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INDEX Page No

1.introduction------------------------------------------------------------- 4

2. Aim -------------------------------------------------------------- 4

3. Objectives ------------------------------------------------------------- 5

4. Back ground of RCC--------------------------------------------------- 5

5. Literature Review------------------------------------------------------- 6

5.1. Lung Cancer--------------------------------------------------------- 6

5.2. Diagnosis and treatment of lung cancer------------------------ 8

5.3. Diagnosis------------------------------------------------------------- 9

5.4. Treatments------------------------------------------------------------10

5.5. Epidemiology and risk factors------------------------------------11

5.6. Other causes of cancer----------------------------------------------11

5.7. Clinical features of lung cancer-----------------------------------12

5.8. General principles in chemotherapy of cancer----------------12

5.9. Anticancer drugs-----------------------------------------------------13

5.10. Complication of Anticancer drugs--------------------------------14

6. Justification----------------------------------------------------------------16

7. Hypothesis-----------------------------------------------------------------17

8. 8.1 Secondary Research ------------------------------------------------18

8.1.1 Advantages of Secondary Research---------------------------18

8.1.2 Disadvantages of Secondary Research-----------------------18

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8.1.3 Types of Secondary-----------------------------------------------19

8.2 Primary Research-----------------------------------------------------20

8.2.1 Advantages of Primary Research ------------------------------21

8.2.2 Disadvantages of Primary Research---------------------------21

8.2.3 Types of Primary Research---------------------------------------22

9.Research Design -----------------------------------------------------------------23

10. Sampling techniques ----------------------------------------------------------24

11. Scope of the study--------------------------------------------------------------24

12. Limitations of the study-------------------------------------------------------25

13. Ethics -----------------------------------------------------------------------------25

14. Bibilography----------------------------------------------------------------------27

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A critical evaluation of the effectiveness of lung cancer

treatment in RCC (Regional Cancer Centre) Kerala, India

1. Introduction

According to Winslow public health is the science or its an art of preventing

disease and promoting health and efficiency through organized community effort

for: sanitation of environment, control of communicable infection education of

personal hygiene in each individual in community .The medical and nursing

services in a firm helps to early diagnosis of treatment and prevent the diseases go

to critical stage (Linda .S.Thompson Adams 2008)

Diseases is one of the abnormal condition of the organisms of our body reacting

with foreign particle it will damage our body functions with particular symptomsand signs some time it will affect organs also

Treatment means particular care provided for the patients to cure diseases by

medication or surgery

Here I would like to research about critical evaluation of effectiveness of lung

cancer treatment in RCC Kerala, India

Cancer is the one of the abnormal growth of unwanted cells in any part of the body

without any control and caught all the tissues .Mainly cancer tissues are

transmitted through blood and lymph through other parts of body (Ernest H.Rosenbaum 2008)

2. Aim

To critically evaluate the effectiveness of lung cancer treatment in RCC (Regionalcancer center) Kerala

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3. Objectives

To critically evaluate lung cancer related theories

To critically evaluate the applications and technology used in the lung

cancer treatment in RCC

To critically evaluate lung cancer treatment and control the growth of

cancer

To critically evaluate use of anticancer drugs and its complication

4. BACK GROUND OF RCC

Fig 2 represents Picture of RCC Kerala

I had select regional cancer institute (RCC) to doing this research it is situated on

the southern part of India

It is a multispecialty cancer treatment hospital started on 1981

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One of the Asias biggest cancer treatment center

More than 2000 bed capacity in RCC

RCC doing researches on the cancer they have well equipped research center

also

They have more than 50 modern operation theaters

RCC provide telemedicine treatment rural areas of India

A fully computerized system available in RCC

A wide range of cancer research ,palliation ,rehabilitation treatment

available in RCC

It is a internationally recognized center for cancer research(www.rcctvm.org)

5Literature review

The following literature review done for the researcher to the purpose of his

research

5.1Lung cancer

Lung cancer means a massive growth of tissue forms in the Larynx it blocks the air

passage inspiration and respiration of the normal body and delays the blood

purification there are two types of lung cancer

1) Small lung cancer

2) Non small lung cancer

These are diagnosis by the cells shape when it views on the microscope

The main symptoms of lung cancer are Cough productive sputum, Haemoptysis,

chest pain, weight loss (Joe Billy Putnam, Ritsuko Komaki 2003)

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There are more than 200 types of cancer. Most of the cancer named as the organ or

which they can affect it. For example the cancer which affect on the organ lung is

called lung cancer and the cancer saffect on the basal cells of the skin called as

basal cell ca

Fig 1 represents the diagram of growth of cancer cells

Body is made of thousands of cells. Mainly cancer will affect on the cells .cells

have very short life period these cells are undergoing mutation(cell division)and

produce new cells this automatic synthesis is need for a healthy body. The cells are

old and damaged these will be die or replaced sometimes these are not replaced it

causes unwanted cell growth and forms a massive tissue called tumors it causes

cancer

There are mainly two types of tumors

Benign tumor

Malignant tumors

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Benign tumors are not causes cancer it can be removed by operation and it

cannot come back and not to be spread on the other part of body

Malignant tumors are cancerous one it could be spread other part of the body

through blood and lymph (Stephen Falk, Chris Williams 2010)

5.2Lung cancer systems diagnosis and treatment

Lung cancer is the uncontrolled growth of cells in the lungs it may be tumors .there

are two types of cancer 1)small cell lung cancer(it means cancer forms small

round cells in lungs) 2)non small lung cancer(the cancer grows in lungs other than

small cells)

The lung cancer cells sometimes travelled to other part of body through blood and

lymph and grows in other organs called secondary cancer

Small cell cancer have two stages limited and extensive lung cancer ,in limited

lung cancer r affect only in the lung .Extensive lung cancer may affect other part

of the body

Non small cancer mainly four stages the most crucial stage is stage 4(Walter Scott 2000)

Stage 1

In stage one cancer cell only affect in patient lungs not in lymph glands .lymph

glands is one of the systems in human body important for immune system

Stage2

in this stage cancer cells slightly affect on the lymph glands near to the affected

lung sometimes it may affect on the chest wall

Stage 3

In stage 3 cancer cells moved from lymph glands to other side of the chest near to

the patient collarbone then the tumor will affect on patient heart

Stage4

This is the crucial stage mainly affect on the patient liver and the bones

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Symptoms

Coughing of blood

A continual cough

Breathing problem

Gruffness

The pain in chest and shoulder

Sometimes patients have the problem like tiredness and weight loss (W. Hinkelbein 2009)

Smoking is the main reason for causing lung cancer

Fig 3 displays the x-ray of the lung cancer patient

5.3Diagnosis

CT scan(computed tomography),Bronchoscopy, FNA(fine needle aspiration

biopsy),Mediastinoscopy these are the techniques used for diagnosis of lung cancer

CT scan

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CT scans means it has take a serious of x-ray of lungs and test for any part of the

patient lungs look abnormal but it is not a reliable test for finding the lung cancer

Bronchoscopy

It is a test doing with insertion of thin tube through patient nose or mouth into his

lungs it is a short procedure which last about 20 minutes, if the middle part of

patient lung is affected bronchoscopy is compulsory

FNA biopsy

It is mainly done if the patients edges of lungs is affected .A ct scan or ultra soundis used to insert a needle through the patient chest and a small pieces is removed

from his lungs for biopsy

Mediastinoscopy

In this procedure surgeon insert a tube into the patient chest making a small cut

above the breast bone this is done nearly to see the surroundings between the

patient lungs and nearby lymph nodes for this procedure small percentage of

general anesthesia is used (Lorraine Johnston 2001)

5.4Treatments

Mostly the cancer treatment is depend upon which type of cancer patient have and

the spread stage and treatment will center on improving the patient symptoms and

quality of live rather than curing the diseases

Surgery

In surgery physician is try to remove the affected part of lung (LOBOCTOMY) or

remove one lung it is called as pneumonectomy) sometimes surgery is not effective

in patients who have in other medical condition

Chemotherapy

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In this treatment mainly uses the medicine like etoposide like drug contains

platinum this drug streams into blood and engulf the cancer cells chemotherapy is

very effective in small cell lung cancer. Chemotherapy is given to the patient

repeated cycle normally chemotherapy is given to the patient three to six cycle

Radiotherapy

Radio therapy is the system to kill the cancer cells using radiation in non cell small

cancer in stage 3 we can use radio therapy it is useful to improve the symptoms of

cancer sometimes cure is not possible

Combined treatment

If in crucial stage of cancer medical experts are used surgery, radio therapy and

chemotherapy it will help to cure small cell cancer and non small cancer of patients

But the limitations of this treatment is it has more side effects

Endobronchial treatment

this treatment mainly used for the cancer in trachea or in the bronchi it can used to

prevent the early stage of cancer transmission it can used to clear the air passage

through trachea it can used when all the treatments are failed (Frank V. Fossella,JoeBilly Putnam, Ritsuko Komaki 2003)

5.5 Epidemiology and risk factors in lung cancer

One of the research conducted in RCC India found that leading causes of cancer

death in men is lung cancer and breast cancer in women if we taken 1 lack men

800 mens will suffer from lung cancer the ratio in women is 500 in 100000

One of the main reason of lung cancer is cigarette smoking and the lung cancer risk

increases with smoking duration it also related with tar of nicotine settled down inlungs and the how much amount of smoke inhaled

The research found that older smokers uses the cigarette more than younger

smokers so we can found the lung cancer mainly affect in older people (Nathan A.Berger - 2010 -)

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5.6Other causes of cancer

It depended upon patients job if he worked on the cancer mining and construction

sites if he inhaled cancer causing agents like asbestos there is a possibility of lung

cancer.asbetos particles are settled down in lungs and block the air passage anddamage the cells coal, vinyl chloride, nickel chromate, arsenic and some organic

chemicals like cloromethyl ethers are lung cancer causing agents

Repeated x-ray radiation and other type of radiation also causes lung cancer and

researcher found that some gases like radon causes lung cancer it occurs naturally

in soil and rocks it can damage the cells of lungs and causes for tumors

In researcher point of view some people body dont have the ability to neutralize

the cancer causing agents such people are more sensitive to cigarette smoking and

cancer causing chemicals and gases (Lois Swirsky Gold, Centre for Studies in Riskand Regulation 2002)

5.7Clinical features of lung cancer

the researcher go through the book of Sujal R Desai got some important

information about clinical features

the most common symptoms of cancer are chronic sough related sputum

production and chest wall pain shoulder pain and sometimes patient felt tiredness

and head ache and the expansion of lung cancer into other part of the body lead to

more clinical symptoms and signs and this time patient feels breathlessness and

chest pain due to pericardial participation this pericardial action occurs cardio

vascular diseases (Fergus Macbeth, Robert Milroy, William Steward 1996)

5.8 General principles in chemotherapy of cancer

1. In cancer chemotherapy a single clonogenic malignant cell is capable ofproducing progeny that can kill the host to effect cure all malignant cells

must be killed or removed survival time is related to the number of cells that

escape chemotherapeutic attack

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2. In any cancer subpopulations of cels differ in their rate of proliferation and

susceptibility to cytotoxic drugs .these drugs kill cancer cells by first order

kinetics ,i.e a certain fraction of cells present are killed by one treatment

3. Drug regimens which can effectively palliate large tumor burdens may becurative when applied to minute residual tumour cell population after

surgery and /or irradiation

4. Whenever possible ,complete remission should be the goal of cancer

chemotherapy drugs are often used in maximum tolerated doses. Intensive

regimens used early yield better results

5. Formerly cancer were treated with one drug at a time .Now ,more commonly

,a combination of

2-6 drugs is given in intermittent pulses to achieve total tumour cells kill,giving

time in between for normal cells to recover

Synergistic combinations and rational sequences are devised utilizing

a) drug which are effective when used alone

b) Drugs with different mechanisms of action

c) Drugs with different toxicities

d) Empirically by trial and error; optimal schedules are mostly devolved by this

procedure (KD Tripathi MD 2005)

5.9 ANTICANCER DRUGS

The anticancer drugs are either kill cancer cells or modify their growth however,

selectivity of majority of drugs is limited and they are one of the most toxic drugsused in therapy

Treatment of malignant diseases with drugs is a recent development started after

1940 when nitrogen mustard was used but the progress has been rapid, both in

revealing pathobiology of the diseases and discovery of new drugs

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In addition to prominent role in leukemias and lymphomas, drugs are used in

conjunction with surgery, radiotherapy and immunotherapy in combined modality

approach for many solid tumors, especially metastatic (Carmen Avendao,J. CarlosMenndez 2008)

Classification of anticancer drugs

Drugs acting directly on cells (cytotoxic drugs)

Alkylating agents (nitrogen mustards)-mustine HCl, cyclophosphamide,

ifosfamide, chlorambucil

Anti metabolites-methotrexate,6-Mercrptopurine,6-Thioguanine

Vincas alkaloids-vincristine,vinblastine

Taxanes-paclitaxel,docetaxel

Antibiotics-Actinomycine ,Doxorubicine,Daunorubicine

Miscellaneous-Hydroxyurea,procarbazine,cisplatine,carboplatine

Drugs altering hormonal milieu

Glucocorticoids-predinisolone and others

Estrogens-fosfestrol

Antiestrogen-Tamoxifen

Antiadrogen-flutamide

Progesins-Hydroxyprogesterone acetate etc (KD Tripathi MD 2005)

5.10Toxicity of anti cancer drugs

Majority of the cytotoxic drugs have more profound effect on rapidly multiplying

cells, because the most important target action are the nucleic acids and their

precursors. Many cancers have a lower growth fraction than normal bone marrow,

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epithelial linings reticuloendothelial system and gonads .these tissues are

particularly affected on dose dependent manner by majority of drugs

Bone marrow

Depression of bone marrow results in granulocytopenia, agranulocytosis,

thrombocytopenia, aplitic anemia this is the most serious toxicity; often the limits

the dose that can be employed .infections and bleeding are the usual complication

Lymphoreticular tissue

Lymphocytopenia and inhibition of lymphocyte function results in suppression of

cell medicated as well as humoral immunity

GIT

Stomatitis ,diarrhea ,shedding of mucosa ,haemorrhages occur due to decrease in

the rate of renewal of the mucous lining .drugs that frequently causes mucositis

are-bleomycin,actinomycin D,doxorubicin,fluorouracil and methotreate

Nausea and vomiting are prominent with many cytotoxic drugs

Skin

Alopecia occurs due to damage to the cells in hair follicles .dermatitis is another

complication

Gonads

Inhibition of gonadal cells causes oligozoospermia and impotence in males;

inhibition of ovulation and amenorrhoea are common in females

Damage to the germinal cells may result in the mutagenesis

Foetus

Particularly all cytotoxic drugs given to pregnant women profoundly damage the

developing foetus abortion, foetal death, teratogenesis

Carcinogenicity

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Secondary cancers ,specially leukemias,lymphomas and histocytic tumors appear

with greater frequency many years after the use of cytotoxic drugs .this may be due

to depression of cell mediated and humoral blocking against neoplasia (FrederickValeriote,Thomas H. Corbett, Laurence H. Baker)

6. JUSTIFICATION

The researcher has selected RCC Trivandrum for conducting the research because

the researcher worked as a nurse in chemotherapy ward of this organization and so

it is very much easy and convenient for the researcher to conduct the study, collect

the data from the respondents and formulate the findings from that. The researcher

could be worked as the part of the cancer research center and got the good

knowledge of the lung cancer diseases and medication, and treatment technologies

and also a brief idea about anti cancer drugs and the complication of it.

Well, another fact for selecting this organization for the research is the

convenience for sampling and studying to the researcher.

7. HYPOTHESIS

Before stating the hypothesis for this research the researcher would like to define

what a hypothesis is. A hypothesis is a statement the validity of which is to be

proven. It is a statement made without any reason or calculation. Sometimes

hypothesis can be proved right and sometimes wrong. In this research, the

researcher puts forward the following hypothesis;

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http://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Frederick+Valeriote%22&ei=amKITI7gCIqRjAeMzahP&ved=0CE4Q9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Frederick+Valeriote%22&ei=amKITI7gCIqRjAeMzahP&ved=0CE4Q9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Thomas+H.+Corbett%22&ei=amKITI7gCIqRjAeMzahP&ved=0CE8Q9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Laurence+H.+Baker%22&ei=amKITI7gCIqRjAeMzahP&ved=0CFAQ9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Frederick+Valeriote%22&ei=amKITI7gCIqRjAeMzahP&ved=0CE4Q9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Frederick+Valeriote%22&ei=amKITI7gCIqRjAeMzahP&ved=0CE4Q9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Thomas+H.+Corbett%22&ei=amKITI7gCIqRjAeMzahP&ved=0CE8Q9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Laurence+H.+Baker%22&ei=amKITI7gCIqRjAeMzahP&ved=0CFAQ9Ag

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The effectiveness of delivering oral hygiene among the elderly residents of beech

house care home is not very high.

This hypothesis can be proven right or wrong and the finding will be the

contribution of the researcher towards beech house in improving its quality of care.

8. RESEARCH METHODOLOGY

Research methodology is nothing but the method of doing the research. The

process and steps of research is elaborated in a methodology. The type of research,

objectives, review of literature, the sampling technique and all such significant

matters related to the research are mentioned.

Primary and secondary research methods are the two main research methods.

The most important point of differentiation between them is that in primary

research the data is directly collected from the respondent or the subjects of the

experiment in the research. But in case of secondary research the data is not

collected directly but that of the primary research will be used.

Secondary research is a research method in which an existing researchs summary

or findings are involved. It does not carry out a direct data collection from therespondents. In secondary research method a review of the primary research is

done and the whole research depends on it. All the facts from the primary research

are collected in secondary research and then the study is continued. Also known as

desk research it processes data that has already been collected by another party.

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Various articles, reports, project findings can be consulted and analysed for this

purpose. This is actually a cheap affair when compared to primary research and

that is the best advantage of secondary or desk research.

8.1 SECONDARY RESEARCH

Secondary research is the research method in which the researcher uses the data

which have already been collected by other s and such data are called Secondary

data.

(Bhattacharyya, D. 2006. P.52).

8.1.1 ADVANTAGES OF SECONDARY RESEARCH (STEWARD, W AND

KAMINS, M.1993)

The first and foremost advantage of secondary research is that it is a lot

economical in terms of money and time. Expenses to be met on the way of

collection of primary data can be avoided and also the time can be saved.

Lot of effort is also saved, that is used in collecting the primary data.

Secondary data also provides a foundation for the collection of primary data.

With the availability of the secondary data the proper requisites of the primary

data can be made. The gaps can be filled and ait can also be identified like what

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data is needed in addition.

Secondary data also provides the researcher a ground to do data comparison.

8.1.2 DISADVANTAGES OF SECONDARY RESEARCH (STEWART, W

AND KAMINS, M 1993)

The first disadvantage of the secondary research is that the data used i.e. the

secondary data is old and can be outdated.

Another disadvantage of secondary data is that it is vast and also inaccurate. It

can sometimes lead to the evolution of new problems and varied contradictory

conclusions.

Also these secondary data were originally collected for some particular purpose.

This can lead to several problems as it may not be appropriate to the purpose in

hand.

Sometimes the secondary data may also be aggregate in some form disabling

the individual observation.

The secondary data may be biased and therefore shaped according to the

mindset of the researcher who primarily would have collected it.

Therefore it can be seen that the secondary data has advantages and disadvantages

as well.

8.1.3 TYPES OF SECONDARY (GODDARD, W., MELVILLE, S. 2004)

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There are different types or sources of secondary data for a secondary research.

Some of the most common among them are;

Books

Journals

Newspapers

Articles in magazines and websites

Reports and publications

Government statistics and company reports

Now in this research the researcher is intending to use the secondary sources of

data like the books, articles in magazines and newspapers, information from the

websites, reports of the organization and so on for the collection of th secondary

data.

The researcher can go through various books to collect data on the theory of lung

cancer. Also information regarding oral health of the cancer patient and its care can

be collected through books.

Various articles which have been published in magazines and newspapers about

the lung cancer treatment and causes symptoms can be reviewed.

Also the reports and brochures of the organization can be analyzed to study its

actual position in the field of the theory of research.

The literature review is possible from all these variety of secondary sources.

8.2 PRIMARY RESEARCH (JANE, W., MORGAN, J.,& SUMMERS, J.

2004)

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It is a research method in which the researcher collects the data himself for the

purpose of a specific study or inquiry. Such data is original in character and is

generated by surveys conducted by individuals or research institutions.

(Bhattacharyya, D. 2006)

Primary research is the type of research which is conducted by collecting some

new and fresh data. This data would have never existed before. It is collected fresh

by someone for the purpose of his study. Unlike secondary data it raw and direct

and collected through various sources like questionnaires, interview schedules,

case study methods and direct interviews and so on.

8.2.1 ADVANTAGES OF PRIMARY RESEARCH

The first point of advantage to be noted for primary research is that the data is

freshly collected here. The researcher collects the data directly from the

respondents through various techniques like questionnaires, interview schedules

and so on.

The data will be up to date and relevant.

Accurate data can be collected because the purpose is already set while data

collection. That is it addresses specific research issue. Greater control over the information is possible and therefore can be shaped as

per the requisites of the researcher.

Primary data collection helps to create a direct link with the respondents and

hence the whole process is natural and original.

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Detailed information can be collected on spot.

Confidentiality of the information is possible in primary research unlike

secondary research where the secondary data is made available publicly free.

8.2.2 DISADVANTAGE OF PRIMARY RESEARCH

Despite of all these advantages, primary research has its own disadvantage as well.

It is a very costly affair.

It consumes a lot of time.

Sometimes the primary data can be modified as per the requirements of the

researcher and so may not be natural always.

Therefore we can see that primary data employed in primary research has both

advantages and disadvantages like secondary data. Instead of all these matters bothprimary data and secondary data are used by researchers today for the purpose of

their research. Since both of the research types have their own qualities and

features , they are employed somewhere or the other for something or the other.

8.2.3 TYPES OF PRIMARY RESEARCH

Following are the main sources of primary research data;

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Questionnaires

Interview schedules

Direct interview method

Case studies

Surveys

Open discussions

Now the researcher will be using a few primary research techniques for the

purpose of his study.

Basically the researcher will be making use of self prepared questionnaires for

collecting the data. The questionnaires will be mailed to colleagues who worked

with him in RCC.

Also phone interview method will be adopted to collect data about the

organization, its care procedures and practices. And the interview with the doctors

help researcher to collect the new theories of lung cancer and its medication

9. RESEARCH DESIGN

Research design is the general design of the type of the research and how it will be

conducted. There are lots of research designs adopted by different researchers.

Here the researcher will be trying to conduct a qualitative research in an inductive

approach. In an inductive approach the researcher starts with specific observations

and then moves to broader generalizations and theories.

Qualitative approach to research is concerned with subjective assessment of

attitude, opinion, and behavior. Research in such a function of researchers insights

and impressions. Such an approach to research generates results either in non-

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quantitative form or in the form which are not subjected to rigorous quantitative

analysis. Generally the techniques of focus group, interviews, projective

techniques and depth interviews are used. A qualitative research is a research in

which an in depth studies is conducted. The qualitative aspects are more valued

here and not the quantitative ones. It also refers to collection of non numerical data

and explanations. Mostly qualitative studies are used for exploratory purposes.

(Kothari, C R. 2008.P.5).

10. SAMPLING TECHNIQUE

There are probability sampling and non probability sampling methods adopted by

the researchers in their research work. Here the researcher is using non probability

sampling method, where not everyone has equal chance or probability of being

selected as a sample for research, but will be selected depending upon the

convenience of the researcher.

Convenient sampling shall be used by the researcher to pick the samples because

of the feature of convenience. As mentioned in the justification part , the researcher

worked as a nurse in chemotherapy ward and so it is really very much convenient

for the researcher to collect data from the respondents

Unstructured interview method and self prepared questionnaire shall be adopted by

the researcher in collecting data from the organization.

The doctors in RCC shall be interviewed to collect data about the organization, its

care plans and policies regarding lung cancer treatment in patient.

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Questionnaires shall be used to collect data from the doctors in RCC to find out the

lung cancer and its symptoms, diagnosis and treatment

Now the data collected from all these sources shall help the researcher to analyze

them and find out the effectiveness of the oral hygiene in beech house care home.

The data collected shall be self analyzed by the researcher without the use of any

SPSS package.

11. SCOPE OF THE STUDY

The scope of this research study is with regards the applications and technology

used in the lung cancer treatment in RCC and the evaluate use of anticancer drugsand its complication

12. LIMITATIONS OF THE STUDY

Time is one limitation of the research because as the time period for the

completion of the research work was already set, it had to be finished at that point

of time at any cost. So the time available to conduct the study was limited.

The use of self prepared questionnaire is another limitation of this research. Not using the SPSS package for analyzing the data collected shall become

another limitation of the research.

13. ETHICS

Ethics in the research is the fundamental norms and standards that the researcher

should follow throughout his research work. To maintain the ethical standards the

researcher has to give importance the following factors:-

Honesty

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To keep up the honesty in the research the researcher should not fabricate, or

misinterpret the data collected for the purpose of the study. One should report the

data with honesty.

Objectivity

The researcher should not progress the research with a bias. The bias in the data

analysis, data interpretation and the experimental design should be avoided and

avoid self deception.

Integrity

The agreement with the agency or the organization should be kept authentic and

the researcher should act sincerely and should be consistent in their action.

Carefulness

The careless faults and the negligence should be avoided. The work should be

critically and carefully analysed based on the genuine data retrieved by theresearcher. The various research activities should be properly recorded.

Respect for Intellectual Property

The researcher should honor the intellectual properties like, patents and copyrights.

Without the consent of the patents or the copyrighters the researcher should not use

the data in the research. The plagiarism should be avoided in the research.

Confidentiality

The confidentiality of the data collected for the purpose of the research should

given much priority. The confidential communication should be protected.

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Human Subjects Protection

The researcher should try to extract maximum benefit from the research and should

respect the human dignity, privacy and autonomy.

The main concern of the researcher should be on retaining the safety of the

respondents and should utilize the resources to make out an effective assessment as

the research progresses.

References

Cites

1)www.rcctvm.org/ Regional cancer canter Trivandrum cited on 26/8/10

2)livekerala.blogspot.com/2010/04/regional-cancer-centre.cited on 26/8/10

3)www.cancerhelp.org.uk ... Lung cancerAbout lung cancercited on 29/8/10

4)lungcancersymptoms .org/cited on 22/8/10

5)www.medicinenet.com ... cancer az list lung cancer index

BOOKS

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http://www.google.co.uk/url?q=http://www.cancerhelp.org.uk/type/lung-cancer/index.htm&sa=X&ei=12OITLKAFNKS4AavyfnSBA&ved=0CB4Q6QUoAQ&usg=AFQjCNFRlOrzM2_sxLp7o6fNdHFmmgdmWQhttp://www.google.co.uk/url?q=http://www.cancerhelp.org.uk/type/lung-cancer/about/index.htm&sa=X&ei=12OITLKAFNKS4AavyfnSBA&ved=0CB8Q6QUoAg&usg=AFQjCNHEEIyFwLR0u3SZK2KDaXSOS0z4xghttp://www.google.co.uk/url?q=http://www.medicinenet.com/script/main/alphaidx.asp%3Fp%3Da_12&sa=X&ei=12OITLKAFNKS4AavyfnSBA&ved=0CDQQ6QUoAQ&usg=AFQjCNF5PJeGORTub-np1VTLY7srWgxf7ghttp://www.google.co.uk/url?q=http://www.medicinenet.com/script/main/forum.asp%3Farticlekey%3D406&sa=X&ei=12OITLKAFNKS4AavyfnSBA&ved=0CDUQ6QUoAg&usg=AFQjCNGBEV5ZIjheiP3ec0LlrsnDNoVcGAhttp://www.google.co.uk/url?q=http://www.cancerhelp.org.uk/type/lung-cancer/index.htm&sa=X&ei=12OITLKAFNKS4AavyfnSBA&ved=0CB4Q6QUoAQ&usg=AFQjCNFRlOrzM2_sxLp7o6fNdHFmmgdmWQhttp://www.google.co.uk/url?q=http://www.cancerhelp.org.uk/type/lung-cancer/about/index.htm&sa=X&ei=12OITLKAFNKS4AavyfnSBA&ved=0CB8Q6QUoAg&usg=AFQjCNHEEIyFwLR0u3SZK2KDaXSOS0z4xghttp://www.google.co.uk/url?q=http://www.medicinenet.com/script/main/alphaidx.asp%3Fp%3Da_12&sa=X&ei=12OITLKAFNKS4AavyfnSBA&ved=0CDQQ6QUoAQ&usg=AFQjCNF5PJeGORTub-np1VTLY7srWgxf7ghttp://www.google.co.uk/url?q=http://www.medicinenet.com/script/main/forum.asp%3Farticlekey%3D406&sa=X&ei=12OITLKAFNKS4AavyfnSBA&ved=0CDUQ6QUoAg&usg=AFQjCNGBEV5ZIjheiP3ec0LlrsnDNoVcGA

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1)Current medical diagnosis & treatment2002(Linda .S.Thompson Adams 2008)

2) Cancer: we live and die by radiation(Michelangelo Delfino, Mary E. Day 2006)

3) Lung cancer: a practical guide to management - Page 104 Fergus Macbeth, Robert

Milroy,William Steward

4)Lung CancerStephen Falk,Chris Williams 2010

5) Current diagnosis and treatment surgery - Page 354 Gerard Doherty, McGraw-Hill

Companies 2009

6)Methods ofCancer Diagnosis, Therapy and Prognosis: General ... - Page 288

M. A. Hayat - 2008

7)Lung cancer: a guide to diagnosis and treatmentWalter Scott - 2000

8)Handbook of Cancer Chemotherapy Roland T. Skeel 2007

9)Lung CancerSujal R. Desai 2007

10) Medicinal chemistry ofanticancer drugs Carmen Avendao,J. Carlos Menndez

2008

11)Essentials of Medical Pharmacology KD Tripathi MD 2005

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http://books.google.co.uk/books?id=gnVltVdhe-AC&q=diagnosis+and+prevent+the+treatment&dq=diagnosis+and+prevent+the+treatment&hl=en&ei=CGWITP2fJ82TjAe5jaCbCQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CD4Q6AEwAghttp://books.google.co.uk/books?id=gnVltVdhe-AC&q=diagnosis+and+prevent+the+treatment&dq=diagnosis+and+prevent+the+treatment&hl=en&ei=CGWITP2fJ82TjAe5jaCbCQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CD4Q6AEwAghttp://books.google.co.uk/books?id=gnVltVdhe-AC&q=diagnosis+and+prevent+the+treatment&dq=diagnosis+and+prevent+the+treatment&hl=en&ei=CGWITP2fJ82TjAe5jaCbCQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CD4Q6AEwAghttp://books.google.co.uk/books?id=gnVltVdhe-AC&q=diagnosis+and+prevent+the+treatment&dq=diagnosis+and+prevent+the+treatment&hl=en&ei=CGWITP2fJ82TjAe5jaCbCQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CD4Q6AEwAghttp://books.google.co.uk/books?id=gnVltVdhe-AC&q=diagnosis+and+prevent+the+treatment&dq=diagnosis+and+prevent+the+treatment&hl=en&ei=CGWITP2fJ82TjAe5jaCbCQ&sa=X&oi=book_result&ct=result&resnum=3&ved=0CD4Q6AEwAghttp://books.google.co.uk/books?id=u3bnPGRxs1YC&printsec=frontcover&dq=cancer&hl=en&ei=hmWITJbHCdO4jAexz9W0Cg&sa=X&oi=book_result&ct=result&resnum=2&ved=0CD0Q6AEwAQhttp://books.google.co.uk/books?id=u3bnPGRxs1YC&printsec=frontcover&dq=cancer&hl=en&ei=hmWITJbHCdO4jAexz9W0Cg&sa=X&oi=book_result&ct=result&resnum=2&ved=0CD0Q6AEwAQhttp://books.google.co.uk/books?id=u3bnPGRxs1YC&printsec=frontcover&dq=cancer&hl=en&ei=hmWITJbHCdO4jAexz9W0Cg&sa=X&oi=book_result&ct=result&resnum=2&ved=0CD0Q6AEwAQhttp://www.google.co.uk/search?hl=en&sa=G&tbo=1&tbs=bks:1&q=inauthor:%22Michelangelo+Delfino%22&ei=hmWITJbHCdO4jAexz9W0Cg&ved=0CD4Q9Aghttp://www.google.co.uk/search?hl=en&sa=G&tbo=1&tbs=bks:1&q=inauthor:%22Mary+E.+Day%22&ei=hmWITJbHCdO4jAexz9W0Cg&ved=0CD8Q9Aghttp://books.google.co.uk/books?id=K3dGFMIH3KgC&pg=PA104&dq=main+symptoms+of+lung+cancer&hl=en&ei=CmaITO6IDdjPjAep1MWgDA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFYQ6AEwBghttp://books.google.co.uk/books?id=K3dGFMIH3KgC&pg=PA104&dq=main+symptoms+of+lung+cancer&hl=en&ei=CmaITO6IDdjPjAep1MWgDA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFYQ6AEwBghttp://books.google.co.uk/books?id=K3dGFMIH3KgC&pg=PA104&dq=main+symptoms+of+lung+cancer&hl=en&ei=CmaITO6IDdjPjAep1MWgDA&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFYQ6AEwBghttp://www.google.co.uk/search?hl=en&sa=G&tbo=1&tbs=bks:1&q=inauthor:%22Fergus+Macbeth%22&ei=CmaITO6IDdjPjAep1MWgDA&ved=0CFcQ9Aghttp://www.google.co.uk/search?hl=en&sa=G&tbo=1&tbs=bks:1&q=inauthor:%22Robert+Milroy%22&ei=CmaITO6IDdjPjAep1MWgDA&ved=0CFgQ9Aghttp://www.google.co.uk/search?hl=en&sa=G&tbo=1&tbs=bks:1&q=inauthor:%22Robert+Milroy%22&ei=CmaITO6IDdjPjAep1MWgDA&ved=0CFgQ9Aghttp://www.google.co.uk/search?hl=en&sa=G&tbo=1&tbs=bks:1&q=inauthor:%22Robert+Milroy%22&ei=CmaITO6IDdjPjAep1MWgDA&ved=0CFgQ9Aghttp://www.google.co.uk/search?hl=en&sa=G&tbo=1&tbs=bks:1&q=inauthor:%22William+Steward%22&ei=CmaITO6IDdjPjAep1MWgDA&ved=0CFkQ9Aghttp://books.google.co.uk/books?id=6QaGPwAACAAJ&dq=lung+cancer&hl=en&ei=tGaITOWJKcuTjAf3rcjLCA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CEMQ6AEwAQhttp://www.google.co.uk/search?hl=en&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Stephen+Falk%22&sa=X&ei=tGaITOWJKcuTjAf3rcjLCA&ved=0CEQQ9Aghttp://www.google.co.uk/search?hl=en&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Chris+Williams%22&sa=X&ei=tGaITOWJKcuTjAf3rcjLCA&ved=0CEUQ9Aghttp://www.google.co.uk/search?hl=en&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Chris+Williams%22&sa=X&ei=tGaITOWJKcuTjAf3rcjLCA&ved=0CEUQ9Aghttp://books.google.co.uk/books?id=a14yDQKv4vMC&pg=PA354&dq=lung+cancer+diagonosis+nd+treatment&hl=en&ei=RmeITJrgM8OQjAfFrZyXBA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CD8Q6AEwAQhttp://books.google.co.uk/books?id=a14yDQKv4vMC&pg=PA354&dq=lung+cancer+diagonosis+nd+treatment&hl=en&ei=RmeITJrgM8OQjAfFrZyXBA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CD8Q6AEwAQhttp://books.google.co.uk/books?id=a14yDQKv4vMC&pg=PA354&dq=lung+cancer+diagonosis+nd+treatment&hl=en&ei=RmeITJrgM8OQjAfFrZyXBA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CD8Q6AEwAQhttp://books.google.co.uk/books?id=a14yDQKv4vMC&pg=PA354&dq=lung+cancer+diagonosis+nd+treatment&hl=en&ei=RmeITJrgM8OQjAfFrZyXBA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CD8Q6AEwAQhttp://books.google.co.uk/books?id=a14yDQKv4vMC&pg=PA354&dq=lung+cancer+diagonosis+nd+treatment&hl=en&ei=RmeITJrgM8OQjAfFrZyXBA&sa=X&oi=book_result&ct=result&resnum=2&ved=0CD8Q6AEwAQhttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22Gerard+Doherty%22&ei=RmeITJrgM8OQjAfFrZyXBA&ved=0CEAQ9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22McGraw-Hill+Companies%22&ei=RmeITJrgM8OQjAfFrZyXBA&ved=0CEEQ9Aghttp://www.google.co.uk/search?hl=en&sa=G&rlz=1G1GGLQ_ENUK374&tbs=bks:1&q=inauthor:%22McGraw-Hill+Companies%22&ei=RmeITJrgM8OQjAfFrZyXBA&ved=0CEEQ9Aghttp://books.google.co.uk/books?id=AzUmGT9F_wEC&pg=PA288&dq=lung+cancer+diagonosis+nd+treatment&hl=en&ei=Rme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