*2.1. Study Population and Samples*

The Fondazione IRCCS Istituto Nazionale dei Tumori (Milan, Italy), the Regina Elena National Cancer Institute (Rome, Italy), the Hospital Papa Giovanni XXIII (Bergamo, Italy), and the Metropolitan and Attikon Hospitals (Athens, Greece) were the centers involved. Consecutive patients with metastatic NSCLC who received platinum-based chemotherapy in combination with either vinorelbine, gemcitabine, or pemetrexed, according to the physician's choice, as first-line therapy between February 2014 and April 2017 were included in the BioRaRe prospective multicenter trial.

All patients had an Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) between 0 and 2 and were at least 18 years of age. Exclusion criteria included any evidence of serious comorbidities that the investigator judged as a contraindication to the participation in the study, pregnancy, and breast-feeding.

Patients evaluable for tumor response according to the RECIST 1.1 criteria were examined, and their demographics and clinical and pathological characteristics were retrieved. E-CRF and medical records were used to collect data.

The study was approved by the Fondazione IRCCS Istituto Nazionale dei Tumori Institutional Review Board (INT18/13) and conducted according to the Declaration of Helsinki ethical principles for medical research involving human subjects. All patients gave signed written informed consent.


Author details

Lourdhu Bruno Chandrasekar1 \*, S. Nagarajan2 , Marimuthu Karunakaran3 and T. Daniel Thangadurai4

1 Department of Physics, The American College, Madurai, India

2 Department of Chemistry, NIT, Imphal, Manipur, India

3 Department of Physics, Alagappa Government Arts College, Karaikudi, India

4 Department of Nanotechnology, Sri Ramakrishna College of Engineering, Coimbatore, India

\*Address all correspondence to<EMAIL_ADDRESS>
© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


**2. Stakeholder analysis as an important tool**

The aim of stakeholder analysis is to evaluate and understand stakeholders from the perspective of an organization, or to determine their relevance to a project or policy [16]. In the undertaking of stakeholder analysis, various questions are asked about the position, interest, influence, inter-relations, networks and other characteristics of stakeholders, with reference to their past and present positions, and future potential [25].

More specifically, stakeholder analysis is an approach, a tool or set of tools for generating knowledge about 'actors' – individuals and organizations – so as to understand their behaviour, intentions, inter-relations and interests. Furthermore, such analysis is beneficial in the assessment of the influence and resources stakeholders bring to bear on the decision-making or the implementation process [26].

Stakeholder analysis is the essential tool to be used in stakeholder management. Stakeholder management is an approach to strategic management of an organization, which emphasizes the crucial role of different stakeholders in the success of the operations of an organization [7, 27]. Stakeholder analysis and stakeholder management are of particular importance to public and non-profit organizations, which have more diverse groups of stakeholders than private for-profit organizations [9].

Although stakeholder analysis is an important building block in stakeholder management, stakeholder analysis itself can make a significant contribution as a research method and as a means of organizational change [28]. Thus stakeholder analysis presents its own, independent and intrinsic value even if an organization is not implementing a thorough stakeholder management approach.

'Stakeholder analysis' is not a clearly defined analysis technique; rather it includes an array of various techniques. Bryson has identified and presented 15 stakeholder identification and analysis techniques [9]. In this article, the stakeholder analysis is described to include the following key stages:

Auvinen et al. used a similar approach in mapping and analysing the positions of Finnish stakeholders in workplace health promotion [14].

The first stage is to identify the key stakeholders. In the stakeholder literature, the definition of the 'wide sense of stakeholders' and the 'narrow sense of stakeholders' is an essential element (see e.g. [29, 30]). The 'narrow sense of stakeholders' limits the scope of stakeholders to groups or individuals who can affect the achievement of an organization's objectives or who are affected by the achievement of an organization's objectives; the 'wide sense of stakeholders' widens the scope of stakeholders to identifiable groups or individuals on which the organizations is dependent for its continued survival [29]. In this article, the wide sense of a stakeholder was applied, and thus the stakeholders were defined as all those who have a legitimate interest (either direct or indirect) in occupational health care and its activities.

The following stage is to classify the stakeholders as either primary or secondary stakeholders [9, 31]. According to Clarkson's widely used definition, the primary stakeholder groups are ones without whose continuing participation the corporation cannot survive as a going concern. Furthermore, the secondary stakeholder groups are those who influence or affect, or are influenced or affected by, the organization, but they are not engaged in transactions with the corporation and are not essential for its survival [31].

The third stage in the stakeholder analysis is to assess the positions and views of the stakeholders, and based on this assessment construct a view of their 'relative importance'. As the analysis of the dynamics of the stakeholders is essential, this stage provides the basis for important activity. The literature of stakeholder analysis and management is rich on varieties of classifications of the stakeholders. Some authors classify the stakeholders according to power, legitimacy and urgency (see e.g. [30]) while another author classifies them according to the issue position and importance [9]. For the purposes of this article, the power/interest matrix was used, as it provides a comprehensive and understandable tool to present positions of the stakeholders (see also [32]).