title: Non-Hodgkin's lymphoma: is India ready to incorporate recent advances in day to day practice?
abstract: BACKGROUND
  Non Hodgkin's Lymphoma (NHL) cure rates are increasing and morbidities are decreasing, with more active pharmacological agents and technological advancements. In spite of this, India is still battling with the prejudices of an economically and educationally impoverished patient base.
  
  
  RESULTS
  We analyzed NHL cases from 2000 to 2006 using data from case sheets. Of 303 cases, only 100 patients had complete workup and received some form of treatment. For 203 patients, reasons for non-compliance were: financial constraint (119), distance from center (38), inability of physician to provide guarantees of cure (13), poor prognosis/fear of recurrence (28)), preferences for alternate medicine (5). Most common investigations that could not be afforded for staging were whole body CT scans and bone marrow aspiration and biopsy. Thirteen patients were in stage III and 53 in Stage IV. The most common regimen was CHOP (Cyclophosphamide, Adriamycin, Vincristine, Prednisolone). Forty-five patients did not complete six courses of CHOP and 35 patients had significant delay. Reasons for delay were intermittent availability of cash (35), intolerable toxicities (30), absence of supportive care (21), given-up attitudes (17). Eighty-three patients suffered Grade III/IV debilitating toxicities. Overall survival at five years was 50%.
  
  
  CONCLUSIONS
  NHL in India is no different from the developed world. However, there are disparities in survivorship and outcomes, due to un-affordability and attitudes of the patients. Therefore, we suggest the development of Community Health Insurance Schemes (CHIs), with the hospital as the nodal center to address the above mentioned issues.
authors.affiliation: Department of Radiotherapy, Shirdi Sai Baba Cancer Hospital, Kasturba Medical College, Manipal - 576 104, Udupi District, Karnataka, India.
authors.forename: Saraschandra
authors.initials: S
authors.lastname: Vallabhajosyula
authors.forename: Gunjan
authors.initials: G
authors.lastname: Baijal
authors.forename: B M
authors.initials: BM
authors.lastname: Vadhiraja
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Fernandes
authors.forename: M S
authors.initials: MS
authors.lastname: Vidyasagar
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000191:economics / Q000627:therapeutic use; D003906:Developing Countries; D004317:Doxorubicin / Q000191:economics / Q000627:therapeutic use; D015251:Epirubicin; D005047:Etoposide; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007069:Ifosfamide; D007194:India; D002955:Leucovorin; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D008727:Methotrexate; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011241:Prednisone / Q000191:economics / Q000627:therapeutic use; D011344:Procarbazine; D014750:Vincristine / Q000191:economics / Q000627:therapeutic use
chemical_list: D011344:Procarbazine; D015251:Epirubicin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D002955:Leucovorin; D007069:Ifosfamide; D011241:Prednisone; D008727:Methotrexate