 As study on smoking and risk for

lung cancer among confirmed male

patients at cancer clinic, Teaching
hospital, Kurunegala, Sri Lanka.

 Names of the reporters:

  Index numbers: D/NNP/22/0050

D/NNP/22/0059

1. Introductory phrase

Currently, over 1.3 billion individuals are classified

as smokers. Every year, over 6 trillion cigarettes are
smoked worldwide. Asian countries now consume
half of all cigarette output. There are around 320
million smokers in China.50% of smokers will
undoubtedly die from smoking-related diseases. In
addition, smoking is the cause of 30 additional
disorders, including CVS, cerebral vascular disease,
COPD, and cancer. For smokers, the most prevalent
cancer kind is lung cancer.

Muller was the first to describe the epidemiological

link between smoking and lung cancer in 1939.
Tobacco use is the leading cause of lung cancer in
90% of men and 79% of women. (ozlu, 2005)

Squamous cell carcinoma is more commonly

connected with smoking. The risk of lung cancer is
rising. There are additional inorganic chemicals such
as cadmium, nickel, arsenic, and so on. Burning
cigarettes include chemical molecules such as
butadiene. Cigarette smoke has a high concentration
of acrolein. The ciliated lining of the lungs is
particularly vulnerable to this toxin. There is also a
significant number of radicals in cigarette smoke,
such as hydrogen peroxide and hydroxyl ion, which
cause oxidative damage in people. 2013 (furrukh)

As a result, when studying the relationship between

smoking and lung cancer in the population, we must
consider various methods, such as measuring the
smoking-lung cancer bond in relation to various
degrees of adaptation for amazing factors (obesity,
physical activity, alcohol consumption, and women's
use of HRT). research designs, study populations,
sex group, and type of lung cancer; and to
investigate dose-response relationships. The impact
of tobacco uses on the risk of lung cancer.

Individual and population-based approaches might

potentially reduce smoking. As a result, the research
is aimed at proving the link between smoking and
the risk of lung cancer in order to reduce the
disease's impact.

2. Review of the literature

Smoking is the leading cause of lung cancer. This

study includes high-risk individuals who took part in
the nationwide lung screening trial. Some criteria
taken into account include self-reported
demographics, smoking history, lung cancer type,
and all-cause mortality. Kaplan-Meirer survival
curves are used to investigate variations in survival
based on trial arm and smoking status. Former
smokers who maintained self-control for 7 years had
a 20% mortality decrease commensurate to the
benefit experienced. The impact of tobacco uses on
the risk of lung cancer.
Individual and population-based approaches might
potentially reduce smoking. As a result, the study is
focused on proving the link between smoking and
the risk of lung cancer in order to assist reduce the
burden of this disease.The combination of smoking
cessation at 15 years and low-dose computed
tomography screening resulted in a 38% reduction in
lung cancer specific mortality (HR,0.62;95%
confidence interval,0.51-0.76).

Seven years of no smoking reduced lung cancer

specific mortality in a manner comparable to low
dose computer tomography screening. This
impairment was exacerbated when avoidance was
paired with screening, emphasizing the need of
smoking cessation efforts in screening programmes.
This is the study's ultimate conclusion. (NL
Christensen, 2018) In 2010, over 28000 people died
in France as a result of tobacco-related lung cancer.
Smoking after diagnosis has a negative impact on
therapy. Smoking cessation is extremely beneficial
in the treatment of early stage lung cancer. Smoking
should be avoided six to eight weeks before surgery
to lower the chance of infection problems. Tobacco's
interaction with P450 cytochrome may modify the
metabolism of various chemotherapies, such as
tyrosine kinase inhibitors of EGF receptors. Finally,
smoking cessation is extremely beneficial in the
treatment of cancer, regardless of the stage of the
disease. Rivera (2016)

This study looks at the dosage of cigarette intake.

They identified lifelong smokers who smoked 1 to
10 cigarettes each day and evaluated their risk. In the
NIH-AARP Diet and Health research, 238525
cancer-free people aged 59 to 82 were tested for
their risk of developing cancer. A questionnaire
administered in 2004-2005 determined the number
of cigarettes consumed per day during nine age
groups (from 15 to >70). They used multivariable-
adjusted cox proportional hazards retrogression with
age as the underlying time matrices to estimate
hazard ratios (HR) and 95% confidence intervals
(CI). Former smokers had a decreased risk of
smoking-related cancer with longer time after
cessation and longer smoking time period among
lifelong 10 cigarettes per day smokers. Life-long 1
and 1-10 cigarettes per day smokers are at a higher
risk of developing cancer than never smokers and
would benefit from cessation, providing additional
evidence that even low amounts of cigarette
smoking cause cancer. (Choi, 2018)
Smokers are at a higher risk. Nonsmokers are more
likely than smokers to develop non-small cell lung
cancer. However, the cause of the relative
development of second primary lung cancer is
unknown. Patients who had resection for stage 1
cancer were identified from an institutional database.
Patients with various histologies and lesions who
had neoadjuvant or adjuvant treatment were
disregarded. The SPLCs were found using Martini
criteria. This was the end outcome. Between 1995
and 2012, 2151 patients had stage 1 adenocarcinoma
resections (308 nonsmokers (14%) and 1843
smokers (86%). Finally, although smokers are more
likely than nonsmokers to develop Non- Small Cell
Adenocarcinoma and second primary lung
malignancies. The vast majority of these second
primary tumors are treatable. Postoperative
monitoring should be recommended for all patients,
regardless of smoking status. (Ripley,2014)

Lung cancer is the most frequent type of cancer

worldwide. According to data, Croatia had the
greatest number of cases of lung cancer among the
other 20 nations in 2012. Tobacco usage is the
leading cause of lung cancer. According to current
figures, more than one-quarter of adults smoke on a
regular basis. The primary goal of this study is to
compare accessible data from Croatia to the rest of
the world.This research included 212 newly
diagnosed lung cancer patients.Small cell lung
carcinoma was found in 12.3% of patients, whereas
non-small cell lung cancer was found in 87.7%.
Finally, smoking cessation is preferable for therapy.
Better treatment choices and earlier diagnosis could
increase overall survival. Kukulj (2014)
3.Summary of Problems

Lung cancer is the most frequent type of cancer

worldwide. Cancer is one of Sri Lanka's most
pressing health issues, according to the s. As a result,
it is critical to understand this condition and its
etiology. The vast majority of persons who become
sufferers of this illness smoke. A recent study found
that smokers had a statistically insignificant odds
ratio (OR) for lung cancer of 40.4 (95% CI
0.95=21.8) when compared to nonsmokers. As a
result, this is a very crucial issue to bring up in the
debate.
According to several research, smoking is also a risk
factor for lung cancer. A firm proof of a strong link
between smoking and lung cancer may aid in
lowering the risk. It may be possible to lessen the
burden of lung cancer caused by smoking by
promoting quitting, enacting tax laws, and taking
other steps to minimize tobacco use. Most
researchers study the relationship between smoking
and the risk of lung cancer in the general population
using systematic reviews and meta-analyses, as well
as whether heavy smokers have a greater risk of lung
cancer than light smokers.

The results of this study will be crucial in

developing new lung cancer legislation and in
educating the general public about the significance
of quitting smoking.
4. Purposes

Overarching Goal

Research on smoking and lung cancer risk was

conducted among male patients with lung cancer at
the Teaching Hospital in Kurunegala, Sri Lanka. 4.2
Particular Goals

1. To determine how smoking and the risk of lung

cancer are related.

2. To determine the relationship between daily

cigarette consumption and the risk of lung cancer.

3. To determine the effects of ongoing smoking on

lung cancer complications.

4. To determine whether smoking—currently or in

the past—can create additional issues.
5. To increase public knowledge of the negative
effects of smoking.

6. To change the government's mindset so that

taxing measures are implemented to lower tobacco
and cigarette usage.

7. To motivate individuals to give up smoking.

5. Resources and Approach

5.1 Research approach

Cross sectional descriptive research will be used

for this investigation.

5.2 Study, location, and population

Patients who have been proven to be men only

Lung cancer patients will be chosen as the study's
population from the cancer clinic at Kurunegala
Teaching Hospital.

5.3 Sample size

Male patients with proven lung cancer will be

chosen from the nursing sister's cancer clinic records
at Kurunegala Teaching Hospital.

Then, 200 male patients with proven lung cancer

will be chosen at random.

5.4 Requirements for inclusion and removal

Create inclusion criterion

Male patients with proven lung cancer aged 30 to 70

who visited the cancer clinic at Teaching Hospital
Kurunegala from August 12 through August 30
would be taken into consideration.
Race and ethnicity will not be taken into
consideration for male patients with lung cancer.

Design of the exclusionary factors

Women who have been diagnosed with lung cancer

in a cancer clinic will not be accepted. Kurunegala
Teaching Hospital.

5.5 Data gathering and data collecting

instruments

All 200 male patients with proven lung cancer will

get a separate questionnaire, and statistics will be
gathered using that information.

The questionnaire will ask you about your daily

cigarette consumption history, smoking habits,
cigarette brands and varieties, how long you've been
a smoker, and other health issues besides lung
cancer.
 5.6 Data entry and analysis

Data will clean, collect, organize and analyze using

statically package for service solution latest version.
(SPSS) A dose response analysis for 1-10 cigarettes
per day, 10-20 cigarettes per day and more than 20
cigarettes per day will be conducted to find the
influence of amount smoked on lung cancer risk.
Association will be considered significant when P
value<0.05(level of significant)

6. Budgets
Items Number Cost per unit (Rs) Total(Rs)

Questionnaire forms(for 600pages 4.00 2400.00

patients)
Printouts(letters) 10 10.00 100.00

Research assistant to data 01 500.00 per 5000.00

collection day(10days)
Transport 2500.00

Binding 01 500.00 500.00

Refreshments 2000.00

Miscellaneous 1000.00

Printouts(research report) 100pages 5.00 500.00

Total 14000.00

7. Moral concerns

The Sir John Kotelawala Defense University's

Faculty of Medicine's ethical review committee will
provide its permission. Every aspect of the research
is conducted in a private, confidential manner. All
participants are informed of the study's objectives,
and they are not being forced to participate.
Participants in this research must voluntarily
participate. Participants' names won't be listed on the
questioners. We do not condemn the participants'
cultural, racial, religious, or traditional views either
during or after the research, there will be no more
contact with the participants.

8. Plan for Action

Tasks to be Dates Persons assigned Days required

performed to task

1 Finalize the Week 1-4 Researcher 20

research proposal (Nov.1 – Nov. 15)
and literature
review
2 Permission from Week 4-6 University 15
authorities (Nov.15 – Nov.30) authority
Hospital director
Ward sister
3 Ethical clearance Week 6-8 Researcher and 15
(Dec.1 - Dec.15) ethical committee

4 Data collection Week 8-18 Researcher 80

(Dec.15 - Feb.1) participants

5 Data entry and Week 18-21 Researcher 20

preliminary data (Feb.1 - Feb. 20)
analysis
6 Data analysis Week 21-22 Researcher 10
(Feb.20 –Feb. 28)

7 Report finalization Week 22-24 Researcher 15

(March 1 – March
15)

9. References
Schultz, H. et al. 1998,’Tobacco or health: A global status report’ Ann Saudi
Med ,18: 195

Ozaki, K. et al. 2010, ‘Effects of chronic cigarette smoking on endothelial

function in young men’, J Cardiol ,56: 307-13

Vazquez, M., Koizumi, J., Henschke, C. and Yankelevitz, D. (2007). Reliability of

cytologic diagnosis of early lung cancer. Cancer, 111(4), pp.252-258.

Furrukh, M. (2013). Tobacco Smoking and Lung Cancer : Perception Changing

Facts = ‫ إدراك تغير الحقائق‬: ‫تدخين التبغ و سرطان الرئة‬. Sultan Qaboos University Medical
Journal, 13(3), pp.345-358.
Yuan JM, Koh WP, Murphy SE, Fan YH, Wang RW, Carmella SG, et al. Urinary
levels of tobacco-specific nitrosamine metabolites in relation to lung cancer
development in two prospective cohorts of cigarette smokers. Cancer Res 2009;
69:2990.

Engeland A, Haldorsen T, Andersen A, Tretli S. The impact of smoking habits on

lung cancer risk: 28 years’ observation of 26.000 Norwegian men and women.
Cancer Causes Control 1996; 7: 36

Darocha, T., Skoczylas, P., Smolen, A. and Gozdziuk, K. (2005). P-288 Active and
passive smoking among students of Polish high schools — national survey
research. Lung Cancer, 49, p.S190.