|Year : 2016 | Volume
| Issue : 3 | Page : 1138-1143
Questionnaire survey to assess the pattern and characteristics of cell-phone usage among Indian oncologists
Anusheel Munshi1, Debanarayan Dutta2, Pramod Tike2, Jai Prakash Agarwal2
1 Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
2 Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
|Date of Web Publication||4-Jan-2017|
Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, Haryana
Source of Support: None, Conflict of Interest: None
Purpose: Obtain baseline data of cell-phone usage in the medical (MO), surgical (SO) and radiation (RO) oncology community practicing in India.
Materials and Methods: Indigenously prepared cell-phone usage related questionnaire was used in the present study after approval by the Institutional Ethics/Scientific Committees. The questionnaire had 41 items and was made to assess the cell-phone usage parameters, utility in clinical practice, awareness, and to compare parameters between oncology specialties. Between November 2009 and January 2010, the questionnaire was sent as an E-mail attachment to 200 oncologists in India.
Results: In all, 123 responses were received (61% responders); 84 (68.3%) were RO. The median age of responders was 35 years. Overall, 80% felt handicapped without cell-phone. The Mean cell-phone score, an index to assess overall usefulness over a score of 1–10, was 6.46 (median 7, standard deviation 1.709). There was no significant difference between RO, MO and SO in duration of usage (P = 0.235), number of cell-phones (P = 0.496), call duration per day (P = 0.490) and dependence on cell-phone (P = 0.574). Age of starting cell-phone usage was earlier in RO (P = 0.086). Professional usage was significantly more by MO and SO compared to RO (P < 0.001); however, the former were less aware of any potential cell-phone hazards compared to RO (P < 0.007).
Conclusion: The results of the first such questionnaire based study have been presented. Most oncologists consider cell-phones a useful tool in patient care. More RO are aware of potential cell-phone hazards compared to non-RO's.
Keywords: Cell-phone usage, India, oncologists, survey
|How to cite this article:|
Munshi A, Dutta D, Tike P, Agarwal JP. Questionnaire survey to assess the pattern and characteristics of cell-phone usage among Indian oncologists. J Can Res Ther 2016;12:1138-43
|How to cite this URL:|
Munshi A, Dutta D, Tike P, Agarwal JP. Questionnaire survey to assess the pattern and characteristics of cell-phone usage among Indian oncologists. J Can Res Ther [serial online] 2016 [cited 2017 May 23];12:1138-43. Available from: http://www.cancerjournal.net/text.asp?2016/12/3/1138/164704
| > Introduction|| |
Mobile phones came to use in the early 1990s and since then have rapidly gained in popularity for various reasons. The past two decades have seen an exponential increase in the use of cellular phones in both developing as well as in developed countries. These phones are convenient, handy, trendy and have become a part and parcel of our day to day life. Even in developing countries, cell-phone has become a routine in the majority of the urban population. A survey in 2009 revealed that 80% of the nearly 500 million people in India cell-phone users. Also, the numbers of cell-phone users in both rural and urban population are increasing rapidly. Consistent with the trend in general society, the use of cell-phones among health professionals is increasing as well. Often these phones are used as a handy substitute for emergency calls, professional discussion and giving medical orders. Medical Professionals including oncologists therefore have not remained insulated from the cell-phone revolution.
Cell-phones however have a downside as well which include increased risk of vehicular accidents, leukemia and sleep disturbances.,, Recently, there have been concerns regarding the potential carcinogenic effect of cell-phones and this has raised ethical, social and medical issues.,,, The reports linking cell-phones and malignancy have been a subject of vigorous discussion and debates.,,,,,,, The presumed carcinogenic potential of cell-phone is believed to be linked to the electromagnetic radiation produced during its usage., There is a striking paucity of data of patterns of cell-phone use in medical professionals. The present survey aimed to obtain baseline data of cell-phone usage among a relatively homogenous cohort of medical (MO), surgical (SO) and radiation oncologists (RO) in India.
| > Materials and Methods|| |
The authors prepared indigenous “in-house” cell-phone usage related questionnaire for the present study. The complete questionnaire along with the proposal of the study was scrutinized and approved by the Institutional Ethics and Scientific Committee. The questionnaire had 41 items to be filled in by the respondents [Table 1]. The questionnaire was broadly divided into the following sections: Characteristics of oncologists (responders) (items 1–12), questions related to possible cell-phone related risk (items 13–23) and questions related to professional usage of cell-phone (items 24–41).
|Table 1: TMH cell-phone use related questionnaire among oncologists (TMH cell-phone questionnaire)|
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The questionnaire was sent by E-mail to practicing oncologists, oncology students, and residents of RO, SO and MO. The questionnaire was in a special version of MS Excel sheet that did not allow inadvertent tampering, editing or sequence change of the questions by the respondents. Most of the questions had drop down menus in which one choice needed to be clicked by the responders, hence the questions could be regarded as closed ended. For the rest, the responses had to be filled in manually. Between November 2009 and January 2010, the questionnaire was sent as an E-mail attachment to 200 oncologists in India. In all 123 responses were received (61% responders).
All data were collected prospectively and analyzed with SPSS version 15. (IBM SPSS Statistics). Frequency tables were generated, and comparison of different factors was done. Comparison of different cell-phone usage related parameters were done between different oncology communities (RO, SO and MO) using nonparametric t-test.
| > Results|| |
Characteristics of oncologists
Characteristics of responders are in [Table 2]. Among the responders, 84 (68.3%) were from RO while the rest were from MO or SO. The median age at evaluation was 35 years, and most of the responders were from government set up (52%), and nearly half of them work in government set up (52%). About 70% of the oncologists started using cell-phone at <35 years; 60% of the responders were aware of some potential “hazards” of cell-phone and towers while 89% were concerned about its use by children. Only 7% use some protective methods (Bluetooth, earphone). About 40% of the oncologists used cell-phone even in a weak signal area.
|Table 2: Characteristics of physicians filled the questionnaire* (n=123)|
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Questionnaires related with possible cell-phone related risk
Questions pertinent to the cell-phone use related risk are documented in [Table 3]. The majority (70%) of the oncologists started using cell-phone below 35 years, usual cell-phone usage is in approximately 60 min daily, and it was mostly used for the professional purpose. About 40% used cell-phone even when the signal was weak. Only 7% of the responders use methods (Bluetooth, earphone). Responders from the RO community start use cell-phone early and used for longer time (cumulative minutes per day).
|Table 3: Factors associated with cell-phone induced health hazard (morbidity)|
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Awareness about hazards of cell-phone use and dependency on cell-phones
Almost 80% responders feel 'handicapped' without cell-phone [Table 4]. RO, SO and MO were all equally “dependent” on the cell-phone. Among the responders, 80% of RO, 82% SO, and 77% of MO feel “handicapped” without cell-phone. Large proportions of responders were aware of possible hazards of cell-phone towers (74/123 responders; 60%) and use of cell-phone in children (110/123 responders; 89%). However, awareness was more in RO (93%) but poor in medical (12%) and surgical (36%) communities (P = 0.014). The majority of the responders (83%) agreed that cell-phone usage was increasing and that it was impacting clinical practice. However, the main contribution of cell-phone was in “time-saving” rather than “financial gains”. Most of the responders (64%) had rated cell-phone between 4 and 7 (10 being the best rating).
|Table 4: Questionnaires related to awareness regarding “cell-phone induced morbidity” and it's dependency|
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Questionnaire related to professional usage of cell-phone
Approximately, 60% of the responders used more than 50% their cell-phone usage for the professional purpose [Table 5]. In professional use, the most common indication was for follow-up of the patients. However, oncologists seldom (4%) remembered cell-phone numbers of the patients. Cell-phone was also actively used for discussion with the colleagues regarding any clinical problem.
An index to assess overall usefulness over a score of 1–10 was designated as mean cell-phone score (CPS). This was also the overall score rating by respondents for the cell-phone. The Mean CPS for all the respondents was 6.46 (median 7, standard deviation 1.709).
Comparison of cell-phone usage related parameters among different oncology communities
Comparison of various cell-phone related parameters was done between RO and others (MO and SO) [Table 6]. There was no significant difference in duration of usage (P = 0.235), number of cell-phones (P = 0.496), call duration per day (P = 0.490), dependence on cell-phone (P = 0.574) and impact of its use in clinical practice (P = 0.115). Age of starting cell-phone usage was earlier in RO (P = 0.086). RO used more GSM phones (P = 0.002), but total professional usage was significantly more by MO and SO (P = 0.001). However, MO and SO were significantly less aware of cell-phone risk related literature (P = 0.007) [Figure 1].
|Table 6: Comparison of cell-phone usage in different oncology communities (RO and others)*|
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|Figure 1: Comparison of radiation oncology versus others: GSM phone use, >50% professional use and awareness of potential hazards of cell-phone|
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| > Discussion|| |
Cell-phones have revolutionized modern day communication. They are especially useful among the professionals to hasten communication and speed up the work. To the best of our knowledge, this is the first study of cell-phone use pattern among oncologists. Cell-phone, as shown by our study, is used by all oncologists for professional as well as personal use. The mean CPS of 6.46 as determined from our study indicates that this device is overall considered as a useful device by an average oncologist.
An important finding of our study was the age of start of cell-phone use by oncologist [Figure 2]. In our study, a major proportion of physicians are young (<35 years), started using cell-phone early in their career (mid 20s), use mainly GSM sets in handheld mode and use mainly for professional purpose for almost 1 h/day. This means that many oncologists are poised to have an exposure lasting for decades. Age of starting cell-phone usage was earlier in radiation oncologists. On the other hand, the majority of these professionals (>99%), though aware of the potential health risk related with use cell-phones, felt dependent on cell-phone. They also felt that cell-phone had improved patient follow-up (and thus patient care) and considered cell-phone a useful tool (giving it a mean score >6 out of 10). There was no significant difference between RO and others (MO and SO) in duration of usage, number of cell-phones, call duration per day, dependence on cell-phone and impact of its use in clinical practice. There was significant difference between RO and others in terms of the type of cell-phone usage (GSM vs. CDMA phones), professional usage and awareness regarding the risk of cell-phone. MO and SO have more professional usage of cell-phone but use mainly newer generation (CDMA) phones.
Electromagnetic radiations such as X-ray and gamma rays are associated with malignancy., Cell-phone also emits electromagnetic radiation and thus it may be appropriate to have measures and risk stratification related to cell-phone use., The possible side effects related to cellular phone use include vehicular accidents, behavioral changes, and lesions such as acoustic neuromas, gliomas, meningiomas and parotid tumors.,,,,,,, While the evidence for vehicular accidents is definitive, the correlation between cell-phone use and the intracranial lesions is not well-established. There are a few postulates theories about the possible carcinogenic potential of electromagnetic radiation. These include generation of “heat shock protein” after electromagnetic radiation, formation of free radicals inside cells damaging DNAs and “Fenton reaction” (catalytic process of iron to convert hydrogen peroxides)., In a recent meta-analysis, personals with frequent cell-phone use for more than 10 years are shown to have hazard ratio of having acoustic neuroma ranging between 0.9 and 1.8. The major problem in establishing the risk factor for cell-phone related malignancy is in its complexity and multiple associated factors. Type of cell-phone (CDMA or GSM), longer usage duration, signal strength (poorer signal strength is related to higher electromagnetic radiation), and intrinsic factors are associated with higher risk in some studies., Recent surge in high-grade gliomas is also attributed to the use of cell-phone. However, a recently published meta-analysis did not find any correlation between cell-phone use and cancer. The follow-up period of all these studies is short, whereas malignancies such as neuromas and meningiomas usually require decades for development of tumor that produces clinical symptoms. Thus, present studies may not be adequately powered to study the risk between cell-phone use and neoplasms especially while assessing the risk for >10 years of use.
The present study is exciting and one of the first of its kind, but is however not devoid of shortcomings. It is a subjective “questionnaire based” hence the information obtained are completely responder dependent. “Telephone bill” checking and verification of the questionnaire was not done. The response rate to the questionnaire was poor; hence the present study may not adequately represent the entire oncologist community practicing in India. We do not have much information or data about the “nonresponders” to assess if they were in any way different from the responders. Further, we are also considering a suitable questionnaire shall be planned after 10 years to the same oncologists to assess the incidence of cancers as well as to see if there is any change in trend in cell-phone usage among the respondents.
In summary, more RO are aware of potential cell-phone hazards compared to nonradiation oncologists. Oncologists feel cell-phone has improved patient follow-up (and thus patient care) and consider cell-phone a useful device. The balance between the judicious use of cell-phone and risk stratification in different professionals will be the future focus in coming years.
| > Acknowledgments|| |
We acknowledge all the RO, MO and SO who participated in the present survey.
| > References|| |
Hansson Mild K, Carlberg M, Wilén J, Hardell L. How to combine the use of different mobile and cordless telephones in epidemiological studies on brain tumours? Eur J Cancer Prev 2005;14:285-8.
Pawl R. Cell phones more dangerous than cigarettes! Surg Neurol 2008;70:445-6.
Hansson Mild K, Hardell L, Kundi M, Mattsson MO. Mobile telephones and cancer: Is there really no evidence of an association? (review). Int J Mol Med 2003;12:67-72.
Gandhi GA. Genetic damage in mobile phone users: Some preliminary findings. Indian J Hum Genet 2005;11:99-104.
Stankiewicz W, Dabrowski MP, Kubacki R, Sobiczewska E, Szmigielski S. Immunotropic influence of 900 MHz microwave GSM signal on human blood immune cells activated in vitro
. Electromagn Biol Med 2006;25:45-51.
Diem E, Schwarz C, Adlkofer F, Jahn O, Rüdiger H. Non-thermal DNA breakage by mobile-phone radiation (1800 MHz) in human fibroblasts and in transformed GFSH-R17 rat granulosa cells in vitro
. Mutat Res 2005;583:178-83.
French PW, Penny R, Laurence JA, McKenzie DR. Mobile phones, heat shock proteins and cancer. Differentiation 2001;67:93-7.
Munshi A, Jalali R. Cellular phones and their hazards: The current evidence. Natl Med J India 2002;15:275-7.
Munshi A, Tiwana M. Etiology of cancer/electromagnetic radiation and cell phones. APOCP Cancer Rep 2010 [In press].
Gandhi OP, Lazzi G, Furse CM. Electromagnetic absorption in the human head and neck for mobile telephones at 835 and 1900 MHz IEEE trans microwave. Theor Tech 1996;44:1884-97.
Hardell L, Sage C. Biological effects from electromagnetic field exposure and public exposure standards. Biomed Pharmacother 2008;62:104-9.
Hardell L, Carlberg M, Söderqvist F, Mild KH, Morgan LL. Long-term use of cellular phones and brain tumours: Increased risk associated with use for>or=10 years. Occup Environ Med 2007;64:626-32.
Han YY, Kano H, Davis DL, Niranjan A, Lunsford LD. Cell phone use and acoustic neuroma: The need for standardized questionnaires and access to industry data. Surg Neurol 2009;72:216-22.
Hardell L, Carlberg M, Hansson Mild K. Pooled analysis of two case-control studies on the use of cellular and cordless telephones and the risk of benign brain tumours diagnosed during 1997-2003. Int J Oncol 2006;28:509-18.
Inskip PD, Tarone RE, Hatch EE, Wilcosky TC, Shapiro WR, Selker RG, et al.
Cellular-telephone use and brain tumors. N Engl J Med 2001;344:79-86.
Hardell L, Mild KH, Påhlson A, Hallquist A. Ionizing radiation, cellular telephones and the risk for brain tumours. Eur J Cancer Prev 2001;10:523-9.
Hardell L, Carlberg M, Hansson Mild K. Case-control study on cellular and cordless telephones and the risk for acoustic neuroma or meningioma in patients diagnosed 2000-2003. Neuroepidemiology 2005;25:120-8.
Christensen HC, Schüz J, Kosteljanetz M, Poulsen HS, Thomsen J, Johansen C. Cellular telephone use and risk of acoustic neuroma. Am J Epidemiol 2004;159:277-83.
Kundi M, Mild K, Hardell L, Mattsson MO. Mobile telephones and cancer – A review of epidemiological evidence. J Toxicol Environ Health B Crit Rev 2004;7:351-84.
Hardell L, Hallquist A, Hansson Mild K, Carlberg M, Gertzén H, Schildt EB, et al.
No association between the use of cellular or cordless telephones and salivary gland tumours. Occup Environ Med 2004;61:675-9.
Schoemaker MJ, Swerdlow AJ, Ahlbom A, Auvinen A, Blaasaas KG, Cardis E, et al.
Mobile phone use and risk of acoustic neuroma: Results of the Interphone case-control study in five North European countries. Br J Cancer 2005;93:842-8.
Schlehofer B, Schlaefer K, Blettner M, Berg G, Böhler E, Hettinger I, et al.
Environmental risk factors for sporadic acoustic neuroma (Interphone Study Group, Germany). Eur J Cancer 2007;43:1741-7.
Nelson PD, Toledano MB, McConville J, Quinn MJ, Cooper N, Elliott P. Trends in acoustic neuroma and cellular phones: Is there a link? Neurology 2006;66:284-5.
Hardell L, Mild KH, Carlberg M, Hallquist A. Cellular and cordless telephone use and the association with brain tumors in different age groups. Arch Environ Health 2004;59:132-7.
Hardell L, Carlberg M, Söderqvist F, Hansson Mild K. Meta-analysis of long-term mobile phone use and the association with brain tumours. Int J Oncol 2008;32:1097-103.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]