a study of lifestyle of women in breast cancer in kailash cancer hospital and research center

A STUDY OF WOMEN IN BREAST CANCER IN KAILASH CANCER HOSPITAL AND RESEARCH CENTER, GORAJ.

AUGUST 2017 RESERCHERS

GORAJ ARCHANA BHATT

ANITA RAKHE

A STUDY OF WOMEN IN BREST CANCER IN KAILASH CANCER HOSPITAL AND RESERCH CENTER, GORAJ

A

Project Submitted to

Department of Social Work

Sardar Patel University

In The Partial Fulfilment

Of the Master Degree of

Social Work (MSW)

2017

Semester 3rd

PROJECT GUIDE SUBMITED BY

DR. MRS. BIGI THOMAS ARCHANA BHATT

READER ANITA RAKHE

CONTENTS

Preface …………………………………………………….. 1

Acknowledgement ………………………………………. ...2

List of Tables & Figures …………………………................3

Chapter List of Contents Page No.

1Introduction & Organization Profile &Research Methodology

1.1 Introduction to study of women in breast cancer1.2 Organization Profile

1.3 Research Methodology

2Data Analysis & Interpretation

2.1 Study of women in breast cancer

3Findings, Suggestions, Conclusion

3.1

3.3 Conclusion

Bibliography

Annexure

PREFACEA Study on “Study of women in breast cancer ’’ was carried out in Kailash cancer hospital and research center.The main objective of the research was to find the situation of women in breast cancer.

A Study of women at the time of cancer is essential to know how their family support, what are physical changes, mentally changes in thoughts, and so on…

The study was done as part of Descriptive Research. Sampling technique used was simple random sampling, for selecting the sample. The primary data was collected by means of questionnaire. The secondary data was collected from the organization records and websites. The study includes various tools and techniques used to collect data by using Interview Schedule, Observation and Discussion. The data was analysed using percentage method. Utmost care has been taken from the beginning of the preparation of the questionnaire till the analysis, findings and suggestions. The analysis leads over to the conclusion that majority women are complaint of tumour in breast. It was found that most of the women was illiterate. Valuable suggestion and recommendations are also given to the women for their healthy and happy life.

Another study on “Study of women in breast cancer” was done in Kailash Cancer Hospital. The main objective of research was to find the situation of women in cancer.

Kailash cancer hospital plays a major role in taking care of their patients and they aim for services provide to middle class and poor sections of the society. The study was mainly focusing on patient‘s satisfaction of the treatment provided by the health canter.

The study was exploratory cum descriptive Research. Sampling technique used was purposive and accidental technique for selecting the sample. The primary data was collected by means of

questionnaire. The secondary data was collected from various websites. The study includes various tools and techniques used to collect data by using Interview Schedule, Observation and Discussion. The principle of confidentiality and dignity was maintained while conducting the research and adding to it care has been taken from the beginning of the preparation of the questionnaire till the analysis, findings and suggestions. Valuable suggestions and recommendations are also given to the organization for the better prospects.

ACKNOWLEDGEMENT: I am graceful to almighty, for the blessing showed upon me for the successful completion of my project. I express my deep sense of gratitude to Mrs Dr. Shivani Mishra, The HOD of Department of Social work, vidhyanagar, for her encouragement and support. I express my deep sense of gratitude and profound thank to my project training guide, Dr.Bigi Thomas for her constant encouragement throughout my project training report. It is an honour to show my deepest and heartily gratitude to our external guide from Social work head of Kailash cancer hospital, Mr. Bipin Solanki for their support in completing this project. This project would not have been possible without the unconditional support and inspiring information of my respondents. I‘m heartily grateful to them for their support throughout the study. I want to thank my parents, friends and staff members from the bottom of my heart for their unconditional support, who never showed their disagreement in regards to the topic

Archana Bhatt Anita Rakhe

LIST OF TABLESSR.NO TABLE PAGE

NO

1 Marital status of respondent2 Education qualification3 Occupation of respondant4 Age at first child birth5 how long your child was breast fed6 stages of diagnoses7 How did you feel about the diagnosis8 Symptoms of the breast cancer9 Attitude about treatment?10 how have your thoughts changed11 how has your life change since you

found out you had breast cancer12 How your husband support?13 if any change in their behaviour after

knowing your situation14 what are the biggest challenges15 if any person have face same problem

in family16 Situation of cancer is curable or not?17 Under what scheme you get treatment

CHAPTER 1

INTRODUCTION, ORGANIZATION PROFILE &

RESEARCH METHODOLOOGY

INTRODUCTION:

Kailash cancer hospital is a public charitable trust working with the Muni Seva Ashram in and around Vadodara district of Gujarat. Its mission is to work for betterment of health in rural communities of Central Gujarat. It is now a Community health organization, working mainly on reproductive and human health.

INTRODUCTION OF STUDY:

Breast Cancer Definition:-

American Cancer Society states that “breast cancer is a malignant tumour that starts in the cells of the breast. A malignant tumour is a group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body”(American Cancer Society, 2012). This disease comes in many forms and is not equal in all women; it varies according to the speed of tumour growth and its ability to spread to other parts of the body. It is impossible to predict the consequences of the disease, since the degree of malignancy varies and also because people react differently to the disease. Regarding aetiology, there is no single cause that explains breast cancer. Currently there is speculation about the causes of increasing breast cancer in the world. Most of the authors point to lifestyle as primary causes. Breast cancer is associated with the Combination ofincreasing age and genetic, hormonal and environmental factors. Being a woman and growing older are the mostSignificant risk factors for breast cancer. Breast cancer is strongly related to age; only 5% of all breast cancers occur in women less than 40 years of age and over 80% of all female

breast cancers occur among women aged 50 or more years. The older a woman gets, the higher is her risk of developing breast cancer. The majority of breast cancers are not hereditary. About 85% of breast cancers occur in women who have no family history of breast cancer. These occur due to genetic mutations rather than inherited mutations that happen as a result of the aging process and life in general. Only about 5-10% of the women who get breast cancer have a family member diagnosed with it.

What is breast cancer?

The female breast is made up mainly of: Lobules–the milk-producing glands Ducts–tiny tubes that carry the milk from the lobules to the nipple Stroma–fatty tissue and connective tissue surrounding the ducts and lobules, blood vessels, and lymphatic vessels…

Cancer is the growth of abnormal cells.The cells can invade and damage normal tissue.Breast cancer can start in any part of the breast.

Causes of breast cancer:-Most likely cause is related to changes in the genetic material (DNA) in our cells.DNA changes are often related to our lifestyle, but some can be due to age and other factors.

Breast cancer risk factors:-

Risk factors are anything that can increase or decrease a person’s chance of getting a disease, such as cancer. There are many known risk factors for breast cancer. Some of these cannot be changed, but some can…

Gender Being a woman is the main risk factor for developing breast cancer

AgingBreast cancer risk increases as a woman gets older

Genetic risk factors About 5% to 10% of breast cancer cases are thought to be hereditary, caused by gene changes (mutations) inherited from a parent. Women with BRCA mutations have a high risk of developing breast cancer during their lifetime. When they do develop it, they are often younger than other women with breast cancer who are not born with one of these gene mutations.Mutations in other genes are less common causes of inherited breast cancer.

Family history of breast cancer Women who have a close blood relative with this disease have a higher risk for breast cancer.

Personal history of breast cancerA woman with cancer in one breast has an increased risk of developing a new cancer in the other breast or in another part of the same breast.

Certain non-cancer breast problems:-

Previous chest radiationWomen who had radiation to the chest for another cancer as a child or young adult are at a much higher risk than those who did not.

Post-menopausal hormone therapy (PHT)Increased risk in women who use or recently used combined PHT for many years

Race African American women are more likely to die of this cancer.

Dense breast tissueWomen with denser breast tissue (as seen on a mammogram) have a higher risk of breast cancer.

Not having children or having them later in life (after age 30) puts a woman at slightly higher risk

More menstrual cyclesSlightly higher risk if a woman started menstruation early or went through menopause late

Not breastfeedingSome studies suggest that breastfeeding may slightly lower breast cancer risk.

Physical activityMore active-lowers risk

OverweightObesity raises risk of having breast cancer, especially for women after menopause

Alcohol use Clearly linked to increased risk

Risk goes up with the amount of alcohol you drink

Preventing breast cancer:-

How all women can lower risk:Get to and stay at a healthy weight

Be physically active

Limit alcohol use

Some women can also think about things like:Breast feeding

Not using hormone therapy to deal with the symptoms of menopause

If a woman is known to be at increased risk (due to personal or family history, or known gene mutations) there are some things she can consider to decrease her chances of breast cancer:

Chemoprevention—the use of drugs to reduce the risk of breast cancer

Preventive surgery for women with very high breast cancer risk there is no sure way to prevent breast cancer. But there are things allwomen can do that might reduce their risk and help increase the odds that if they do get breast cancer, it’s found at an early, more treatable stage…

Breast cancer screening:-

Screening is testing to find cancer, or other diseases, early in people who have no symptoms.

Screening can help find cancers when they are small and have not spread –when they have a better chance of being cured.

Breast cancer screening is done withMammograms

In some cases, breast MRI

Why screen for breast cancer?The size of a breast cancer and how far it has spread are important factors in predicting the prognosis

Breast cancers found during screening exams are more likely to be small and still confined to the breast (survival outlook).

Screening for breast cancer:

MammogramIn some cases, Breast MRI (magnetic resonance imaging) For women at high risk of breast cancer based on certain factors, both MRI and mammogram exams of the breast are recommended.A mammogram is an x-ray of the breast.For a mammogram, the breast is pressed between 2 plates to flatten and spread the tissue. It produces a picture of the breast tissue.

Clinical breast exam:-A clinical breast exam (CBE) is an exam of your breasts by yourself or health care professional. Research has not shown a clear benefit of physical breast exams done by either a health professional or by yourself for breast cancer screening

Breast MRI For certain women at high risk for breast cancer, a screening MRI is recommended along with yearly mammogram.

MRI scans use magnets and radio waves (instead of x-rays) to has a higher false-positive rate (where the test finds something that turns

out not to be cancer), which results in more recalls make detailed, cross-sectional pictures.

THEORIES ON THE NATURAL HISTORY OF BREAST CANCER:-

1. The Halsted Theory: Spread from One SourceFor 60 years, starting in 1894 (or perhaps earlier), breast cancer was seen in medical literature to be a disease that arose in one location (the breast) and, if left untreated, spread through the lymphatic system first to nearby lymph nodes and subsequently to other organs in the body. This theory of "contiguous" development of metastases was articulated by Dr. W.S. Halsted, inventor of the Halsted radical mastectomy. It has thus become known as the Halsted theory, Halsted hypothesis, Halsted paradigm, Halsted model, or "halstedian view."

2. The Alternative Theory: Systemic DiseaseIn 1954 and 1967 an alternative theory was formulated and, after studies were done, was put forth in rather definitive terms in a 1980 lecture by Dr. Bernard Fisher. He stated "that breast cancer is a systemic disease . . . and that variations in effective local regional treatment are unlikely to affect survival substantially."

Following the therapeutic implications of this "systemic theory," the systemic disease has been attacked in recent years by chemotherapy and hormone therapy to the whole body. Under a pure version of this theory, the only purpose of so-called "local or regional control" (breast surgery and local or regional radiotherapy) is to prevent a local tumour from getting out of hand and causing harm in that location, not to prevent future metastases to other parts of the body. That is, under this theory any distant metastases of any significant have

already occurred at the time that a breast tumour is found by touch (palpation) or in a mammogram.

3. Citizens and Doctors, Halsted or Systemic TheoriesI think that the average citizen instinctively holds a basically Halstedian theory in her mind. One commonly hears the notion that "getting the tumour out" is the most important step. Chemotherapy is seen as a kind of "mopping up operation" in case any metastases had occurred earlier from the breast to other parts of the body (the contiguous route for development of tumours). I know that I was quite surprised when I learned that my friend's oncologist recommended delaying surgery while doing chemotherapy, something that seemed contrary to the goal of getting rid of the "main problem" first. Subsequently, I came to understand that to do surgery first can actually be viewed as delaying chemotherapy, and why one might want to do the chemotherapy first.

Doctors trained in the past 15-20 years are more likely to have been trained under the "systemic theory," in which distant metastases of some size are considered to be probable in the case of any breast cancer that has been detected (other than DCIS, ductal carcinoma in situ). Such doctors may instinctively discount the new studies showing a *survival* advantage in some women from having radiotherapy after a mastectomy (though they seem to have little problem with studies showing survival advantages from radiotherapy that follows lumpectomies).

Or perhaps some of those who accept the evidence that radiation after lumpectomy improves survival statistics, but do not conceive of getting survival advantages from radiation after mastectomy, hold a basically Halstedian viewpoint, but cannot imagine what tumour burden might be left after a mastectomy with clean margins.

At any rate, what are we to make of the facts that (a) controlling regional disease with radiation after mastectomy helps some women survive longer (meaning that the site from which "secondary dissemination" could have occurred got eradicated by the

radiotherapy -- a neo-Halstedian fact, perhaps you could call it) and (b) controlling distant disease with chemotherapy and/or tamoxifen helps some women survive longer (meaning that the disease had already disseminated or was systemic in the first place -- a systemic-theory-supporting fact)? One answer could be to construct a theory or hypothesis that accounts for both kinds of therapy successes.

Dr. Samuel Hellman of the University of Chicago did just this in a 1994 lecture, and labeled it a "spectrum theory."

4. The Spectrum Theory, or Combined TheoryIn the 1994 Karnofsky Memorial Lecture, Dr. Hellman reviewed the history of theories of breast cancer development ("natural history") from 1894 to present, and then proceeded to state the case for what he calls the "spectrum theory." My discussion of the Halsted and systemic theories, above, is based in part on his lecture.

One of the reasons that he felt called upon to formulate a new theory was that the studies showing a survival benefit from radiation therapy after mastectomies could not be adequately explained by the reigning systemic theory that has the attention of most oncologists -- yet he believes that the studies, regardless of any limitations they may have, are providing important information that should not be ignored. Since data that contradicts a reigning theory can sometimes be disregarded, he thought it important to describe why it is the current theory (the "conventional wisdom") that should yield, not the data.

In his lecture, "Natural History of Small Breast Cancers," J. of Clinical Oncology, 12:2229 (1994) (but do not think that this involves only small cancers), Dr. Hellman wrote, in part:

"[Under the Halsted model, the] underlying premise is that breast cancer is an orderly disease that progresses in a contiguous fashion from primary site, by direct extension, through the lymphatics to the lymph nodes, and then to distant metastatic sites. It implies that effective treatment must recognize this orderly, contiguous disease spread. . . . . [It] was not until recently that an alternative hypothesis was accepted. That hypothesis suggests that breast cancer is a

systemic disease and implies that small tumours are just an early manifestation of such systemic disease, which, if it is to metastasize, has already metastasized. This was first suggested [in 1954 and 1967 and then in 1980 by] Karnofsky lecturer, Bernard Fisher [who said the things I quoted earlier in this message]."

HOWEVER, "A third hypothesis considers breast cancer to be a heterogeneous disease that can be thought of as a spectrum of proclivities extending from a disease that remains local throughout its course to one that is systemic when first detectable."

Now, friends and colleagues, listen to what he says next:

"This hypothesis suggests that metastases are a function of tumour growth and progression. Lymph node involvement is of prognostic importance not only because it indicates a more malignant tumor biology, but also because persistent disease in the lymph nodes can be the source of distant disease." [Most italics here and throughout these pages are added by John Bonine, with no further notation of the fact.]

Note the implications of that quotation: tumour-containing lymph nodes (and perhaps other sites) might be a SECOND source from which cancer can spread to the rest of the body.

"Persistent disease, locally or regionally, may give rise to distant metastases and, therefore, in contrast to the systemic therapy [that is, the chemotherapy or tamoxifen], locoregional therapy is important."

In other words, better surgical removal of residual tumors may be important. He labels his new theory a "third, or spectrum, theory" and says in some instances inadequate treatment of potential local or regional tumors may lead to additional metastasis occurring.

Radiotherapy may be important, even after "local" control has been done through a lumpectomy or even a mastectomy, so that "regional" problem is addressed, to prevent it from becoming the source of a later systemic problem through additional metastases.

Dr. Hellman expresses it this way:

"The first general question useful in distinguishing among the the three hypotheses is at what time in the natural history of breast cancer do distant metastases occur? The systemic disease hypothesis suggests that these occur before clinical detection and argues that local eradication of disease makes little or no difference."

Run that last sentence by your eyes again. Doctors are generally stating these days that breast cancer is "a systemic disease" by the time that we can detect its existence in any person's body. Systemic diseases are attacked systemically -- through chemotherapy or anti-estrogen therapy (or ovarian ablation, as recently noted), and under the systemic theory, "local eradication of disease makes little or no difference."

But Dr. Hellman of the University of Chicago thinks that breast cancer is not always ONLY a systemic disease by the time it is discovered, but instead can be a disease in which, some of the time, the continued presence of local tumors can lead to additional metastases in the future and thus we must in some instances try to go after even those whose presence we cannot detect.

He says that persons with small breast cancers might be of two types -- a group of that has "indolent and clinically unimportant cancers," and a "second group" of persons who have "a localized cancer that, if left to grow, will become disseminated and result in the patient's death." Unfortunately, when patients are seen with small breast cancers detected only by mammography (and this would ipso facto mean also those who have small cancers that cannot be detected at all) "we cannot tell whether the tumor detected is one of these indolent and clinically unimportant cancers or not."

But Dr. Hellman says that the evidence suggests that there are at least some patients who have small cancers that, if left untreated, will eventually metastasize -- but that if treated by radiation therapy may not, producing greater survival.

"The randomized trial performed in Stockholm of adjuvant radiation following mastectomy bears directly on this point. The study is important since the treatment would be acceptable by today's

standards" (among "This study shows the expected reduction in locoregional recurrences, but is also shows an accompanying decrease in distant metastases and deaths due to breast cancer." Read that sentence again.

A group of researchers looked at all randomized trials of mastectomy with or without radiotherapy, and concluded, earlier in 1994: "'The reduction of breast cancer deaths suggests that radiation therapy may have a value beyond the clearly established improvements obtainable for local control.'" (Dr. Hellman cites Cuzick, et al., "Cause-specific mortality in long-term survivors of breast cancer who participated in trials of radiotherapy," J. Clin. Oncol. 12:447-453 (1994).)

Dr. Hellman says that there are tumors "that are destined to remain localized," others "that metastasize as a function of size," others "that possibly disseminate from persistent lymph node disease," and finally some that "have occultly disseminated by the time of diagnosis, since locoregional treatment is not universally effective in preventing metastases." This last group benefits from systemic therapy, such as chemotherapy. The first group needs little concern. The second, and possibly third, group is where regional and local radiotherapy can make a difference -- even after mastectomy. The problem is knowing what kind of tumor one is seeing, and in part one cannot know which are which.

He suggests that if a tumor is quite small (less than or equal to 2 cm in size) it may be sufficient to use local and regional treatment (surgery and radiation), even with "some axillary node involvement," because even if there has been some metastasis to distant sites in the body, the body may be able to deal with a small number of cells (or they not be very malignant). "When tumors are larger, the likelihood for metastasis increases. . . ."

In conclusion, Dr. Hellman wrote:

"Both the Halsted and the systemic hypotheses are too restricting. The hypothesis most consistent with the data is that breast cancer is best thought of as a spectrum of disease with increasing proclivity for

http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8120544&form=6&db=m&Dopt=r



metastasis as a function of tumor size, but for anytime size there is a proportion of patients with distant metastasis." (My emphasis.)

Colleagues, I will have much more to write about this, for I am trying to read and understand all the major scientific journals articles on the use of radiation therapy after mastectomy for some persons. This first posting can stand as an attempt to demonstrate why radiation therapy after a mastectomy might(theoretically) help prevent distant metastases and promote long-term survival.

My later postings will survey the literature of the past two years saying that radiation therapy for some post-mastectomy patients HAS INDEED proved to lead to more survival for some women. I'll also summarize the results of my survey soon. And I'll quote from the views of some other prominent researchers, such as Dr. Abram Recht of Harvard University Medical School.

http://darkwing.uoregon.edu/~jbonine/rad03.html

ORGANIZATION PROFILE

KAILASH CANCER HOSPITAL:-

The PurposePujya Anuben Thakkar came to Goraj in 1980 and looking at the plight of the people of this area. She called on doctors from Vadodara to provide a weekly health care camp and gradually MSA began to give basic medical facilities to the people of south-western Gujarat. In 1981 A small dispensary as started and gradually with the support of philanthropists, a 95 bed ultra modern hospital, Akshar Purshottam Arogya Mandir was established in 1988. Now APAM offers a full range of inpatient services to meet needs of the community. Our professional, qualified staff is able to deliver laboratory, nursing, physical therapy, radiology, social and surgical services with the personalized touch designed to make the patients feel relaxed and at home. The service provided to people is irrespective of their financial, religious or any other considerations. Needy patients are provided treatment and financial assistance as per their requirements. The people of this area had to travel long distance like Ahmadabad and Mumbai for advanced treatment for disease like Cancer which was not possible for them due to financial and other constraints. So in 2001 Pujya Shree Anuben Thakkar and Dr.Vikram Patel decide to build a State of Art Hospital which will provide the people of this area excellent health services under one roof and this laid the foundation to Kailash Cancer Hospital & Research Centre. Unlike any other hospital, this hospital is situated in the rural area of Gujarat to serve the people of the region who are deprived of technologies and advanced facilities for the lack of knowledge and economic strength. At KCHRC we offer specialised an basic treatment in nearly every branch of medicine. We have a panel of trained experts who are available to review individual cases through referrals to highly skilled

specialists who support and monitor during every phase of diagnosis and treatment.

Critical Care Services: Our outstanding staffs of specialist are on their toes to provide care in case of critical situations.

Diabetics Services: Understanding diabetics and all of its aspects leads to better diabetes management and control.

Diagnostic Medical ServicesKailash Cancer Hospital & Research Foundation has provided the finest medical care service to the people of South eastern Gujarat. Our mission is to provide the best quality medical facility to every section of society irrespective of religion, caste, financial status just on humanitarian ground. We believe that every person has a right health care and we try to provide the same.

Cancer Care ServiceWe are ranked as one of the leading cancer hospitals in India for the number of patients diagnosed and treated annually. The hospital is designed to provide curative and preventive treatment, post therapy support service, palliative care in hospice and domiciliary facility.

Other Service

Gynaecology and Obstetric General Surgery Children Services: It is the only hospital in the area to work for

child care. We are able to provide families in this area with comprehensive range of specialised pediatric services close to home.

Imaging/Radiology: Radiology/16 Slice C.T. Scan/X Ray is a full service department which strive to meet al patient and clinician needs in diagnostic imaging and image-guided procedures. We were the first Hospital in Gujarat to have a 16 Slice C.T. Scan.

Urology

Organization Profile:-

Registered Office: Muni seva ashram campus, Waghodiya road, Vadodara- 390025 (At post Goraj)

Legal Advisor: Dr.Yogendra Shah

Dr.Bansi Shah

Bharat Patel

Ashok Thakkar

Present board of Trustees comprises of the following:Sr. No Name Designation

1 Dr.Vikrambhai Patel Chairmen

2 Dr. Vikrambhai PatelDr.Tushar VaishnavDr.Chetan Shah

Cor. committee members

3 Dr.Rajesh kanthariya Medical director

4

Swatiben PandyaHaidar Ali Zangarwala

Management staff

AdministratorH.R.Manager

RANGE OF SERVICES OF KAILASH CANCER HOSPITAL, MUNI SEVA ASHRAM, GOARJ:-

VISIONMany charitable institutions first develop a mission and then structure an organization to accomplish that mission. In contrast, Muni Seva Ashram started without any formal mission or objectives. The founder, Anuben Thakkar, under her Guruji’s direction, only sought to serve the needy and deprived of Goraj.

Three decades later, the Ashram has emerged as a clean, serene and tranquil place where love for humanity abundantly bubbles through all corners, exploiting natural resources in the most sustainable manner using cutting edge technologies in renewable energy even though tucked in a remote tribal belt. This has made the ashram a self-reliant homogeneous unit. This is the handy-work of Ashram's chairperson, Dr. Vikram Patel who as Anuben's right-hand man developed Ashram's infrastructure while paying full respect to nature.

Thus, the Ashram's vision can now be simply stated as :

"To serve, strengthen and sustain the well being of the less fortunates without any discrimination and build organisational resilience through agriculture, health, education, welfare programmes and alternative energy by deploying most appropriate technologies in total harmony with nature, culture and human values"

In the last two decades Muni Seva Ashram has increased its scope of activities by many folds, credit for this exemplary growth goes to Pujya Anuben, for her love for humanity and to Dr. Vikrambhai who

integrated education, health care, alternative energy, social services and agriculture to create an Ashram that Mahatma Gandhi would have been truly proud of. He wouldn't have hesitated to move from Sabarmati ashram to the Muni Seva Ashram!. Banter apart; the Ashram is an amazing place and these pages will provide only glimpses of what it is really like. There is no equal to visiting the Ashram. We invite you to visit at least once in your life time. We guarantee that the moments will be cherished for the remainder of your life.

MISSION:

HEALTH CARE

To integrate clinical excellence, appropriate advanced technologies and systems, passion and compassion to provide superior and ethical healthcare at affordable price which contributes to the physical, psychological, social and spiritual well being of the patient communities with the spirit of equality, dignity and interfaith.

To fulfil its mission, Muni Seva Ashram has setup two independent hospitals on the same campus that provide state-of-the-art medical care to the rural population: Akahar Purshottam Arogya Mandir, which provides general medical care and the Kailash Cancer Hospital and Research Canter, which focuses on oncology and nuclear medicine. Both hospitals charge a token amount for care, which is fully subsidized by Muni Seva Ashram if patients cannot afford it, thereby providing 100% free care to the most needy.

Akshar Purshottam Arogya MandirThe Purpose:When Anuben first came here, she found that the people of this area did not have even the basic amenities. There was complete lack of Government infrastructure, health care and educational facilities. Many lives were lost or rendered useless due to diseases or health complications, this moved Anuben and she decided to provide basic health care service to the backward tribes of this area. She went to S.S.G. Hospital of Baroda and convinced Dr. Kapadia, an intern of SSG Hospital, to visit Goraj on weekly basis and this way the weekly outdoor clinic was started in Goraj in 1981. Dr. Vikram used to visit Goraj along with Dr. Kapadia, after completion of his Medical studies Dr. Vikram joined Goraj and gradually under Anuben's guidance and with Dr. Vikrambhai's unwavering support this small clinic has turned into 95 bed ultra modern Hospital. Today nearly 150 villages around Goraj have benefited from this hospital's facilities

Details for Akshar Purshottam Arogya Mandir:

ECG 1,584 Vaccine 700 Out Door Patient 44,301 Indoor Patient 4,956 Indoor Patient 82.6 Major Surgeries 888 Free Cataract Surgeries 72 Complicated Deliveries 157 Pathology 22871

Facilities:A brief list of some of the major specialties treated at the hospital:

ENT Ophthalmology Sonography Gynaecology and

Obstetric Gastroenterology Laparoscopy Endoscopy Dentistry

Orthopaedic Dermatology Urology Nephrology Plastic Surgery Oncology Neurosurgery Vascular

surgery

Specialties:Arogya Mandir is equipped with the best and latest patient care systems. For providing such quality health care delivery systems. Arogya Mandir is the first hospital in India to have anaesthesia monitoring systems like Physio Flex and Cicero EM, used for monitoring anaesthesia in critically ill patients

In the many years of Ashram's existence we came across rural patients suffering from Cancer. As there was no diagnostic centre, most of the patients came to know about the disease in an advanced stage where cure was not possible. Also in absence of Cancer hospital near Vadodara, the villagers had to travel to Ahmadabad or Mumbai. Most villagers feeling lost in big cities avoided going there. The main idea behind the hospital is not just having world class facilities, but making these facilities available to every segment of the society.Since inception, the Ashram has always come across patients of cancer who:

live in villages

have no local access to early-detection and treatment services avoid travelling to big cities due to cost, language, and cultural

barriers, and usually lose their lives to the disease

To help stop this almost entirely avoidable cause of the destruction of so many families and so much human-wealth, Muni Seva Ashram, together with many philanthropists and donors around the world, founded the Kailash Cancer Hospital and Research Centre. This canter of healing and research makes available the best and the most affordable healthcare to everyone in the society, regardless of their religion, caste, creed.KCHRC was the first hospital in the state of Gujarat to offer:

High-energy linear accelerator, with a multileaf collimator, an inverse-planning system for intensity modulated radiotherapy, and a simulator. These are used to shape radiation beams as per the dimensions of tumors, to deliver precise doses, and spare damage to nearby normal tissue. At present, some 90 to 95 patients are treated every day. Many more fail to benefit, as we have only one such machine and an increasing number of people are being diagnosed today than ever before.

Multi-detector, 16-slice CT scan - a high speed scanner for Radiology that takes takes ultra-thin sections and true 3D images

Full-field digital mammography unit, used for early detection and treatment of breast cancer

Positron emission tomography with STE technology, helpful in diagnosing, staging, and monitoring treatment in Oncology, Neurology, Cardiology, and other conditions.

The hospital also has:

Conventional radiology, sonography and doppler units A well-equipped histopathology lab with Thermo Scientific

equipment A pathology lab with Dry Chemistry Analyser, a fully-automated

ELISA reader, and an Enhanced Chemilunminescence Analyser (ECI) kit

Blood Banking and Component Therapy to test donated blood, and minimise immunologic complications of transfusion

10 operation theaters to perform all kinds of cancer-related surgeries

The hospital at Muni Seva Ashram treats 60,000 patients each year. Till date the hospitals have treated nearly 12, 00,000 patients suffering from various diseases and medical interventions. KCHRC has treated nearly 15,000 patients of various types of cancer.

EducationTo provide opportunities for learning and realising and enhancing the inner potential of the students through integral education and value based life-skills to mould them into confident, professionally sound, socially responsible and spiritually awakened generations of noble citizens who wilfully shoulder leadership to make this world a wonderful place to live.

For Ex...

16 Creche Centers

Sharda Mandir Residential Primary School

Vivekanand Residential High School, Vankuva

Nursing College

School of Clinical Research

SocialTo enable, empower and encourage comprehensive care and rehabilitation of the less privileged, the challenged and the needy and to improve the quality of their lives by providing care, respect and fulfilment

For Ex..

Bhagini Mandir

Parivar Mandir

Vanprasthashram:

Gokul

Mathura

Vrindavan

Govardhan

RESEARCH METHODOLOGY:-

Title- A Study of women in breast cancer.

OBJECTIVES OF STUDY:- What are the situation of women in cancer How their family support. What are the physical changes What are the symptoms of cancer What are the main reason of breast cancer Patient have any information about cancer or not What are their financial condition How they feel about their situation of cancer How their social life is change Under what schemes his/her get a treatment.

SIGNIFICANCE OF STUDY:-

To spread awareness about breast cancer among women. To spread awareness among people about symptoms of

breast cancer. To spread awareness among women about

monthly/yearly regular check-up.

RESEARCH DESIGN:-

Exploratory cum Descriptive in nature

Exploratory research because it is the initial research into a hypothetical or theoretical idea. This is where a researcher has an idea or has observed something and seeks to understand more about it. An exploratory research project is an attempt to lay the groundwork that will lead to future studies, or to determine if what is being observed might be explained by a currently existing theory. Most often, exploratory research lays the initial groundwork for future research.

Descriptive research because once the groundwork is established, the newly explored field needs more information. The next step is descriptive research, defined as attempts to explore and explain while providing additional information about a topic. This is where research is trying to describe what is happening in more detail, filling in the missing parts and expanding our understanding. This is also where as much information is collected as possible instead of making guesses or elaborate models to predict the future - the 'what' and 'how,' rather than the 'why.'

POPULATION: -

The total element of the universe from which sample is selected for the purpose of study is known as population. ThePopulation of our research is a study of women in kailash cancer hospital and research center.Population size is small so all the respondents are deemed as population as well as sample.

TOOL OF DATA COLLECTION

The data source: Primary and Secondary

The research approach: Survey Method The research instrument: Questionnaire Method

The Respondent for study of women in breast cancer, are the patients of breast cancer

QUIESTIONNEIR SCHEDULE: -

Questions are framed in such a way that the answers reflect the ideas and thoughts of the respondents with regard to lifestyle, family support and awareness in women in breast cancer.

LIMITATIONS OF THE STUDY:-

This study is only limited to Kilash cancer hospital. The method of random sampling is suitable for small populations only. To create good image, respondents may give responses vary from the facts. Some respondents hesitated to give the actual situation.This study covers only those patients who were currently admitted in hospital. This study covers only those patients who are treated in this hospital.

CHAPTER 2

DATA ANALYSI

&

INTERPRETATION

TABLE1.1Q4.Marital status of respondent

Sr. No Percentage TotalMarried 100% 20Unmarried 0% 20

total0%

20%

40%

60%

80%

100%

120%

marriedunmarrid

As per the table all of the respondent ladies are married.

Q5. Education qualification

Sr.no Education qualification

Respondent Percentage

1 Illiterate 9 45%

2. Primary 6 30%

3 S.S.C 2 10%4 H.S.C 1 5%5 Graduate 0 0

6 Post- graduate

0 0

7. Total 20 100

Total number of respondent is 20 but in total number of respondent only 5% ladies are clear H.S.C exam. And only 10% of ladies are attempt S.S.C exam means only 2 ladies of the 20 respondent. And only 30% of the ladies get there

primary education and the most of the ladies the ration of 45% was illiterate. The conclusion of that table most of the ladies is illiterate.

Q6. Occupation of respondant

Sr. No Occupation Respondent Percentage 1 Housewife 19 95%

2 Labour work 0 0

3 Private sector 0 04 Government 1 5%

5 TOTAL 20 100%

Out of total number of respondent the major respondent are illiterate so the work as a house wife. In this table show that 95% of respondent are work as a house wife. And only 5% of respondent are work in Government sector.

Q.8 Age at first child birth

Sr. No Age group Respondent Percentage 1 15-19 4 20%2 21-25 14 70%3 25-30 2 10%4 Total 20 100%

the above As per table shows that major respondent have age group of 21-25 years age group when they give a birth to their 1st child.

Q.9 how long your child was breast fed?Sr. No Year group Respondent Percentage 1 < 1 years 3 15%2 1 year 9 45%3 2 year 7 35%4 3 year 1 5%5 3< year 0 06 Total 20 100%

As par the above table we show that 35% of the ladies feed their child to 2 year and 45% of the respondent feed their child to 1year and less 15%

respondent feed their child to less than 1 year and only 5% respondent feed their child to 3 years.11. Stages of diagnoseSr. No Stages Respondent Percentage1 1st stage 1 5%2 2nd stage 12 60%3 3rd stage 7 35%4 4th stage 0 05 Total 20 100

As per the above table only 5% of total respondent belong to 1st stage of breast cancer. And only 35% of respondent are belong to 3rd stage of the breast cancer. The major respondent belongs to the 2nd stage of the cancer. 12. How did you feel about the diagnosis?Sr. No Feel Respondent Percentage1 Anger 2 10%2 Anxiety 1 5%3 Depressed 5 25%4 Sad 9 45%5 Loosed 3 15%6 Total 20 100

As per the above table the majority of respondent feel sad about their condition and 25% if the respondent are depressed about their condition. And 15% respondent thinks that they loosed something after knowing the situation of breast cancer.

16. Attitude about treatment?Sr. No Attitude Respondent Percentage1 Positives 15 75%2 Negative 5 25%3 Total 20 100

The 75% of respondent have a positive attitude related their treatment. They give positivity to treatment. 17. How have your thoughts changed?Sr. No Thoughts Respondent Percentage 1 Socially 7 35%2 Physically 7 35%3 Emotionally 6 30%4 Total 20 100

The 35% of respondent done operation so they have physically loose so their thoughts change physically. And other 35% of respondent does not feel socially completed so they doesn’t survive in society normally because of hair loose and the operation of the breast. 18. How has your life change since you found out you had breast cancer?

19. How your husband support?Sr. No Support Respondent Percentage 1 Positive 12 60%2 Negative 2 10%3 Average 6 30%4 Total 20 100%

Sr. No

Changed Respondent Percentage

1 Socially 7 35%2 Physically 7 35%3 Emotionally 3 15%4 Family

related3 15%

5 Total 20 100

13. Symptoms of the breast cancer?

Sr. No Symptoms Respondents Percentage 1 Change in

size4 20%

2 Discharge form nipple

0 0

3 Lumps or swellings

0 0

4 Dimpling on the skin

0 0

5 Change the appearance

0 0

6 Tumour 16 80%7 Total 20 100%

20. If any change in their behaviour after knowing your situation?

Sr. No Change Respondent Percentage 1 Positive 14% 70%2 Negative 6 30%3 Total 20 100

21. What are the biggest challenges?

Sr. No Biggest challenge

Respondent percentage

1 Socially 7 35%2 Emotionally 6 30%3 Physically 7 35%4 Total 20 100

22. If any person have face same problem in family?

As per the surrey 85% of Respondents does not have any related problem in family.

23. Situation of cancer is curable or not?Sr. No Situation Respondents Percentage 1 Curable 13 65%2 Non

curable7 35%

3 Total 20 100

Sr. No Problem Respondent Percentage 1 Yes 3 15%2 No 17 85%3 Total 20 100

24. Under what scheme you get treatment?

Sr. No Scheme Respondent Percentage

1 Maa yojana 13 65%

2 I.C.S 0 0

3 Mukhymantri rahat fund

0 0

4 Trust 3 15%

5 By own 2 10%

6 Total 20 100

CHAPTER – 3

MAJORFINDINGS,

SUGGESTIONS

&

CONCLUSION

MAJOR FINDINGS:The major findings are as follow:Table no 1 indicate that the majority of respondent is

married. So we find that breast cancer ration is high after the marriage. Table no.2 indicates that major of the respondent are

illiterate. There are 45% of respondent are illiterate. And the second highest ration of respondent is only study on primary level. And only 1 respondent complete their higher secondary education.Table no. 3 indicates that occupation of the respondent.

That shows that 95% of the respondents are work as a house wife. And only one respondent that is 5% of respondent works in a government sector. Table no.4 indicates that the age of the woman for birth

of their first child. That table also show that the age of the marriage of the woman. Majority of the respondent give the birth of the child in the age group 21-25. That is show 70% of all over respondent. And 20% of respondent give their child birth on the age of 19th year. That covers 20% of the all over respondent. Table no.5 indicates that the period of the breast feeding

of their child. The majority of respondent feed their child as long as 1 year. The shows 45% of the all over respondents. And the second highest period of the feeding id 2 year. Those cover 35% of all over respondent. Table no.6 shows that the stage of the diagnoses. That

show that majority of the patient is under the stage. The major respondent id on 2nd stage of the diagnosis. That shows the 60% of the respondent. And the second highest majority of respondent is in 3rd stage of the breast cancer.

Table no.7 indicates that feeling of the respondent after knowing the cancer. The majority of the patients feel sad about their conditions that ration is 45%. The other respondent feel depressed after knowing their situation of cancer. That respondent ration id 25%. Other 3 respondent feel lost after knowing the situation. That ration is 15%. Table no 8 indicate the symptoms of the breast cancer.

The major respondents have complained about tumour in their breast. That ration is 80 %( 16) if the all over respondent. Table no. 9 indicate that the respondent attitude about

their treatment. That shows 2 types of attitude Positive and Negative. The majority of respondent show positive attitude about their treatment. That show 75 %( 15) of the ration. Table no 10. Indicate that how respondents thoughts was

changed during the treatment. That show that 35% of respondents socially thought changed and also the physically because of the operation on the breast.Table no. 11 indicates that how respondent lives change

during the treatment. The majority of the respondent life was change on physical basis because of operation on their breast and all most the respondent lost their breast during the treatment so their physically and socially life was change. Table no. 12 indicates that how respondent husband

support them during the treatment. The majority of respondent said that their husband support them positively that ration cover 60 %( 12).Table no. 13 indicate that what the major change in

respondents husband behaviour after knowing their situation. The majority of the respondent said that their

husband was change positively they support them and also give a support to them. Table no.14 indicates that what respondent biggest

challenge was. The majority of the respondent said that the biggest challenge in their treatment is the physical challenge because they lost their breast.Table no. 15 that table indicate the ration of the same

problem face on family by any other in past? The respondent said that there are no one of the family member have same type of cancer problem in the past of the family.85 %( 17).Table no. 16. Indicate that the situation of the respondent

is curable or not. The majority of the respondent is in curable situation of the cancer. That show the ration of the 65 %( 13).Table no. 17 indicates that under which scheme

respondent get a treatment. The majority of the respondents get a treatment under the Maa Yojana. That is the Gujarat government scheme. The 65% of breast cancer patient get a treatment under that scheme.

SUGGESTIONS

Take a more improvement in behaviour of nurses with patients and their family members, it must be humble behaviour.

Change in the structure of chemo therapy ward so we can reduce fights for turn for chemo between patients.

There are also change in structure of radiation therapy ward for balancing the patient’s time who up-down daily from far areas and also doctor’s time.

Management department also take strict steps on cleanliness in garden area so that patient’s n their family members do not throw garbage at any place.

CONCLUSION As a part of our project work, we got an opportunity to

spend a period of 45 days in Kailash cancer hospital and Research center, Goraj. We conducted major studies in the organization i.e. A Study on breast cancer in women. It helped me to analyze the working of the organization which helped as to convert our theoretical knowledge into practical.

It is important to show that what are the main causes of breast cancer, what are the symptoms of it, what are the treatments of it etc...

Based on available study we suggests the women to maintain a limit in alcohol, maintain healthy weight , avoid long term hormone therapy, stay physically active, eat foods high in fiber , emphasize olive oil , avoid exposure to pesticides , continue some exercise or yoga in their daily life.

BIBLIOGRAPHY

http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=5848&context=etd

ANNEXURE

DEPARTMENT OF SOCIAL WORKKAILASH CANCER HOSHPITAL

GORAJ STRUCTURE OF THE INTERVIEW QUESTAION

1. Name:2. Date of birth: 3. Age 4. Marital status:

married unmarried 5. Education completed:

Illiterate SSG HSC

Graduation post graduation

6. Occupation:

Farmer Labour Self employ

Government employ any other

7.

Number of children

Gender Age

8. Age at first child birth :

9. How long your child was breast fed.

10. Date of diagnosis :

11. Stage of diagnosis :

1st stage 2nd stage

3rd stage 4th stage

12. How did you feel about the diagnosis?

Anger anxiety depressed

Sad loosed

13. Symptoms of breast cancer? change in size or shape of one or both breasts discharge from either of your nipples a lump or swelling in either of your armpits dimpling on the skin of your breasts a change in the appearance of your nipple

14. What information do you have about your condition?

15. What did you think about breast cancer before you were diagnosed?

16. Attitude about Treatment Positive Negative

17. How have your thoughts changed?

18. How has your life changed since you found out you had breast cancer?

Socially

Physically

Emotionally

If any problem related to family life you face?

19. How your husband’s support? Positive Negative Average

20. If any change in their behavior after knowing your situation

Positive

Negative

21. What are the biggest challenges? Socially

Physically

Emotionally

22. If any person have face same problem in family in past?

Yes No

23. Situation of cancer is curable Incurable

24. If you know about various schemes of government related to cancer?

Yes No

25. Under what scheme you get treatment ?

Maa-Yojana

Indian cancer society

Mukhyamnatri rahat fund

From muni sevashram trust

By own

a study of lifestyle of women in breast cancer in kailash cancer hospital and research center

Healthcare