PROFORMA FOR REGESTRATION OF SUBJECT FOR

DISSERTATION

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

MR. IMRAN SHEIKH MRUTUNJAY CIRCLE,GHATAPRABHA-591306DIST: BELGAUM

2. NAME OF THE INSTITUTESMT M.C VASANTHA COLLEGE OF NURSING, NAUBAD, BHALKI ROAD, BIDAR.

3. COURSE OF THE STUDY AND SUBJECT

I YEAR M. Sc. NURSING,MEDICAL SURGICAL NURSING

4. DATE OF ADMISSION 10-4-2012

5. TITLE OF THE STUDY

“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON IMPORTANCE OF ANTIOXIDANTS WITH REGARD TO PREVENTION AND TREATMENT OF CANCER AMONG STAFF NURSES AT SELECTED HOSPITALS BIDAR.”

[2]

6. BRIEF RESUME OF THE INTENDED WORK6.1 INTRODUCTION

Health is the level of functional or metabolic efficiency of a living being. In humans,

it is the general condition of a person's mind and body, usually meaning to be free from

illness, injury or pain (as in "good health" or "healthy"). In order to have a good health good

nutrition is essential1.

Good nutrition is essential to good health through out life, beginning with child life

and extending to old age. Food and nutrition continue to provide essential support during the

adult aging process. Good nutritional status through out life helps prevent the development

and progression of disease and disabilities in later life, as well as promoting successful

medical treatment outcome, thereby significantly contributing to the quality of life.

Throughout life good nutrition is required to stay away from diseases like cancer.

Cancer is a group of diseases with similar characteristics, which can occur in all

living cells in the body and different cancer types have different natural history. The myth

that cancer affects people mostly in the developed countries is being broken by the fact that,

of the 10 million new cancer cases seen each year worldwide, nearly 5.5 million are in the

less developed countries. Cancer is the second most common cause of death in the developed

world and a similar trend has emerged in the developing countries too. Cancer prevalence in

India is estimated to be around 2.5 million, with over 8,00,000 new cases and 5,50,000

deaths occurring each year due to this disease. More than 70% of the cases report for

diagnostic and treatment services in the advanced stages of the disease, which has lead to a

poor survival and high mortality rate2.

Antioxidants are substances that may protect cells from the damage caused by

unstable molecules known as free radicals. Free radical damage may lead to cancer.

Antioxidants interact with and stabilize free radicals and may prevent some of the damage

[3]

free radicals might otherwise cause. Examples of antioxidants include beta-carotene,

lycopene, vitamins C, E, and A, and other substances3.

Free radicals create a destructive process in our cells, causing the molecules within

the cells to become unstable. They may even be a big player in the formation of cancerous

cells by a “chain-reaction” effect, causing other cells to become damaged. Because of the

inherent instability of free-radicals, they try to attack other healthy cells to get stable

themselves. This causes the once-healthy cells to react in the same way, attacking others in

never-ending attempt for cellular stability.

Antioxidants help fight oxidation, a normal chemical process that takes place in the

body every day. It can be accelerated by stress, cigarette smoking, and alcohol. When there

are disruptions in the natural oxidation process, highly unstable and potentially damaging

molecules called free radicals are created. Oxygen triggers the formation of these destructive

little chemicals, and, if left uncontrolled, they can cause damage to cells in the body. It's

much like the chemical reaction that creates rust on a bicycle or turns the surface of a cut

apple brown.

Antioxidants neutralize free radicals as the natural by-product of normal cell

processes. Free radicals are molecules with incomplete electron shells which make them

more chemically reactive than those with complete electron shells. Exposure to various

environmental factors, including tobacco smoke and radiation, can also lead to free radical

formation. In humans, the most common form of free radicals is oxygen. When an oxygen

molecule (O2) becomes electrically charged or “radicalized” it tries to steal electrons from

other molecules, causing damage to the DNA and other molecules. Over time, such damage

may become irreversible and lead to disease including cancer. Antioxidants are often

described as “mopping up” free radicals, meaning they neutralize the electrical charge and

prevent the free radical from taking electrons from other molecules4.

[4]

Free radical production is actually a normal part of life, part of the equation of simply

breathing in oxygen. Usually, the body's natural defense systems neutralize free radicals that

develop, rendering them harmless. However, environmental assaults on the body, such as

UV-radiation, pollutants and alcohol, can overpower the body's ability to neutralize free

radicals, allowing them to cause damage to the structure and function of the body's cells.

There is good evidence that this damage contributes to aging and leads to a host of illnesses,

including cancer and heart disease5.

Considerable laboratory evidence from chemical, cell culture, and animal studies

indicates that antioxidants may slow or possibly prevent the development of cancer.A 2009

study looked at data from NHANES (1999–2000 and 2001–2002) and the U.S. Department

of Agriculture Flavonoid Database to estimate the total antioxidant intake (from diet and

supplements) of adults in the United States. The researchers calculated the daily intake of

vitamin C, vitamin E, carotenes, selenium, and flavonoids. They found that supplements

accounted for 54 percent of vitamin C; 64 percent of vitamin E (alpha-tocopherol); 14

percent of carotenes; 11 percent of selenium; and 2 percent of flavonoid intake. Nutritional

deficit have been shown to contribute significantly to many diseases that occur in the

elderly6.

[5]

6.2 NEED FOR THE STUDY

Cancer is a leading cause of death in the United States alone. Nearly 23% of all

deaths are cancer related. This statistic is frightening and the reason so much emphasis is

placed on can cancer treatments and preventions. The adage "An ounce of prevention is

worth a pound of cure" is particularly relevant when it comes to cancer, so it is very

important that the general population is aware of how to promote health naturally in order to

stave off cancer.

There are many different forms of cancer and various effects that can lead to it.

However, lack of antioxidants has been shown to exacerbate conditions that may lead to

cancer. According to the American Cancer Society, there is clear evidence that a lack of

antioxidants can increase risk of cancer and cancer related deaths. Research has proven

beyond a reasonable doubt the connection between antioxidants and cancer.

The human body has several innate defense systems against free radicals. However,

the innate oxidant defense system is not sufficient to adequately deal with the amount of free

radicals produced and is now thought that dietary antioxidants which counter free radicals,

are essential for health and well being .

The earliest and most important way to stop free radical damage is to fortify your diet

with antioxidant rich food. Consuming more antioxidant helps provide the body with tools to

neutralize harmful free radicals. It is estimated that there are more than 4000 compounds in

foods that act as antioxidants. The most include vitamin C, E, beta carotene and the mineral

selenium. Antioxidants-food substances that slow down cell damage and may improve

immune function and keep the body healthy.

The first large randomized trial on antioxidants and cancer risk was the Chinese

Cancer Prevention Study, published in 1993. This trial investigated the effect of a

combination of beta-carotene, vitamin E, and selenium on cancer in healthy Chinese men and [6]

women at high risk for gastric cancer. The study showed a combination of beta-carotene,

vitamin E, and selenium significantly reduced incidence of both gastric cancer and cancer

overall7.

A randomized trial of selenium in people with skin cancer demonstrated significant

reductions in cancer and cancer mortality at various sites, including colon, lung, and prostate.

The effects were strongest among those with low selenium levels at baseline.

A study conducted on defining the role of antioxidants in the prevention of prostate

cancer. This is the largest individually randomized, multicenter cancer prevention trial

conducted that has maintained high rates of adherence and retention for 4 to 7 years. This

trial recruited 35,533 men who were randomly assigned to four groups (selenium, vitamin E,

selenium + vitamin E, and placebo) in a double-blind fashion between 2001 and 2004.

Eligibility included age 50 years or older (African American men) or 55 years or older (all

other men), a serum prostate-specific antigen level of ≤4 ng/ml, and a digital rectal

examination not suspicious for prostate cancer. Antioxidant formulations used were oral

selenium (200 μg/d from L-selenomethionine) and matched vitamin E placebo, vitamin E

(400 IU/d of all rac-α-tocopheryl acetate), and matched selenium placebo, selenium +

vitamin E, or placebo + placebo for a follow-up of minimum of 7 years and a maximum of

12 years. The primary outcome was prostate cancer and prespecified secondary outcomes

were lung, colorectal, and overall primary cancer. At median overall follow-up of 5.46 years

(range: 4.17–7.33 years), hazard ratios for prostate cancer were 1.13 (99% CI, 0.95–1.35; n =

473) for vitamin E, 1.04 (99% CI, 0.87–1.24; n = 432) for selenium, and 1.05 (99% CI, 0.88–

1.25; n = 437) for selenium + vitamin E vs. 1.00 (n = 416) for placebo. There were

statistically non significant increased risks of prostate cancer in the vitamin E group (p =

0.06) and Type 2 diabetes mellitus in the selenium group (relative risk, 1.07; 99% CI, 0.94–

1.22; p = 0.16).This study concluded that selenium or vitamin E alone or in combination at

the doses and formulations used prevent prostate cancer8.

[7]

The investigators personal experience is that while he was working in the medical I

C U, a majority of the client who were admitted suffered from some nutritional disorders and

cancer and in most cases the care givers were unaware of the special nutritional needs of the

cancer client. All these factors prompted the investigator to assess the knowledge of the staff

nurses and to plan teaching to improving the nutritional needs to prevent and treat cancer.

[8]

6.3 REVIEW OF LITERATURE

A study was conducted on Antioxidants and Cancer Therapy at Institute for Integrative

Cancer Research and Education, Evanston. The objective was the consideration of whether to

use antioxidants concomitantly with chemotherapy and radiation therapy. First, the early

hypotheses of the role of antioxidants in carcinogenesis gave a simplified and often

inaccurate picture of the physiological effects of specific antioxidants. Antioxidants can

have protective effects that have nothing to do with oxidation; on the other hand, they can

under some circumstances develop prooxidant properties and promote carcinogenesis. A

number of clinical studies have already demonstrated beneficial effects of antioxidants in

ameliorating side effects of chemotherapy. The study concludes that more theoretical work

on the chemistry of antioxidants and chemotherapy drugs suggests that antioxidants might

improve therapeutic efficacy of antineoplastics by counteracting aldehydes that impede the

passage of cells through the cell cycle9.

[9]

A study was conducted on Daily intake of antioxidants in relation to survival among

adult patients diagnosed with malignant glioma. Adult patients diagnosed with malignant

glioma during 1991-1994 and 1997-2001 were enrolled in a population-based study.

Diagnosis was confirmed by review of pathology specimens. The results shown that

Geometric mean values for 11 fat-soluble and 6 water-soluble individual antioxidants,

antioxidant index and 3 macronutrients were virtually the same when comparing all cases (n

= 748) to self-reported cases only (n = 450). For patients diagnosed with Grade II and Grade

III histology, moderate (915.8-2118.3 mcg) intake of fat-soluble lycopene was associated

with poorer survival when compared to low intake (0.0-914.8 mcg), for self-reported cases

only. High intake of vitamin E and moderate/high intake of secoisolariciresinol among Grade

III patients indicated greater survival for all cases. In Grade IV patients, moderate/high intake

of cryptoxanthin and high intake of secoisolariciresinol were associated with poorer survival

among all cases. Among Grade II patients, moderate intake of water-soluble folate was

associated with greater survival for all cases; high intake of vitamin C and genistein and the

highest level of the antioxidant index were associated with poorer survival for all cases.The

associations observed in our study suggest that the influence of some antioxidants on survival

following a diagnosis of malignant glioma are inconsistent and vary by histology group.

Further research in a large sample of glioma patients is needed to confirm/refute our results10.

[10]

A randomized controlled trial was conducted on Antioxidant vitamins supplementation

and mortality, in head and neck cancer patients. The objective was to verify long-term

supplementation with high-dose antioxidant vitamins, especially vitamin E (α-tocopherol), may

increase all-cause mortality. With α-tocopherol (400 IU/day) and β-carotene (30mg/day)

supplements among 540 head and neck cancer patients treated by radiation therapy. The

supplements were given during radiation therapy and for 3 additional years. Results concur

with previous reports to suggest that high-dose vitamin E could be harmful. Conducted a

multicenter, double-blind, placebo-controlled, randomized chemoprevention trial with α-

tocopherol and β-carotene supplements among patients treated by radiation therapy for head

and neck cancer. During the recruitment period, 1,151 new patients with stage I or II

squamous cell carcinoma of the head and neck were treated in the participating radiation

oncology centers. Of these 1,151, 15% refused to participate and 38% were ineligible.

The remaining 47% (n = 540) were eligible and consented to be enrolled. The baseline

characteristics of the 273 and 267 patients randomly assigned to the supplement and

placebo arms, respectively, were similar in the 2 groups. The compliance with the

prescribed supplementation was excellent throughout the trial. The result shown that the

supplement arm, the average compliance, assessed by capsule count, was 90% during

radiation therapy and 88, 84 and 80% during the 1st, 2nd and 3rd years after the end of

radiation therapy, respectively. In the placebo arm, these figures were 89, 86, 83 and

80%, respectively11.

[11]

A pilot study was conducted on Improved Survival in Patients with End-stage Cancer

Treated with Coenzyme Q10 and Other Antioxidants. The objective was to evaluate the

survival of patients with end-stage cancer who received supplements of coenzyme

Q10 and a mixture of other antioxidants (e.g. vitamin C, selenium, folic acid and β-

carotene). During a period of 9 years, 41 patients who had end-stage cancer were

included. Forty patients were followed until death and one patient was lost to follow-up

and presumed dead. Primary cancers were located in the breast, brain, lungs, kidneys,

pancreas, oesophagus, stomach, colon, prostate, ovaries and skin. The median predicted

survival time was calculated from Kaplan-Meier curves for each patient at inclusion.

The result shown that Median predicted survival was 12 months (range 3 - 29 months),

whereas median actual survival was 17 months (1 - 120 months), which is > 40% longer

than the median predicted survival. Mean actual survival was 28.8 months versus 11.9

months for mean predicted survival. Ten patients (24%) survived for less time than

predicted, whereas 31 (76%) survived for longer. The study concludes that treatments

were very well tolerated with few adverse effects12.

A systematic review and meta-analysis was conducted on antioxidant supplements for

prevention of gastrointestinal Cancers at Dimitrinka Nikolova. The objective was to establish

whether antioxidant supplements reduce the incidence of gastrointestinal cancer and

mortality. Outcomes were analyzed with fixed-effect and random-effects model meta-

analyses and were reported as relative risk with 95% CIs. The result was 14 randomized trials

(n=170 525). Trial quality was generally high. Heterogeneity of results was low to moderate.

Neither the fixed-effect (relative risk 0·96, 95% CI 0·88–1·04) nor random-effects meta

analyses (0·90, 0·77–1·05) showed significant effects of supplementation with -carotene,

vitamins A, C, E, and selenium (alone or in combination) versus placebo on esophageal,

gastric, colorectal, pancreatic, and liver cancer incidences. In seven high-quality trials (n=131

727), the fixed-effect model showed that antioxidant significantly increased mortality (1·06,

[12]

1·02–1·10), unlike the random-effects meta-analysis (1·06, 0·98–1·15). Low-quality trials

showed no significant effect of antioxidant supplementation on mortality. The difference

between the mortality estimates in high-quality and low-quality trials was significant

(Z=2·10, p=0·04 by test of interaction).carotene and vitamin A (1·29, 1·14–1·45) and -

carotene and vitamin E (1·10, 1·01–1·20) significantly increased mortality, whereas -

carotene alone only tended to increase mortality (1·05, 0·99–1·11). The study concludes that

in four trials selenium showed significant beneficial effect on the incidence of gastrointestinal

cancer13.

A case control study conducted on Nutrition and cancer in Uruguay. The objective

was to examine the protective role of dietary antioxidants (carotenoids, vitamin C, vitamin E,

glutathione, and flavonoids) in lung cancer risk, involving 541 cases of lung cancer and 540

hospitalized controls was carried out. The result shown that carotenoids and vitamin E were

associated with significant reductions in risk of lung cancer (OR = 0.43, 95% CI = 0.29-0.64

for total carotenoids and OR = 0.50, 95% CI = 0.39-0.85 for vitamin E). A joint effect for

high vs. low intakes of b-carotene and glutathione was associated with a significant reduction

in risk (OR = 0.32, 95% CI = 0.22-0.46). The study concluded that dietary antioxidants are

associated with a significant protective effect in lung carcinogenesis and that the inverse

association for glutathione14.

A  Systematic review of trials and meta-analysis was conducted on Antioxidants

Vitamin C and Vitamin E for the Prevention and Treatment of Cancer. The objective was to

evaluate the evidence of the supplements vitamin C and vitamin E for treatment and

prevention of cancer. Thirty-eight studies showed scant evidence that vitamin C or vitamin E

beneficially affects survival. The researcher identified only 3 studies that reported

statistically significant beneficial results: vitamin C was found to be beneficial in a single

trial of bladder cancer and vitamin E increased survival in patients with advanced cancer.

The result shown that in analyses of 6 individual cancers, the prevention of prostate cancer

[13]

in subjects treated with α-tocopherol was statistically significant (RR=0.64, 95% CI: 0.44,

0.94).A study concludes that dietary antioxidant is a substance in foods that significantly

decreases the adverse effects of reactive species, such as reactive oxygen and nitrogen

species, on normal physiological functions in humans15.

A case control study conducted on Antioxidants and breast cancer risk- a population-

based in Canada Centre for Chronic Disease Prevention and Control, Public Health Agency of

Canada. The objective was to assess the association between antioxidants and breast cancer

risk in a large population. The study population included 2,362 cases with pathologically

confirmed incident breast cancer (866 premenopausal and 1,496 postmenopausal) and 2,462

controls in Canada. The result was compared with subjects with no supplementation, 10 years

or longer supplementation of zinc had multivariable-adjusted odds ratios (OR) and 95%

confidence intervals (CI) of 0.46 (0.25-0.85) for premenopausal women, while

supplementation of 10 years or longer of multiple vitamin, beta-carotene, vitamin C, vitamin E

and zinc had multivariable-adjusted ORs (95% CIs) of 0.74 (0.59, 0.92), 0.58 (0.36, 0.95), 0.79

(0.63-0.99), 0.75 (0.58, 0.97), and 0.47 (0.28-0.78), respectively, for postmenopausal women.

The Concludes that supplementation of zinc in premenopausal women, and supplementation of

multiple vitamin, beta-carotene, vitamin C, vitamin E and zinc in postmenopausal women for

10 or more years may protect women from developing breast cancer16.

A study was conducted on potential anticancer properties of grape antioxidants in

department of Nutrition and Food Science, Wayne State University, Detroit, USA. Dietary

intake of foods rich in antioxidant properties is suggested to be cancer protective. Foods rich

in antioxidant properties include grape (Vitis vinifera). The composition and cancer-

protective effects of major phenolic antioxidants in grape skin and seed extracts are discussed

in this review. Interestingly, some of these activities were also demonstrated in animal

models. However, in vivo studies have demonstrated inconsistent antioxidant efficacy.

Nonetheless, a growing body of evidence from human clinical trials has demonstrated that

[14]

consumption of grape, wine and grape juice exerts many health-promoting and possible anti-

cancer effects. Thus, grape skin and seed extracts have great potential in cancer prevention

and further investigation into this exciting field is warranted17.

To assess the efficacy of a combination of these micronutrients in reducing the

incidence of recurrent adenomas in subjects on post-polypectomy endoscopic follow-up, a

double-blind placebo-controlled randomized trial was started in Italy in 1988. A total of 411

patients were randomized to receive either an active compound (200 μg selenium, 30 mg

zinc, 2 mg vitamin A, 180 mg vitamin C, 30 mg vitamin E) or a placebo daily for 5 years. Of

them, 330 had follow-up colonoscopy (164 in the intervention and 166 in the placebo group).

The results shown that after a median follow-up of 4 years (range 1-15 years), 100 patients

had recurrence: 38 in the intervention and 62 in the placebo arm. The 15-year cumulative

incidence of recurrence was 48.3 % in the intervention and 64.5 % in the placebo arm

(HR = 0.59; log-rank P = 0.009). A 39 % reduction of the risk of recurrence was observed in

the intervention compared to the placebo group (adjusted HR = 0.61; 95 % CI 0.41-0.92): the

risk reduction was similar for small tubular (adjusted HR = 0.61; 95 % CI 0.37-0.99) and

advanced adenomas (adjusted HR = 0.50; 95 % CI 0.24-1.01). the study concludes that our

study showed a statistically significant effect of antioxidant supplementation on adenoma

recurrence. Further clinical trials are needed to address the role of antioxidants in subgroups

of subjects at increased risk for colorectal cancer18.

The study was conducted on Melatonin and cancer: current knowledge and its

application to oral cavity tumours. An extensive review of the research literature was

conducted using PubMed, Science Direct, ISI Web of Knowledge, and the Cochrane base.

The results shown that this study highlights the growing importance of MLT in the prognosis

and treatment of certain tumours, including epidermoid carcinoma in the oral cavity.

Moreover, it opens up a highly original, encouraging line of research in the field of tumours.

The study concludes that MLT contributes to protecting the oral cavity from tissue damage

[15]

caused by receptor action. Experimental evidence suggests that it may be useful in the

treatment and prognosis of tumour processes in the oral cavity19.

6.4. STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of structured teaching programme on importance

of antioxidants with regard to prevention and treatment of cancer among staff nurses at

selected hospitals Bidar”.

6.5 OBJECTIVES

1. To assess the pretest knowledge score on antioxidants with regard to prevention

and treatment of cancer among staff nurses.

2. To assess the effectiveness of structured teaching programme on importance of

antioxidants with regard to prevention and treatment of cancer among staff

nurses by comparing pretest and posttest knowledge score.

3. To find out the association between the level of knowledge with selected

demographic variables.

6.6 OPERATIONAL DEFINITIONS

1. Effectiveness :

It refers to the improvement in the knowledge of the staff nurse regarding

importance of antioxidants in prevention and treatment of cancer after undergoing

structured teaching programme as evidenced by increase in the post test mean score.

2. Structured teaching programme:

It refers to the systematically developed instructions and teaching aids

designed for staff nurse to improve the knowledge regarding the importance of

antioxidants in prevention and treatment of cancer.

[16]

3. Staff nurse:

It refers to nurses who are working in cancer hospital and who have registered

as ANM, GNM, BSC nursing.

4. Antioxidant diet:

It refers to food sources rich in vitamin C, vitamin E, beta carotene, and the

mineral selenium, that helps to neutralizes highly reactive destructive compounds

called free radicals.

6.7 ASSUMPTIONS

1. Staff nurses may have inadequate knowledge regarding importance of

antioxidants in prevention and treatment of cancer.

2. Structured teaching programme may enhance the knowledge of the staff

nurses regarding importance of antioxidants in prevention and treatment of

cancer.

6.8 HYPOTHESIS

H 1: There is a significant difference between pre test and post test knowledge scores

of significant staff nurse after receiving structured teaching program regarding

importance of antioxidants in prevention and treatment of cancer.

H 2: There is a significant association between the post test score of the significant

staff nurse with selected demographic variables.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

Staff nurses who are working at selected hospitals.

7.2 METHOD OF DATA COLLECTIONS

7.2.1 Research design

[17]

Pre experimental one group pre test post test design

7.2.2 Setting.

Study will be conducted in the selected hospital, Bidar.

7.2.3 Population.

Staff nurses working in hospital.

7.2.4 Sample.

Staff nurses working in selected hospital Bidar.

7.2.5 Sample size

60 Staff nurses.

7.2.6 Sampling Technique

Non probability convenience sampling technique.

7.2.7 Criteria for sample selection

Inclusion Criteria –

1. Staff nurses who are working in the selected hospitals.

2. Staff nurses who are interested to participate in the study.

3. Staff nurses who are on duty at the time of study.

Exclusion Criteria.

1. Staff nurses who are on leave at the time of study.

2. Staff nurses who are not willing to participate in the study.

7.2.8 Tool for data collection

Section A: Sociodemographic variables of the staff nurses

Section B: Self administered knowledge questionnaires on importance of antioxidants.

Section C: Structured teaching programme on importance of antioxidants with regard to

prevention and treatment of cancer among staff nurses to be administered.

7.2.9 Method of data collection

[18]

After obtaining the permission from concerned authorities and informed consent from

the samples, the investigator will collect the base line demographic data.

Phase 1: Pre test will be conducted to assess existing knowledge of the significant staff

nurses regarding importance of antioxidants using a structured questionnaire.

Phase 2: Structured teaching programme on importance of antioxidants in prevention and

treatment of cancer will be administered to the significant staff nurses for one hour duration

on the same day with the help of flash cards.

Phase 3: One week after the structured teaching programme, post test will be administered to

assess the level of knowledge on importance of antioxidants in prevention and treatment of

cancer to the same subject with the help of same questionnaire.

Duration of study: 4 weeks

7.2.10 Data analysis and interpretation

The data collected will be analyzed using descriptive and inferential statistics.

Descriptive Statistics : Frequency, Percentage Distribution, Mean and Standard Deviation

will be used.

Inferential Statistics : Paired‘t’ test will be used to analyze the significant difference

between the mean pre test and post test knowledge score.

Chi squire test will be used to analyze the association between the post test knowledge and

selected demographic variables.

XI. PROJECTED OUTCOME

This study will help the investigator to know the existing knowledge of cancer

patients on antioxidant diet. Also, administration of planned teaching programme will helps

to improve their knowledge on antioxidant diet and its significance in preventing the further

complications of cancer.

7.3 Does the study require any investigation or interventions to the patients or other human beings or animals?

Yes. Structured teaching programme will be administered for the staff nurses.

[19]

7.4. Has ethical clearance been obtained from your institution?

Formal permission will be obtained from the concerned authorities of the hospital.

8. LIST OF REFERANCE

1. Health. From Wikipedia, the free encyclopedia. Available at : URL:

http://en.wikipedia.org/wiki/Health.

2. Ranjani Mohan. Cancer in India. Available at:URL:

http://www.chillibreeze.com/articles_various/cancer-in-India.asp#a : Copyright 2004

llibreeze Solutions Pvt. Ltd.

3. What are antioxidants? Available at :URL:

http://www.healthmash.com/health/antioxidants.html: Copyright 2011.

4. www.cancer.gov/cancertopics/factsheet/prevention/antioxidants

5. www.cancer.gov/Common/PopUps/popDefinition.aspx?

id=CDR0000556412&version=Patient&language=English

6. 6. Antioxidants and Cancer Prevention: Fact Sheet National cancer institute.

Reviewed: 07/28/2004. Available at http://www.cancer.gov/cancertopics/factsheet/

prevention/ antioxidants

7. Hemant R. Pathak and Bhupendra P. Singh, “Defining the role of antioxidants in the

prevention of prostate cancer”. Indian J Urol. 2009 Jul-Sep; 25(3): 417–418.

8. Block KI. “Antioxidants and cancer therapy: furthering the debate”. Integr Cancer

Ther. 2004 Dec;3(4):342-8.

[20]

9. Gerald N DeLorenze, Lucie McCoy, Ai-Lin Tsai, Charles P Quesenberry, Jr,

Terri Rice, Dora Il'yasova,and Margaret Wrensch. “Daily intake of antioxidants in

relation to survival among adult patients diagnosed with malignant glioma”. BMC

Cancer. 2010; 10: 215

10. Bairati I, Meyer F, Jobin E, Gélinas M, Fortin A, Nabid A, Brochet F, Têtu B.

Antioxidant vitamins supplementation and mortality: a randomized trial in head and

neck cancer patients. Int J Cancer. 2006 Nov 1;119(9):2221-4.

11. Hertz N, Lister RE. Improved survival in patients with end-stage cancer treated with

coenzyme Q(10) and other antioxidants: a pilot study. J Int Med Res. 2009 Nov-

Dec;37(6):1961-71.

12. Goran Bjelakovic a, Dimitrinka Nikolova a, Rosa G Simonetti a, Christian

Gluud a, “Antioxidant supplements for prevention of gastrointestinal cancers”. The

Lancet, Volume 365, Issue 9458, Pages 471 - 472, 5 February 2005

13. Ronco AL, De Stéfani E, Boffetta P, et al. Vegetables, fruits, and related nutrients

and risk of breast cancer: a case control study in Uruguay. Nutr Cancer 1999;

35(2):111-119.

14. Coulter ID, Hardy ML, Morton SC, Hilton LG, Tu W, Valentine D, Shekelle PG.

“Antioxidants vitamin C and vitamin e for the prevention and treatment of cancer”. J

Gen Intern Med. 2006 Jul;21(7):735-44.

15. Sai Yi Pan, Jia Zhou, Laurie Gibbons, Howard Morrison, Shi Wu Wen and the

Canadian Cancer Registries Epidemiology Research Group. Antioxidants and

breast cancer risk- a population-based case-control study in Canada. BMC Cancer

2011, 11:372.

16. http://www.biomedcentral.com/1471-2407/11/372

17. Kequan Zhou and Julian J. Raffoul. “Potential Anticancer Properties of Grape

Antioxidants”. Journal of Oncology, Volume 2012 (2012). http://www.hindawi.com/

journals/jo/2012/803294/.

[21]

18. Bonelli L, Puntoni M, Gatteschi B, Massa P, Missale G, Munizzi F, Turbino L,

Villanacci V, De Censi A, Bruzzi P. Antioxidant supplement and long-term reduction

of recurrent adenomas of the large bowel. A double-blind randomized trial. J

Gastroenterol. 2012 Oct 13.

19. Cutando A, Aneiros-Fernández J, Aneiros-Cachaza J, Arias-Santiago S. “Melatonin

and cancer: current knowledge and its application to oral cavity tumours”. J Oral

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09. SIGNATURE OF THE CANDIDATE :

10. REMARKS OF THE GUIDE :

11.1 NAME AND DESIGNATION OF GUIDE : MRS C.C.GADDGI

11.2 SIGNATURE :

11.3 CO GUIDE (IF ANY) :

11.4 SIGNATURE :

11.5 HEAD OF THE DEPARTMENT : MRS C.C.GADDGI

11.6 SIGNATURE :

12.1 REMARKS OF THE PRINCIPAL :

12.2 SIGNATURE :

[22]

[23]