Establishment of Hospital-based Cancer Registry in the Clinical Oncology Department of Ain Shams University Hospitals

Abstract

Cancer is a major public health problem and the best way to evaluate its impact on population is to review cancer mortality records, which underestimate its impact on the community. So, calculation of incidence rates of new cases is important and reflects the true impact of cancer. This can be achieved by a strong and reliable registry system. Because of its importance, for several years, trials to establish a National Cancer Registry program were carried out in Egypt, with the aim of obtaining incidence data on cancer for better assessment and monitoring of the magnitude of the problem. One of the great challenges of the program is to include Cairo in the registry, being the capital with many hospitals, centers and clinics dealing with cancer patients. Data about cancer patients can be obtained from medical records, which need to be revised for accuracy and completeness. This study aims to assess the feasibility of current medical records for use in cancer registry in the Clinical Oncology Department of Ain Shams University, to set up a model of cancer registry form to be used in the establishment of a computerized hospital-based registry system and provide hospital-based data of cancer cases for a whole year . The study was conducted at the five oncology units (clinics) of the Clinical Oncology Department of Ain Shams University Hospitals, where 100 medical records were assessed for feasibility of use in registry, then registry data was collected from all newly diagnosed cancer cases (943 cases) from 30 May 2012 till 1ST June 2013 using the form of the National Registry Program of Egypt (NCRPE). Descriptive analysis of the results was done; analysis of possible environmental risk factors association with certain cancers was assessed. This was followed by introduction of the software program of the NCRPE to allow storage, easy retrieval of information and analysis of data.

As regards, the assessment of feasibility of medical records for use in registry, the study revealed that the records are not feasible for registry use where in 22% of the examined records are complete regarding the core items of the registry form, 44% of the records contain three of the core items and 32% contain only two core items and without the presence of all core items the medical records can never satisfy the registry needs. Regarding the registry data collected through a whole year using NCRPE registry form, the study revealed that breast cancer was the most frequent cancer (25% of total cancers in both sexes) to be followed by lung cancer (8.5%). Colorectal is the 3rd frequent cancer (7.5%), followed by brain and CNS tumors (5.6%) and liver cancer (4.5%). More than 80% of the cancer cases are above the age of 40, females constitutes more than 60% of the cases in our study and that that more than 85% of them are living in urban areas as 80% of them are living in Cairo. Among male cancer cases, results of the study has shown variation in most frequent cancers in different age groups. Bain and CNS cancers occupies rank 1 in the younger age groups, being found in about 28% of them, However, in older age groups lung cancer is the most frequent cancer. Among female cases, different cancers is observed in different age groups as in male cases. Yet among females, breast cancer is the most frequent cancer with a peak in the age group (40-59) years.

Regading environmental risk factor assessment, the current study shows a strong association between smoking and certain cancers. Environmental Tobacco Smoking (passive smoking) is found to be highly associated with breast cancer cases, where 60.4% of the breast cancer cases are exposed to passive smoking. Among the male cases study results have shown association between active tobacco smoking and lung, bladder and prostate cancers.

The software progam of the NCRPE was introduced in the Clinical Oncology depatment which is a web-based application developed by the registry and centrally stored on the main server of the ministry of Communication and Information Technology. “Double Minus” program was developed to detect duplicate cases to complete the data processing cycle. Duplicate forms were shown on the screen for the data manager to complete one form and discard the other or include the 2nd form as double primary with adjustment of sequence number. The program store all data entered allows exporting the data at any time into an excel file in a way that facilitate direct analysis of the data for research purposes.