and 54 systematic reviews were identified. The focus groups found the draft booklet to be informative and easy to read. They reported a lack of clarity about the cause of osteoarthritis and were surprised that the pain could improve. The value of exercise and weight loss beliefs was accepted and reinforced, but there was a perceived contradiction about heavy physical work being causative, while moderate exercise was beneficial. There was a fear of dependency on analgesia and misinterpretation of the message on hyaluranon injections. The information on joint replacement empowered patients to discuss referral with their GP. The text was revised to accommodate these issues. The booklet was readable, credible, and useful to end-users. A randomized controlled trial is planned, to test whether the booklet influences beliefs about osteoarthritis and exercise35. STATEMENT OF THE PROBLEM “A study to assess the psychosocial needs of oral cancer patients in selected cancer hospitals at Bangalore in a view to develop an information booklet”. 15 6.3 OBJECTIVES OF THE STUDY 1) To assess the psychosocial needs of oral cancer patients. 2) To find association between the psychosocial needs of oral cancer patients with their selected demographic variables. 3) To develop an information booklet on psychosocial needs of oral cancer patients. 6.4. OPERATIONAL DEFINITIONS 1) Assess: In this study, it refers to the critical analysis and exploration of psychosocial needs of oral cancer patients. 2) Psychosocial needs: It refers to those needs arising in the physical, informational, emotional, psychological, social, spiritual, and practical domains as part of a patient’s experience of cancer and its treatment. 3) Oral cancer: It refers to malignancies indicative of unchecked cell growth that are mainly found in and around the oropharynx, gingiva, floor of the oral cavity, lower lip and base of the tongue. 4) Oral cancer patient: It refers to the oral cancer patients who are diagnosed with oral cancer and hospitalised. 5) Information booklet: It refers to the concise and comprehensive information material regarding psychosocial needs of oral cancer patients; which includes actions necessary to attain optimal well being. 16 6.5 ASSUMPTIONS Oral cancer patients are unable to meet their psychosocial needs. Information booklet provided by the investigator would update their knowledge regarding psychosocial needs of oral cancer patients. 6.6 DELIMITATIONS Study is delimited to oral cancer patients of selected cancer hospitals at Bangalore. 7. MATERIALS AND METHODS 7.1 SOURCES Data will be collected from the oral cancer patients in selected cancer hospitals at Bangalore. 7.1.1 RESEARCH APPROACH Exploratory research approach 7.1.2 RESEARCH DESIGN Non-experimental descriptive research design 7.1.3 VARIABLES UNDER THE STUDY Research variable: Information booklet on psychosocial needs of oral cancer 17 patients Demographic variable: Selected demographic variables such as age, gender, religion, type of family, marital status, educational qualification, occupation, income, number of previous hospitalization and any previous exposure to health education, mass media, information booklet etc regarding cancer. 7.1.4 SETTING OF THE STUDY The study will be conducted in selected cancer hospitals at Bangalore. 7.1.5 POPULATION The population for the study comprises of oral cancer patients in selected cancer hospitals. 7.1.6 SAMPLE The sample will be oral cancer patients aged 18 years and above who are hospitalized in selected cancer hospitals at Bangalore. 7.1.7 SAMPLE SIZE The sample size will be 100 oral cancer patients. 7.1.8 SAMPLING TECHNIQUE Convenient sampling technique will be used. 7.1.9 CRITERIA FOR SELECTION OF THE SAMPLE Inclusion criteria Oral Cancer Patients who are willing to participate. Oral Cancer Patients available during data collection. 18 Exclusion criteria Oral cancer patients who are unable to communicate due to any other reasons like hearing impairment, oral surgery or chronic illness etc. Oral cancer patients who are unconscious. 7.2 METHOD OF DATA COLLECTION A structured interview questionnaire method. 7.2.1 TOOLS FOR DATA COLLECTION The researcher will collect data through structured interview questionnaire. It comprises two parts. Part I: Demographic Variables like age, gender, religion, type of family, marital status, educational qualification, occupation, income, number of previous hospitalization and any previous exposure to health education, mass media, information booklet etc regarding cancer. Part II: Structured Interview Questionnaires (SIQ) on Psychosocial Needs of Oral Cancer Patients. 7.2.2 DATA COLLECTION PROCEDURE Structured Interview Questionnaire (SIQ) will be used to collect data from oral cancer patients after obtaining the formal permission. 19 7.2.3 METHOD OF DATA ANALYSIS Collected data will be analyzed using descriptive and inferential statistics. Descriptive statistics: The data collected will be organized and summarized by using descriptive statistics like mean, frequency, percentage distribution and standard deviation. Inferential statistics: The association between psychosocial needs of oral cancer patients with their selected demographic variables will be found using chi-square test. 7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENT OR OTHER HUMANS OR ANIMALS? Yes, non - invasive intervention will be done. The psychosocial needs will be assessed by using a Structured Interview Questionnaires (SIQ) on Psychosocial Needs of Oral Cancer Patients followed by providing information booklet on Psychosocial Needs of Oral Cancer Patients. 7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOU’RE INSTITUTION? a) Yes, Ethical clearance will be obtained from the research committee of E.T.C.M College of Nursing, Kolar. b) Permission will be obtained from the concerned authorities of the selected cancer hospitals of Bangalore. c) Informed consent will be obtained from the oral cancer patients who are willing to participate in the study. 20 8. LIST OF REFERENCES 1. K.Park. Park’s text book of preventive and social medicine. 20thedition. Banarsidas Bhanot publishers. 2009. p 13-15,142. 2. Joyce M. Black Haws JH. Text book of medical surgical nursing. 7th ed. vol 3; p 33336. 3. WHO. World health organization. Feb 2012 Available from: URL: http://www.who.int/mediacentre/factsheets/fs297/en/ 4. The global economic burden of non- communicable diseases. A report by the world economic forum and the Harvard school of public health. September 2011. 5. Imran Ali; Waseem A .Wani and Kishwar Saleem. Cancer scenario in India with future perspective. Cancer therapy. 2011.8: p 56-70. 6. Hospital based cancer registry statistic of cancer. 2011 Available from: URL: http://www.kidwai.kar.nic.in/statistics.htm 7. Alina Morrow. MS.OmniMedicalSearch.com. 2010 Available from: URL: http://www.omnimedicalsearch.com/conditions-diseases/oralcancer- overview.html 8. Medical News Today. Medical news today.com. 2009 Available from: URL: http://www.medicalnewstoday.com/articles/165331.php 9. Douglas SI, Foley H, Lipson. Assessment of psychosocial problems. Psycho Oncology. 2007. 16(4): p 358-64. 10. IARC. International Agency for Research on Cancer. World cancer day. 2012 Available from: URL http://www.iarc.fr/en/mediacentre/iarcnews/2012/worldcancerday2012.php 21 11. World Health Organisation.World NO Tobacco Day. 2010 Available from: URL: http://en.wikipedia.org/wiki/World_No_Tobacco_Day 12. The World Oral Health Report. Continuous improvement of oral health in the 21st century the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiology. 2003 13. Oral Cancer Foundation. Incidence and Prevalence of oral cancer.2012 Available from: URL: http://ocf.org.in/professional/IncidenceAndPrevalence.aspx 14. Khan Z. An Overview of Oral Cancer in Indian Subcontinent and Recommendations to Decrease its Incidence. .WebmedCentral.2012. 3(8): WMC003626 15. Saman Warnakulasuriya. Global epidemiology of oral and oropharyngeal cancer. Oral Oncology journal. 2009. 45: p 309–316. 16. Airoldi M, Garzaro M, Raimondo L, Pecorari G, Giordano C, Varetto A, et al. Functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer. Head and neck. 2011. 33(4): p 458-68. 17. Ms. Ann Langius, Hjordis Bjorvell, Magnus G. Lind. Functional status and coping in patients with oral and pharyngeal cancer before and after surgery. Head and Neck. 1994. 16(6): p 559–68. 18. Bras. M. Psychological problems of patients with cancer. 2010. Medicinska naklada. Zagreb. Croatica. 2010. 22: p 227-30. 19. R. Cogwell Anderson, K. Anderson Franke. Psychological and Psychosocial Implications of Head and Neck Cancer. The Internet Journal of Mental Health. 2002. 1: p 1531-2941. 20. Mouth cancer in India and tobacco kills. 2011 22 Available from: URL: http://www.oralcancerawareness.org/mouth_cancer.html 21. Mouth Cancer Foundation. Learn about. 2012 Available from: URL: http://www.mouthcancerfoundation.org/get-info/learn-about 22. Adler NE, Page AEK (Eds). Cancer care for the whole patient. Meeting psychosocial health needs. The National Academies Press. 2008: p 23-30. 23. Fitch M. Provisional Cancer Network Supportive Care Work Group. Report and Recommendations. Submission to cancer care Ontario, Toronto.1994. 24. D.I. Conwaya, D.L. Stocktonb, K.A.A.S. Warnakulasuriyac, G. Ogden and L.M.D. Macphersona Oral Oncology. 2006. 42(6): p 586-592. 25. Chen PT, Kuan FC, Huang CE, Chen MF, Huang SH, Chen MC et al. Incidence and patterns of second primary malignancies following oral cavity cancers in a prevalent area of betel-nut chewing: a population-based cohort of 26,166 patients in Taiwan. Jpn J Clin Oncol. 2011 Dec. 41(12): p 1336-43. 26. Lizzy Sunny,Yeole BB, Hakama M, Shiri R, Sastry PSRK, Mathews S et al. Oral cancer in Mumbai, India. A fifteen years perspective with respect to incidence trend and cumulative risk. Asian Pacific Journal of Cancer Prevention. 2004. 5: p 294-300. 27. A.Nandakumar, K.T, Thimmasetty, N.M. Sreeramareddy, T.C. Venugopal, Rajanna, A.T Vinutha et al. A population based case-control investigation on cancers of oral cavity in Bangalore, India.1990. 62: p 847-851. 28. McIllmurray MB, Thomas C, Francis B, Morris S, Soothill K, Al-Hamad A. The psychosocial needs of cancer patients: findings from an observational study. Euro J Cancer Care (Engl). 2001 Dec. 10(4): p 261-9. 23 29. David CL, Williamson K, Tilsley DW. A small scale, qualitative focus group to investigate the psychosocial support needs of teenage young adult cancer patients undergoing radiotherapy in Wales. . Euro J Oncol Nurs. 2012 Sep.16 (4): p 375-9. 30. Howell D, Mayo S, Currie S, Jones G, Boyle M, Hack T et al. psychosocial health care needs assessment of adult cancer patients: a consensus-based guideline. 2012Dec. 20(12): p 3343-3354. 31. Scott. J. The psychosocial needs of leprosy patients. Leprosy Review. 2000. 71: p 486-491. 32. Butow P, Brindle E, McConnell D, Boakes R, Tattersall M. Information booklets about cancer: factors influencing patient satisfaction and utilization. Patient Educ Couns. 1998 Feb.33 (2): p 129-41. 33. Hoarau H, Kantor G. Understanding the information booklet "For a better understanding of radiotherapy”. Cancer Radiotherapy. 2000 Jul-Aug. 4 (4): p 30816. 34. Blacklay A, Eiser C, Ellis A. Development and evaluation of an information booklet for adult survivors of cancer in childhood. The United Kingdom Children's Cancer Study Group Late Effects Group. Arch Dis Child. 1998 Apr.78 (4): p 340-4. 35. Williams NH, JonesAmoakwa E, Burton K, Hendry M, Lewis R J, Bennett P et al. The Hip and Knee Book: developing an active management booklet for hip and knee osteoarthritis. Br J Gen Pract. 2010 Feb. 60(571): p 64-82. 24 9. SIGNATURE OF THE CANDIDATE The research topic selected is relevant and 10. REMARKS OF THE GUIDE feasible for the study. MR. PRAVEEN. A. LONI 11. NAME AND DESIGNATION Associate Professor & HOD of Mental 11.1. GUIDE Health Nursing Department, ETCM College of Nursing, Kolar, 563101 11.2. SIGNATURE OF THE GUIDE 11.3. CO-GUIDE (if any) 11.4. SIGNATURE OF THE CO-GUIDE MR. PRAVEEN. A. LONI 11.5. HEAD OF THE DEPARTMENT Associate Professor & HOD of Mental Health Nursing Department, ETCM College of Nursing, Kolar, 563101 11.6. SIGNATURE OF THE HOD 12.1. REMARKS OF THE 12. PRINCIPAL This topic was discussed with the members of the research committee and finalized. She is permitted to conduct the study. 12.2. SIGNATURE OF THE PRINCIPAL 25