Search

The introduction of smartphones has revolutionized how late adolescents (aged 18-21 years) access and use the internet. Vast troves of health information are today just a tap or swipe away, with smartphones and internet connectivity becoming increasingly accessible. The need for eHealth literacy among late adolescents is now gaining importance as it ensures an effective use of health information. This study conducted a survey among 427 late adolescents in order to evaluate their eHealth literacy levels; their perceptions of the quality of online health information; their level of trust and credibility in online health and checked if acquiring health information through the online medium led to a change in their behavior intention. The results showed that most of the late adolescents preferred viewing multiple websites for their health information needs. Health information in the form of text and images were preferred over video content; and most preferred accessing online health information in their native language. Cancer and obesity are the common health issues of interest to both genders. Mobile applications (apps) were the least preferred mode of accessing heath information despite the high usage of smartphones. eHealth literacy and credibility positively predicted behavior intention while quality of health information did not predict behavior intention.

Purpose: Breast cancer (BC) presents a major public health challenge world-over including India. While several risk-factors, early signs and symptoms of BC are known, the knowledge and awareness of this disease remains poor among the population. The present study aimed to determine the extent of knowledge and awareness of BC, its risk factors, early signs and symptoms and breast self-examination (BSE) practice as an early detection method among Indian college-going female students. Design/methodology/approach: The authors conducted a cross-sectional survey at a University in Delhi-NCR. Data on socio-demographic, knowledge and awareness of BC including BSE was collected using a pretested questionnaire. Chi-square test and logistic regression analysis was performed. All tests were two-sided and significance was set at p < 0.05. Findings: A total of 866 female students participated in the study with mean age of 22.32 (±0.146) years having mean body mass index (BMI) of 21.22 (±3.52). As high as 82.1% of the participants had heard of BC but while 74.8% thought early detection is possible, 70.7% believed BC cannot be prevented. Gene mutations (60.2%) were identified as a significant risk factor, while breast pain (61.4%) was commonly recognized as a sign of BC. Only 29.8% of students ever performed BSE. Increased odds of performing BSE (OR = 3.4) was found among students who recognized gene mutations as an important BC risk factor. Research limitations/implications: Knowledge and awareness of BC including BSE among female college students were found to be below average. It is suggested that there is an urgent need for increasing BC awareness among young girls through workshops and mobile-health interventions. Practical implications: This study provides new information on the level of knowledge and awareness of BC risk factors, sign and symptoms and self-examination practice among young college girls. Moreover, this study advocates the need for design and implementation of a sustainable digital health model for active population BC screening, which is not being done currently. Social implications: BC is a highly aggressive disease, which is now one of the leading causes of morbidity and mortality in India and world over. Although the knowledge of BC risk factors and its signs and symptoms have increased, the awareness of these elements among the general population at large is low and/or missing, especially in India. Furthermore, as a consequence of unorganized screening programs in the country, majority of women are presenting young with locally advanced disease. Understanding the existing level of knowledge and educating school, college and University students of the pertinent factors and screening practices such as BSE could drastically help in improving the self-screening and/or clinical examination rates. This could potentially lead to early detection and improved prognosis, thus ameliorating disease burden. Originality/value: This study is one of the few studies conducted in India among young female college students belonging to non-medical backgrounds, delineating the level of knowledge and awareness of BC risk factors and signs and symptoms along with practice of early detection method such as BSE. The study has a considerable sample size and provides valuable evidence for a need to implement programs incorporating digital health models for accelerating awareness and screening of young girls in both rural and urban settings.

Stressors associated with illness and hospitalization can have long-term adverse effects on young children's development and wellbeing. Professionals who work with young children appreciate the power of children's play for their development as human beings; nonetheless, play is sometimes viewed as inappropriate or unnecessary for children in traumatic or stressful circumstances. The objective of this paper is to highlight the benefits of play for children in the context of coping with medical stressors as a tool to promote child and family resilience, adaptive coping responses, quality of life, and child development. We first review the various purposes play can serve for young children in the hospital. The impacts of hospital play for children and families and opportunities for professionals to facilitate children's play during hospitalization are then described and illustrated through a case study portrayal of a young child coping with an inpatient admission for cancer treatment.

Objectives: The purpose of this study was to develop and research an interactive health education programme on NCDs in a rural subpopulation of Bengaluru and to build 'health champions' among young people to contribute to the prevention of NCDs in India. Design: A descriptive qualitative approach was used to develop and evaluate an interactive educational programme. Students, aged 12-16, from a rural secondary school took part in the study. Method: Participants were separated into five focus groups covering different NCDs including hypertension, diabetes mellitus, otitis media, oral cancer and malnutrition. Each focus group was interviewed face-to-face before, during and after all activities. Content analysis was conducted using a directed approach. Results: Findings were organised into themes that described aspects of learning that enhanced or detracted from student understanding about NCDs. Conclusion: Findings from this study show that creative methods have a positive impact on educating students, aged 12-16, on NCDs.

Background: This paper aimed to explore the palliative care (PC) needs and barriers to access among cancer patients in a rural region of North India with a high cancer burden. Methods: A Participatory action research (PAR) approach was employed. Situational assessment, community sensitization workshops (CSWs) and door-to-door surveys were planned, conducted and developed over three PAR cycles. A parallel convergent mixed-methods approach was adopted wherein the quantitative data from door-to-door surveys and qualitative data from CSWs and investigator field notes were collected and analyzed to provide a comprehensive understanding of PC needs and barriers to access. Descriptive statistics and thematic analysis were used. Results: A total of 27 CSWs involving 526 stakeholders were conducted. A total of 256 cancer patients were assessed for PC needs and symptom burden using the Supportive and Palliative Care Indicators (SPICT-4ALL) and the Edmonton Symptom Assessment System (ESAS) tool, respectively. Based on the SPICT assessment, all patients (n = 256) satisfied general and/or cancer-specific indicators for PC. The majority (56.6%) had ≥ one moderate-severe symptom, with the most common symptoms being tiredness, pain and loss of appetite. Analysis of qualitative findings generated three themes: unmet needs, burden of caregiving, and barriers and challenges. Cancer affected all domains of patients' and their families' lives, contributing to biopsychosocial suffering. Social stigma, discrimination, sympathizing attitudes and lack of emotional and material support contributed to psychosocial suffering among cancer patients and their caregivers. Lack of awareness, nearby healthcare facilities, transportation, essential medicines, trained manpower and education in PC, collusion, fear of social discrimination, faulty perceptions and misconceptions about cancer made access to PC difficult. Conclusions: The study emphasize the need for and provide a roadmap for developing context-specific and culturally appropriate CBPC services to address the identified challenges and needs. The findings point towards education of CHWs in PC; improving community awareness about cancer, PC, government support schemes; ensuring an uninterrupted supply of essential medicines; and developing active linkages within the community and with NGOs to address the financial, transportation, educational, vocational and other social needs as some of the strategies to ensure holistic CBPC services. Trial registration: Clinical Trial Registry of India (CTRI/2023/04/051357). [ABSTRACT FROM AUTHOR]

Objective: To examine the content of Instagram posts about oral cancer and assess its usefulness in promoting oral cancer awareness and early detection practices. Methods: A systematic search of Instagram for posts about oral (mouth) cancer was conducted using the hashtags #oral cancer and #mouth cancer. Posts usefulness in promoting awareness and early detection was assessed using the early detection usefulness score, and caption readability was assessed using the Flesch Kincaid readability score. Results: A total of 81,000 posts were identified, and 200 posts were thoroughly evaluated. Included posts gathered a total of 48,118 (mean = 420.59 likes) and 27,898 views. Most posts (81.5%) were educational to the lay person, and India and the UK were the major contributors. The most discussed topics were prevention and early detection (55%). Representative clinical images were present in 35.5% of posts. Only 9.5% of posts mentioned the source of information, and the mean usefulness score was only 2.1 out of 10. The mean reading ease score was 56.7 ± 43.8 (range from 1 to 98 out of 100). Conclusion: Instagram shows potential for promoting oral cancer awareness, particularly in prevention and early detection. However, concerns regarding content quality, scientific validity, and clarity persist. [ABSTRACT FROM AUTHOR]

Cancer is a global issue and hence various efforts are being made. Iron oxide is considered a significant biochemical agent in the biomedical arena for cancer treatment. Marine macroalgae-mediated iron oxides especially, magnetite (Fe3O4) nanoparticles (NPs) are a prospective alternative to diagnose and treat cancer owing to their fluorescent and magnetic properties. We intend to appraise the usability of the aqueous extract of Rosenvingea intricata (R. intricata) in Fe3O4 NPs synthesis and to study their cytotoxic effects against human hepatocarcinoma (Hep3B) and pancreatic (PANC1) cancer cells. In the present study, R. intricata were collected from the coastal region of South Andaman, India. Aqueous extracts of R. intricata were utilized to synthesize Fe3O4 NPs via the co-precipitation method. Phycosynthesized Fe3O4 NPs exhibited wide peak at 400–600 nm from ultraviolet–visible diffused reflectance spectroscopic analysis which validated the formation of NPs. Band edge emission peak at 660 nm in fluorescent spectra confirmed the quantum confinement in Fe3O4 NPs. Fourier transform infrared spectroscopy confirmed the role of R. intricata as a capping and reducing agent with functional groups such as O–H, C–H, C=O, N=O, C=C, C–O, C–N, and C–S arising from amino acids, polysaccharides, aliphatic hydrocarbons, esters, amides, lignins, alkanes, aliphatic amines, and sulfates. Physicochemical properties such as crystallite size (14.36 nm), hydrodynamic size (84.6 nm), irregular morphology, elemental composition, particle size (125 nm), crystallinity, and saturation magnetization (0.90007 emu/g) were obtained from x-ray diffractometer, dynamic light scattering, scanning electron microscopy, energy dispersive x-ray spectrometer, high-resolution transmission electron microscopy, selected area electron diffraction and vibrating sample magnetometer techniques, respectively. The cell viability showed dose-dependent cytotoxic effects and enhanced the apoptosis against Hep3B and PANC1 cancer cells. R. intricata extract capped Fe3O4 NPs could be the most appropriate and effective nanomaterial for cancer treatment and management. [ABSTRACT FROM AUTHOR]

Aim: The coronavirus disease 2019 (COVID‐19) pandemic affected cancer service delivery and the feasibility of following the standard treatment guidelines. The present paper describes the use of clinical care guidelines for cancer management in routine practice and the approach adopted towards cancer care during the COVID‐19 pandemic in India. Methods: A web‐based survey was done in 107 hospitals (including public and private health facilities) that hosted Hospital‐Based Cancer Registries under the National Cancer Registry Programme. The participants comprised Principal Investigators of these registries, who were also medical, surgical, and radiation oncology clinicians. The survey was done between May 1, 2021, and July 31, 2021. Participants were provided with a web link for the survey questionnaire, confidential login, and password. Results: The study found high utilization of Clinical Practice Guidelines (CPGs) during practice, with eight out of ten physicians constantly to referring them. The study reported lack of knowledge, skills, and training to administer the treatment based on the guidelines followed by organizational infrastructure and affordability of treatment by the patients as the factors hampering utilization. International clinical guidelines were preferred when compared to national guidelines. The COVID‐19 pandemic decreased the use of CPGs, wherein six out of ten clinicians reported their use. Conclusion: Stakeholders who formulate clinical guidelines must consider the practical aspects and feasibility of implementing such guidelines during a pandemic and similar situations. This should be coupled with adequate changes in care practice to ensure optimal care delivery and a continuum of cancer care in routine and pandemic‐imposed situations. [ABSTRACT FROM AUTHOR]

Cancer poses a significant health threat to the elderly, accounting for a substantial proportion of cancer patients aged 65 and above. As life expectancy continues to rise and the population ages, the incidence of cancer in the elderly is expected to increase further. Age is a major risk factor for the majority of common cancers, with the incidence and prevalence rising as individuals grow older. Factors such as chemoprevention and environmental carcinogen elimination may influence the process of carcinogenesis. Studies reveal that the incidence and mortality rates of various cancers in the elderly and extremely old individuals are on the rise worldwide, with most types peaking around the age of 75 to 90, followed by a sharp decline. Birth cohort and period effects also play a complex role in the connection between aging and cancer risk. Clinical trials often exclude older individuals, limiting our understanding of cancer treatments' effects on this particular age group. More research is needed to focus on the unique requirements of older adults with cancer. [ABSTRACT FROM AUTHOR]

The topic of public health is indispensable to talk about. It is essential to discuss new inventions, new and improved treatments, and their efficiencies with different combinations, but one thing that is important to remember is whether these inventions are available for those in need. Availability concerns are linked with affordability, as the affordability of a drug determines its consumption; furthermore, affordability can lead to overconsumption. The Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement provides flexibility to control the misuse of patent monopolies. The object of this research is twofold: one is to investigate whether and how Pakistan incorporates TRIPS flexibilities in its national patent legislation, and the second is to find out the reason for unaffordable cancer treatment in Pakistan. This research highlights that the use of TRIPS flexibilities in Pakistan will help the state authorities to provide better health facilities to the public generally as well as particularly in cancer cases, as cancer treatment in Pakistan is unaffordable. The methodology applied for this research is primarily comparative and bears the qualitative aspect of the issue. This research concludes that Pakistan's legal system fails to incorporate effective legal provisions related to TRIPS flexibilities, and it also highlights that the ever-greening of patents results in the high prices of cancer medicines in Pakistan. This research further recommended that there is a dire need to incorporate and use TRIPS flexibilities in the country to control the high prices of cancer treatment and cancer mortality rate in the country. [ABSTRACT FROM AUTHOR]

In emerging economies like India, the focus of public health policies is shifting toward the treating non-communicable diseases to preventing communicable diseases. The public welfare demands appropriate targeted healthcare subsidies for non-communicable diseases. In this paper, we investigate whether out-of-pocket expenditure toward mitigating non-communicable diseases for the poorer section of the population is catastrophic by nature. In a representative futuristic scenario for an emerging economy, we have collected the cancer patients' expenditure data from the patients and hospital management in a not-for-profit cancer hospital located in the state of Kerala. We have analyzed the variation of expenditure categorized as government subsidy toward treatment, private expenditure toward medical goods and services, and private expenditure toward non-medical goods and services against different socio-economic variables. The analysis of catastrophic health expenditure data reveals that relatively lower income lower-income households face more risk of catastrophic health expenditure and are in greater need of government subsidy. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate the effectiveness of the Online Psycho-Oncology Counseling (OPC) in reducing distress levels among cancer patients. Methods: The research employs a paired sample t-test analysis to compare distress scores before and after the intervention. The study includes 30 solid tumor patients aged 30-59, undergoing cancer treatment. Distress levels were measured using the Distress Thermometer before and after the OPC intervention. Paired distress scores were computed for each participant, and a paired sample t-test was conducted to assess the statistical significance of the observed changes. Result: A statistically significant reduction in distress scores post-OPC intervention (t-value = 3.657, df = 29, p < 0.05) was observed. The mean distress score decreased from 5.67 ± 1.093 before OPC to 4.77 ± 1.675 after OPC. Importantly, 26.6% of participants shifted from high to low distress levels. The findings suggest that the Online Psycho-Oncology Intervention is effective in alleviating distress among cancer patients. The paired sample t-test provides robust statistical evidence supporting the positive impact of OPC on psychological well-being. Additionally, semi structured interview schedule was followed to explore the feasibility and satisfaction of the OPC program. Likert scale and thematic analysis was followed to analyze the qualitative data. Conclusion: Further research with larger cohorts and extended follow-up periods is recommended to enhance the understanding of the long-term effectiveness of psycho-oncology interventions in the digital realm. [ABSTRACT FROM AUTHOR]

Background: Cancer patients are vulnerable to infections due to immunosuppression caused by cancer itself and its treatment. The emergence of antimicrobial-resistant bacteria further complicates the treatment of infections and increases the mortality and hospital stays. This study aimed to investigate the microbial spectrum, antimicrobial resistance patterns, risk factors, and their impact on clinical outcomes in these patients. Methods: A prospective study was conducted at a tertiary care cancer hospital in Patna, Bihar, India, which included cancer patients aged 18 years and older with positive microbial cultures. Results: This study analysed 440 patients, 53% (234) of whom were females, with an average age of 49.27 (± 14.73) years. A total of 541 isolates were identified, among which 48.01% (242) were multidrug resistant (MDR), 29.76% (150) were extensively drug resistant (XDR), and 19.84% (112) were sensitive. This study revealed that patients who underwent surgery, chemotherapy, were hospitalized, had a history of antibiotic exposure, and had severe neutropenia were more susceptible to MDR and XDR infections. The average hospital stays were 16.90 (± 10.23), 18.30 (± 11.14), and 22.83 (± 13.22) days for patients with sensitive, MDR, and XDR infections, respectively. The study also revealed overall 30-day mortality rate of 31.81% (140), whereas the MDR and XDR group exhibited 38.92% and 50.29% rates of 30-day mortality respectively (P < 0.001). Possible risk factors identified that could lead to mortality, were cancer recurrence, sepsis, chemotherapy, indwelling invasive devices such as foley catheter, Central venous catheter and ryles tube, MASCC score (< 21) and pneumonia. Conclusions: This study emphasizes the necessity for personalized interventions among cancer patients, such as identifying patients at risk of infection, judicious antibiotic use, infection control measures, and the implementation of antimicrobial stewardship programs to reduce the rate of antimicrobial-resistant infection and associated mortality and hospital length of stay. [ABSTRACT FROM AUTHOR]

The measurements of radon concentrations in drinking water sources in and around the Main Central Thrust (MCT) region in Garhwal Himalaya, India, were carried out using the scintillation detector-based SMART RnDuo technique for radiation protection purposes. Radon values in the analyzed samples were observed between 1.1 and 183.9 Bq L−1 (AM = 19.7 Bq L−1). Radon values in 94% of the samples were found well below the World Health Organization (WHO) reference limit. The estimated radiation doses for different age groups were found higher than the WHO safe limit of 100 µSv y−1 (from all sources including radon) except for the age groups of 0–12 months infants and 1–3 years children. The results of this study may be useful for future studies on epidemiology, examining hidden faults, uranium exploration etc. [ABSTRACT FROM AUTHOR]

Tobacco use remains a significant public health concern globally, with over 8 million anticipated deaths annually by 2030, despite declining rates in some high-income nations. Smoking is prevalent worldwide, particularly in developing and middle-income countries, where over 80% of smokers reside. The inhalation of tobacco substances leads to various diseases, including cancer and respiratory ailments, resulting in more deaths than AIDS, tuberculosis, and other major causes combined. Secondhand smoke exposure also poses significant health risks. The economic burden of tobacco-related deaths and diseases is substantial, especially in low- and middle-income economies, where almost 80% of tobacco-related deaths occur. Lack of awareness, societal influence, and ineffective enforcement of anti-tobacco laws contribute to widespread tobacco use. Although antitobacco campaigns and policies have shown some success, challenges persist, particularly in rural areas where tobacco dependence is high. In India, despite declining tobacco use attributed to awareness campaigns and increased taxes on cigarettes, certain demographics, such as middle-aged individuals, illiterates, and rural residents, continue to have high tobacco consumption rates due to inadequate implementation of anti-tobacco norms and limited access to information. Quitting smoking can significantly extend life expectancy and reduce the risk of smoking-related diseases. However, nicotine addiction poses a challenge, with only a small percentage of users successfully quitting without assistance. Professional support and cessation drugs can double the likelihood of successful quitting, and nicotine replacement therapy has shown effectiveness. Overall, there is no safe level of cigarette use, emphasizing the importance of comprehensive tobacco control efforts to mitigate the global health and economic impacts of tobacco use. This review deals with the health risks associated with tobacco consumption in humans. [ABSTRACT FROM AUTHOR]

Introduction: Rapid increase in antimicrobial-resistance is leading to urgent need for newer broad-spectrum antimicrobials. Therefore, we have evaluated the antimicrobial résistance spectrum of India-discovered novel antibiotics (levonadifloxacin) against clinical isolates recovered from cancer patients. Materials and Methods: The study was conducted in the microbiology department, over a period of 1 year between May 2021 and June 2022 and 374 consecutive and nonduplicate Gram-positive (GPC) and MDR Gram Negative Bacteria (GNB) isolate were analyzed from 3,880 cancer patients in study. The identification and antimicrobial sensitivities of bacterial isolates were performed according to standard laboratory protocols by using automated identification system (VITEK-2-8.01; BioMérieux, Germany). The activity of levonadifloxacin and comparator antibiotics was evaluated using disk diffusion methods as per Clinical and Laboratory Standards Institute 2022 guidelines. Results: The mean age of the patients were 51.6 ± 14.59 years with male: female ratio of 1.2:1. The prevalence of GPC was 167 (44.65%) and MDR-GNB was 207 (55.34%). The most common GPC was Staphylococcus aureus; 97 (58.08%) followed by Enterococcus species 66 (39.52%). In GNB, Escherichia coli; 93 (44.92%) was the most common followed by Klebsiella pneumoniae; 45 (21.73%). Levonadifloxacin susceptibility was present in 98.7% methicillin-resistant S. aureus and 96% methicillin-susceptible S. aureus and 77.1% Enterococcus-species. Additionally, all the fluoroquinolones-resistant S. aureus isolates were susceptible to levonadifloxacin (WCK-771) except one isolate. Also, levonadifloxacin-(WCK-771) exhibits 100% susceptibility fluoroquinolone susceptible GNB, such as E. coli, K. pneumoniae, Pseudomonas species, and Acinetobacter species. Interestingly, all fluoroquinolones-resistant Salmonella species and Stenotrophomonas maltophilla exhibited 100% susceptibility to levonadifloxacin (WCK-771). Conclusion: Levonadifloxacin (WCK-771) possesses potent activity against all the MDR Gram-positive pathogens including the coverage of susceptible Enterobacterales and MDR S. maltophilla and Burkholderia cepacia suggesting its potential utility in the management of polymicrobial infections. [ABSTRACT FROM AUTHOR]

Background: Cancer survivors experience a decrement in health-related quality of life (HRQoL) resulting from the disease as well as adverse effects of therapy. We evaluated the HRQoL of cancer patients, stratified by primary cancer site, stage, treatment response and associated adverse events, along with its determinants. Methods: Data were collected from 12,148 patients, sampled from seven purposively chosen leading cancer hospitals in India, to elicit HRQoL using the EuroQol questionnaire comprising of 5-dimensions and 5-levels (EQ-5D-5L). Multiple linear regression was used to determine the association between HRQoL and various socio-demographic as well as clinical characteristics. Results: Majority outpatients (78.4%) and inpatients (81.2%) had solid cancers. The disease was found to be more prevalent among outpatients (37.5%) and inpatients (40.5%) aged 45–60 years and females (49.3–58.3%). Most patients were found to be in stage III (40–40.6%) or stage IV (29.4–37.3%) at the time of recruitment. The mean EQ-5D-5 L utility score was significantly higher among outpatients [0.630 (95% CI: 0.623, 0.637)] as compared to inpatients [0.553 (95% CI: 0.539, 0.567)]. The HRQoL decreased with advancing cancer stage among both inpatients and outpatients, respectively [stage IV: (0.516 & 0.557); stage III (0.609 & 0.689); stage II (0.677 & 0.713); stage I (0.638 & 0.748), p value < 0.001]. The outpatients on hormone therapy (B = 0.076) showed significantly better HRQoL in comparison to patients on chemotherapy. However, palliative care (B=-0.137) and surgery (B=-0.110) were found to be associated with significantly with poorer HRQoL paralleled to chemotherapy. The utility scores among outpatients ranged from 0.305 (bone cancer) to 0.782 (Leukemia). Among hospitalized cases, the utility score was lowest for multiple myeloma (0.255) and highest for testicular cancer (0.771). Conclusion: Older age, lower educational status, chemotherapy, palliative care and surgery, advanced cancer stage and progressive disease were associated with poor HRQoL. Our study findings will be useful in optimising patient care, formulating individualized treatment plan, improving compliance and follow-up. [ABSTRACT FROM AUTHOR]

Background: Cancer incidence and mortality vary across the globe, with nearly two-thirds of cancer-related deaths occurring in low- and middle-income countries. The rural-urban disparity in socio-demographic, behavioural, and lifestyle-related factors, as well as in access to cancer care, is one of the contributing factors. Population-based cancer registries serve as a measure for understanding the burden of cancer. We aimed to evaluate the rural-urban disparity in cancer burden and care of patients registered by an Indian population-based cancer registry. Methods: This study collected data from Varanasi, Uttar Pradesh, India, between 2017 and 2019. Sex and site-specific age-standardised rates for incidence and mortality per 100,000 population were calculated. Rural-urban disparities in cancer incidence and mortality were estimated through rate differences and standardised rate ratios (with 95% confidence intervals). Univariable and multivariable regressions were applied to determine any significant differences in socio-demographic and cancer-related variables according to place of residence (rural/urban). Crude and adjusted odds ratios with 95% confidence intervals were calculated. Results: 6721 cancer patients were registered during the study duration. Urban patients were older and had better literacy and socioeconomic levels, while rural patients had higher odds of having unskilled or semi-skilled professions. Diagnostic and clinical confirmation for cancer was significantly higher in urban patients, while verbal autopsy-based confirmation was higher in rural patients. Rural patients were more likely to receive palliative or alternative systems of medicine, and urban patients had higher chances of treatment completion. Significantly higher incidence and mortality were observed for oral cancer among urban men and for cervical cancer among rural women. Despite the higher incidence of breast cancer in urban women, significantly higher mortality was observed in rural women. Conclusions: Low- and middle-income countries are facing dual challenges for cancer control and prevention. Their urban populations experience unhealthy lifestyles, while their rural populations lack healthcare accessibility. The distinctness in cancer burden and pattern calls for a re-evaluation of cancer control strategies that are tailor-made with an understanding of urban-rural disparities. Context-specific interventional programmes targeting risk-factor modifications, cancer awareness, early detection, and accessibility to diagnosis and care are essential. [ABSTRACT FROM AUTHOR]

Bleeding from the genital organ after a year of menopause is called postmenopausal bleeding. The causes may be either benign or malignant, originating from genital (uterine or extrauterine) and extragenital sites. About 3% of postmenopausal women suffer from uterine cancer. This present study aimed to analyze the clinical significance of postmenopausal bleeding concerning the source, associated risk factors, and various endometrial pathologies, including malignant and premalignant conditions. This retrospective study was conducted over four years and featured postmenopausal bleeding patients who met the inclusion criteria. Different causes of bleeding were noted and managed. Data collection on the history, clinical examination, blood test, and endometrial biopsy was performed on women with endometrial bleeding. The collected data were analyzed using standard descriptive statistics and presented using frequency tables. A total of 88 women were admitted, of whom 73 (82.95%) had endometrial bleeding and 15 (17.05%) experienced bleeding from other sites. The endometrial bleeding group mostly consisted of women aged >50-60 years (45.20%). Hypertension (26.03%), diabetes (21.91%), obesity (43.83%), and nulliparous (5.48%) were the risk factors present among the patients. The majority of the patients (41.10%) were within five years of menopause. The transvaginal ultrasound findings indicated that 56.16% of the women had an endometrial thickness of >10 mm, while 9.59% had an endometrial thickness of =4 mm. Upon histological investigation, endometrial hyperplasia (34.24%), atrophy (38.36%), and cancer (4.11%) were detected. Furthermore, a prevalence of 16.44% was identified as proliferative endometrium, whereas polyps were found in 6.84% of cases. In conclusion, postmenopausal bleeding is mostly benign, but it may raise concerns about the possibility of malignancy, which can be distressing for women. Disregarding the amount and frequency, postmenopausal bleeding requires a thorough evaluation, primarily because adequate management can prevent the progression of many premalignant cases to be endometrial cancer. [ABSTRACT FROM AUTHOR]

Though many studies have linked shared decision-making with positive patient outcomes and patient satisfaction, there is less research on the practicality and feasibility of such an approach, specifically, in India. Recent findings indicate that contextual constraints of the patients and family caregivers are fused with and inevitably shape their decision-making style. This study investigates the influence of individual (paternalistic and shared decision-making style) and contextual (financial status of the patients) factors on certain cultural aspects of decision process, namely, trust in doctors, patient's agency, emotional distress and attribution of responsibility. Data were collected using a survey questionnaire from a sample of 306 participants. Linear mixed models were used to analyse the responses. The results indicate that a shift towards shared approaches does yield qualitatively superior outcomes in terms of increased trust in doctors and patients' agency along with reduced emotional distress. The study also emphasises the role of cultural metaphysical beliefs in attributing responsibility for treatment decisions. Further, low financial status was found to be associated with higher trust in doctors, lower patient agency, and increased emotional distress for both patients and family caregivers. The move towards shared decision-making, considering the contextual realities of patients, could be instrumental in addressing critical issues, such as prevalence of collusion, superficial role of informed consent, and high reliance on doctors' authority or expertise. [ABSTRACT FROM AUTHOR]

Purpose. To describe the beliefs, barriers and promotion practices of Indian nurses' regarding healthy eating (HE) behaviours amongst cancer survivors, and to gain insights into whether their educational qualifications might affect the promotion of HE. Methods. Data was gathered using a validated questionnaire, 388 of the approached 400 nurses who worked at a tertiary care hospital in India gave informed consent to participate in the study. The Mann-Whitney U test and the Chi square analysis (for continuous and categorical variables respectively) were performed to carry out sub-group comparisons based on the qualification of the nurses i.e., Bachelor of Science in Nursing (BSc) and General Nursing and Midwifery (GNM). Results. The nurses believed that dieticians/nutritionists were primarily responsible for educating the cancer survivors regarding HE. HE was promoted by nurses' relatively equally across multiple treatment stages ("during" treatment 24.4%, "post" treatment 23.1%; and "pre" treatment 22.3%). Nurses' believed HE practices had numerous benefits, with improved health-related quality of life (HRQoL) (75.7%), and mental health (73.9%) being the most frequent responses. The most frequently cited barriers by the nurses in promoting HE were lack of time (22.2%), and lack of adequate support structure (19.9%). Sub-group comparisons generally revealed no significant difference between the BSc and GNM nurses in their perceptions regarding HE promotion to cancer survivors. Exceptions were how the GNM group had significantly greater beliefs regarding whether HE can "reduce risk of cancer occurrence" (pD0:004) and "whether or not I promote HE is entirely up to me" (pD0:002). Conclusion. The nurses in India believe in the promotion of HEpractices among cancer survivors across various stages of cancer treatments. However, they do face a range of barriers in their attempt to promote HE. Overcoming these barriers might facilitate effective promotion of HE among cancer survivors and help improve survivorship outcomes. Implications for cancer survivors. Indian nurses employed in the two tertiary care hospitals wish to promote HE among cancer survivors, but require further knowledge and support services for more effective promotion of HE. [ABSTRACT FROM AUTHOR]

Introduction: Head and neck malignancies are responsible for 30% of all cancers in India with a dramatic increase in numbers due to widespread tobacco consumption. This study aims to assess the epidemiological and histopathological spectrum of these tumors. Materials and Methods: A large retrospective review of 5469 biopsy-proven patients presenting between 2018 and 2022 with head and neck cancers was done. Tumors were analysed for distribution according to sites of presentations, gender, age and histopathological profiles. Results: With a male-to-female ratio of 4.2:1, men constituted 80.80% of the study population. Mean age of presentation in women was 53.5 years, whereas men presented at an earlier age of 47.2 years. Oral cavity was the commonest site involved (59.7% cases) followed by the oropharynx (23.8% cases). Buccal mucosa was the commonest subsite involved with 1112 cases followed by tongue lesions with 1088 cases. Larynx was responsible for 17.04% of cases. All subsites were more commonly affected in men with the highest Male: Female ratio of 8.29:1 seen in larynx. The lowest ratio of 1.02:1 was seen in lesions of the face and scalp. Squamous cell carcinoma (SCC) was the most common histopathological diagnosis encountered in 88.97% of cases followed by basal cell carcinoma which was seen in 2.10% lesions. Conclusion: Oral cavity lesions constitute the bulk of head and neck cancer presentations in India. The disease is more prevalent in men overall and men present at a younger age in comparison to women. SCC is the most prominent histopathology encountered in our study. [ABSTRACT FROM AUTHOR]

Background: Cancer affects mental health in older adults with cancer (OAC), affecting almost 50% of the patients. There are only a few studies on psychiatric disorders in OAC, especially in low resource settings. We report on our real-world experience of prevalence of and factors associated with psychiatric disorders in OAC referred to a psycho-oncology service in an Indian tertiary care cancer institute. Methods: We retrospectively analysed medical and psycho-oncology records of patients aged 60 + on cancer-directed treatment or follow-up for < 2 years after treatment completion, referred to psycho-oncology services in a tertiary care cancer centre in Mumbai, India, from Jan 2011-Dec 2017. We recorded sociodemographic, clinical, and treatment-related variables, as well as past psychiatric disorders. The ICD-10 was used to record current psychiatric disorder type and presence. IBM SPSS version 24 (Armonk, NY, USA) was used for descriptive measures, tests of association, and logistic regression analysis. The study protocol was approved by Institutional Ethics Committee and registered with the Clinical Trials Registry-India (CTRI/2020/06/026095). Results: Of 763 patients included in the study, 475 (62.3%) were males and 436 (57.1%) were inpatients, with a median age of 65 years. 93% of the patients had a solid tumour and 207 (27.1%) had a history of psychiatric disorder. A current psychiatric diagnosis was noted in 556 patients (72.9%) on initial presentation, of which adjustment disorders, delirium and depression and anxiety disorders were most frequently seen in 25.2%, 21% and 11.1%, respectively. On univariate analysis, a past history of psychiatric disorders (χ2 = 34.6, p < 0.001), lower performance status (χ2 = 9.9, p = 0.002) and haematolymphoid malignancy (χ2 = 4.08, p = 0.04) significantly increased the risk of current psychiatric diagnosis. Logistic regression confirmed these variables as significant. Conclusion: Older adults with cancer referred to psycho-oncology services have high rates of psychiatric disorders at their initial presentation, mainly adjustment disorders, delirium and depression and anxiety. A past history of psychiatric disorders, lower performance status and haematolymphoid cancers significantly increased the risk of psychiatric disorders. Multidisciplinary psycho-oncology teams including a psychiatrist should be integrated in comprehensive care of this group of patients. Further research outcomes and effect of psycho-oncological interventions is required in older adults with cancer in LMIC settings. [ABSTRACT FROM AUTHOR]

Thyroid carcinoma is the most common malignancy of the endocrine system and accounts for nearly 1.5% of all new cancer cases in India. The incidence of thyroid cancers is on the rise secondary to multiple factors including the widespread use of radiological imaging. Surgery remains the cornerstone of treatment, and radioactive iodine therapy plays a pivotal role in differentiated thyroid cancer. Radiation therapy appears to be an underutilized treatment modality. In this review, we have summarized the role of radiation in the treatment of thyroid cancer. [ABSTRACT FROM AUTHOR]

A scientometric study examines the publication's quantitative and qualitative trends in a particular research area. The present study investigates 2,854 leukemia research outputs of India published from 1989 to 2020, indexed in the Web of Science Core Collection database. Software, including bibliometrix Biblioshiny, BibExcel, HistCite and VOSviewer, have been used for data analysis. The Pediatric Blood & Cancer journal has the highest number of published articles. The USA collaborated with the highest number of publications with India. The All India Institute of Medical Sciences had the maximum number of publications. Bakshi S, Sharma A and Varma N were the leading authors of publications about leukemia research in India. Keyword analysis revealed that acute lymphoblastic leukemia, chronic myeloid leukemia, leukemia, acute myeloid leukemia and apoptosis were the main research hotspots in the area in all publications. The Department of Biotechnology (DBT), India and the National Institute of Health (NIH), USA, were the major funders in the leukemia research publications in India. The limitation of the study is that the data used is entirely dependent on the Web of Science (WoS) Core Collection database. So, the quality of the study is entirely dependent on the input information imported from the WoS database. [ABSTRACT FROM AUTHOR]

Background: Cancer has been the leading cause of death worldwide, and palliative care is an approach that improves the quality of life (QoL) of patients and their families facing the problem associated with life-threatening illness. Hospice care helps patients and their family to cope with the change from treating the cancer to living life as fully as possible through their final days. This study aimed to (1) assess the sociodemographic and clinical profile of terminally ill cancer patients, (2) assess the QoL among terminally ill cancer patients receiving palliative care, and (3) study various determinants affecting their QoL. Material and Methods: A cross-sectional study was conducted among terminally ill cancer patients receiving palliative care at the Hospice Centre, Community Oncology Centre, Ahmedabad. Based on previous years' admission data, a sample size of 360 was taken. Patients who are seriously ill up to the extent that they were unable to respond and had a previous positive history of psychiatric illness before the diagnosis of cancer were excluded. Institutional ethical committee (IEC) permission was obtained before the study. Statistical analysis was performed using the Chi-square test in Statistical Package for the Social Sciences (SPSS) software. Results: The mean age of participants was 48.1 ± 13.0 years. The gender distribution of participants was males and females (226 (62.8%) and 134 (37.2%)), respectively. On studying, the involvement of various anatomical sites as "primary site of cancer" revealed that head and neck carcinoma had the highest (63.3%) involvement and hematological cancer had the lowest (0.6%) involvement. Of total, 62% of participants had "below-average QoL," followed by 34.9% of participants having "significantly poor QoL." There was a significant association between different age groups, time lag in cancer diagnosis, and treatment initiation and QoL. Conclusion: Spearman's rank correlations between the majority of factors fell in "low partially positive" category except for the physical well-being (factor 2) and psychosocial well-being (factor 3) with optimism and belief (factor 7), where they were in "low partially negative" category. [ABSTRACT FROM AUTHOR]

Malignant solitary fibrous tumor of the breast is one of the rarest types of breast malignancy. To the best of our knowledge, only six cases have been reported so far. Here we have presented such a case from India, where a 52-year-old lady presented with a 10 cm x 8 cm breast lump. Diagnosis was achieved with the help of FDG PET, histopathology and immunohistochemistry, which showed nuclear positivity for STAT6. Fluorescent in situ hybridization (FISH) molecular study for SS18-SSX was used to rule out the differential diagnosis of synovial sarcoma. Guidelines for the management of this type of breast malignancy still do not exist. We have done a review of the literature in order to discuss which might be the best management in such cases. Evidence on this very rarest type of breast malignancy is still evolving. The interest in the case described here relies on its rarity, difficulties in achieving diagnosis and formulation of the proper management. [ABSTRACT FROM AUTHOR]

Background: Cancer is, no doubt, a life-threatening illness, and it has a long-term effect on the physical and mental health of the patients, particularly on their quality of life (QOL). The present article is an attempt to examine the role of socioeconomic factors, illness duration and spirituality on the QOL of cancer patients. Methods: The sample consisted of 200 cancer patients (100 men and 100 women patients) belonging to the state of Tripura, a Northeastern state of India. Out of 200 cancer patients, most of them (100, 50%) were suffering from oral cancer, followed by lung and breast cancer. General Information Schedule, Quality of Life Patient/Cancer Survivor Version (developed by Ferrell, Hassey-Dow and Grant), and The Spiritual Experience Index- Revised (developed by Genia) were used for data collection. For analysis of data, independent t-test, analysis of variance, and multiple linear regression were computed. The statistical analysis was carried out using IBM SPSS Version 25.0. Results: The findings showed no significant difference in QOL scores among the subgroups of cancer patients in socioeconomic and illness factor, except for family income. Further analysis revealed that only spirituality and educational qualification of cancer patients significantly predicted their QOL. Conclusion: The current article can act as a springboard for further studies in this area and provide aid for socioeconomic development while improvising cancer patients' QOL. [ABSTRACT FROM AUTHOR]

Objective: To describe the clinical pattern of childhood and adolescent cancers across India using hospital-based data in the National Cancer Registry Program. Methods: Records of 60720 cancer cases in the 0–19 year age group for the period 2012–2019 from 96 hospital-based cancer registries were reviewed. Childhood cancers were classified based on the International Classification of Childhood Cancer (ICCC). Descriptive analysis was used to examine the distribution of cancer by five-year age groups, sex and ICCC diagnostic groups and subgroups. Data were analysed using IBM SPSS software and visualised using R software. Results: 3.2% and 4.6% of all cancer cases in India were among children in the 0–14 year and 0–19 year age groups respectively. The male-to-female ratio for all cancers was 1.72 for 0–14 years and 1.73 for 0–19 years. The four leading groups of cancers among 0–14 year olds were leukemia (40%), lymphoma (12%), central nervous system tumor (11%) and bone cancer (8%). The four leading cancers among the 0–19 year age group were leukemia (36%), lymphoma (12%), bone (11%) and central nervous system tumor (10%). Conclusion: Cancers in the 0–14 and 0–19 age groups accounted for a considerable proportion of all cancers with significant male preponderance. Such information helps to fine-tune research and planning strategies. [ABSTRACT FROM AUTHOR]

Background: In 21st century, Cancer has emerged as the one of the major public health problem across the globe. It exerts a significant impact on everyone involved ranging from individual affected to their families, communities and healthcare systems. According to GLOBOCON 2020, female breast cancer has surpassed the lung cancer as the most common cancer across worldwide with an estimate of 2.3 million new cases (11.7%) being diagnosed followed by lung cancer (11.4%). Objectives: The present study was conducted to study the overexpression of cyclooxygenase-2 (COX-2) in the patients of breast cancer and its association with the clinical, pathological data, including age, size, site of tumor, histological type, grade, lymph node metastasis and stage of tumor. Material and Methods: This was a Prospective Study carried out in a Tertiary Care Centre situated at western part of India. The study duration was 1 year, and the period was from November 2022 to November 2023 with the department of Pathology after obtaining clearance from the institutional ethics committee and written informed consent from the study participants. All patients diagnosed with breast carcinoma attending Tertiary Care Centre were included. Exclusion criteria included tru-cut biopsy, breast excisions without axillary evacuation, lumpectomies without axillary evacuation, cases with no residual invasive carcinoma after pre-surgical (neoadjuvant) chemotherapy or with massive necrosis or fibrosis. A p-value of <0.05 was considered statistically significant. Results: Out of 20 patients, 85% of patients were females and rest 15% males. ER positivity was seen in 85% of cases, while PR positivity was observed in 75% of cases. HER-2/neu overexpressed was seen in 20% while COX-2 overexpression on immunohistochemistry was seen in 10% patients. The association between COX-2 overexpression and ER negative was statistically significant (p = 0.016). Conclusion: It can be concluded from the present study that the inhibition of COX-2 expression may lead to retard tumour progression and thus, limiting breast carcinogenesis which may have therapeutic implications for the prevention and treatment of breast cancer in such patients with high risk. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study is to identify drug-related problems (DRPs) for elderly cancer patients receiving chemotherapy by implementing pharmaceutical care services. Methods: In this interventional study, patients were followed after each cycle till 12 weeks. The MOATT-MASCC teaching tool was used to educate patients about their therapy. The outcome measures included the occurrences of any DRPs such as inappropriate medication dose, dosage form, route of administration, therapeutic duplication, failure of the patient to adhere to the medication regimen, adverse drug reactions (ADRs), and drug–drug interactions (DDIs) and to resolve it. Results: On 186 patients, there were 38% ADRs, 16% DDIs, 6% non-adherence to therapy, 4% medical conditions for which no medication was prescribed, and 1% therapeutic duplication and transcribing error was identified. A total of 226 ADRs were documented. Nausea and vomiting were the most frequently occurring ADRs (24%) and platinum compounds caused the highest number of ADRs. Assessments of causality showed that the majority of cases are 'probable' (50%). In evaluating the severity of ADRs, 53% of ADRs were 'moderate' and 51% of ADRs were 'probably' preventable. Upon assessing the DDIs, 35% of the prescriptions had 'monitor therapy'. All of the DRPs, that were identified were notified to the treating oncologists and resolved without any disagreement. Conclusions: Pharmaceutical care is essential for elderly cancer patients. Oncologists and pharmacists should work together to identify and manage DRPs as well as educate patients about their disease. This will help in improved patient care and a better therapeutic outcome. [ABSTRACT FROM AUTHOR]

Health related quality of life (HRQOL) is a multidimensional concept that encompasses the patient's perceptions of his or her physical, emotional, social, and cognitive functions. Despite DTC patients' long survival, HRQOL has been shown to be lower than in the general population. There is a scarcity of data on HRQOL in thyroid cancer in the Indian population and especially goiter endemic area. As a result, the authors conducted a health-related quality of life survey in patients managed at their center in Northern India's Sub-Himalayan region using two widely accepted questionnaires. Adults with differentiated thyroid cancer who had surgery with or without radio-iodine ablation and had recovered for at least 6 months were assessed using health quality of life surveys, the QLQ-C30 and QLQ-THY34 of the European Organization for Research and Treatment of Cancer Quality of Life Group. The survey was completed by 57 adults with a mean age of 45.64 ± 15.64 years. The average time between the survey and treatment was 13.3 ± 10.8 months. After surgery, the QLQ-C30 found a significant reduction in insomnia, appetite loss, constipation, diarrhea, and financial difficulties, whereas radio-iodine ablation significantly improved global health status. The QLQ-THY34 found a significant increase in symptoms such as voice concerns, hair problems, dry mouth, shoulder functioning, tingling, and worrying after surgery, with a significant improvement in swallowing and job impact symptoms. The surgical extent had no impact. The quality of life for people with differentiated thyroid cancer in goiter-endemic areas is similar to that of other areas. However, the limited number of subjects in the study warrants further large sample size longitudinal study to understand the exact Health-related quality of life in thyroid cancer in endemic area. [ABSTRACT FROM AUTHOR]

Background: Secretory carcinoma (SC) is a newly described entity which has been often misdiagnosed earlier as acinic cell carcinoma on cytology. Diagnosing SC was initially based upon identifying the ETV6:NTRK3 fusion gene with the help of fluorescence in situ hybridization (FISH). Lately, with more knowledge of the reliable histomorphology, cytology, and immunohistochemistry features, definitive diagnosis can be confidently made without the help of FISH in almost every case. Materials and Methods: Six histologically confirmed cases of SC were studied. The cytology slides of all the six cases were retrieved and reviewed to identify the characteristic features which could have helped in raising the possibility of SC on fine needle aspiration cytology itself. Cell blocks were also studied, wherever available. Results: Patients were all male with average age of 35.2 years. The six cases in the current study demonstrated at least focal cytoplasmic vacuolization of varying sizes, papillae formations, and bland nuclear features on fine needle aspirate smears. It was also seen that S-100 and mammaglobin immunohistochemistry (IHC) are very helpful in confirming the diagnosis. Conclusions: The results of the current study highlight the cytomorphological features which may help in clinching the diagnosis SC on cytology itself. They also highlight certain cytological features which help to rule out the other differential diagnoses. [ABSTRACT FROM AUTHOR]

This study describes the epidemiology, clinical extent of disease at diagnosis and treatment modalities of cancer among older adults (aged 60 years and older) in India. Secondary data analysis of the National Cancer Registry Programme, which includes 28 Population-Based Cancer Registries (PBCRs) and 96 Hospital-Based Cancer Registries (HBCRs). PBCR data were used to estimate the incidence in terms of crude rate (CR), age-adjusted incidence rate (AAR), age-specific rate (ASpR) and cumulative risk. Trends in the AAR were calculated with the Annual Percentage Change (APC) using join-point regression. HBCR data were used to describe the clinical extent of the disease at diagnosis and the treatment modalities. There is a wide heterogeneity across the country for the incidence of cancer and for the leading cancer sites among older adults. Males had a higher incidence rate compared to females in the majority of the registries. Aizawl had the highest AARs among both genders (males: 1388.8; females: 1033.0). Females had the highest ASpR at 65–69 years (482.8), whereas for males it was above 75 years (710.4). Cervical, stomach and oesophageal cancers were on the decline. The incidence of cancer among older adults was estimated to increase by 13.5% in 2025 as compared to 2020. The increasing cancer incidence among older adults in India poses a huge burden on the health system. There is a need to increase their participation in clinical trials, advocating comprehensive geriatric assessment and strengthening geriatric oncology within programs addressing older adult's care to deal with the rising cancer burden on the health system borne by them. [ABSTRACT FROM AUTHOR]

Background: Esophageal cancer is a highly aggressive malignancy often associated with a poor prognosis because of locoregional failure and distant metastases. About 60-70 percent of the patients present at an advanced stage, have a median survival in the range of 6-10 months, and are not amenable to definitive treatment. Dysphagia is the most common complaint, seen in 80%-90% of patients. The priority for managing patients with advanced disease is dysphagia control, which in turn can improve nutritional intake and quality of life. External-beam radiotherapy (EBRT) is one of the major means of palliation. Objective: The primary goal of our study was to assess the efficacy of external beam radiotherapy in alleviating dysphagia in patients with esophageal cancer. Materials and method: This was a single arm prospective clinical study conducted in a tertiary care hospital in northeast India. The study comprised of 57 esophageal cancer patients, ineligible for definitive treatment. The patients received EBRT of 30 Gy in 10 fractions over two weeks. Dysphagia was graded using Modified Takita's grading system. Patients were followed up at one-month intervals after treatment to assess dysphagia and acute toxicity. Results: Out of 57 patients in the study, subjective dysphagia relief was seen in 82.45%. The median dysphagia score decreased from 3 to 2 at the end of the 3-month post treatment period. (p < .001). In terms of treatment-related toxicity, treatment was well tolerated. No grade 4-5 toxicity was encountered. The most commonly encountered toxicity was radiation esophagitis, which affected 15 patients (26.31%). Conclusion: Radiation significantly improves dysphagia in esophageal cancer patients. It is an effective, non-invasive, and well-tolerated way to treat dysphagia in selected individuals with incurable esophageal cancer. [ABSTRACT FROM AUTHOR]

The deltaic areas of the Mahanadi River basin are densely populated and are prone to contamination due to sewage, industrial waste, and agricultural runoff. The present study offered a systematic approach to evaluate the degree of heavy metal pollution in sediment and its impact on human health. The granulometric study revealed a relatively violent energy condition in the study region. Statistical parameters such as cluster dendrogram analysis and principal component analysis revealed a mixed source at Kujang and the dominance of a mafic source at Subala. The mean concentration of Co (47.25 ppm) and Pb (44.70 ppm) at Kujang and Co (37.03 ppm) and Pb (61.27 ppm) at Subala exceeded the global average value. The geo-accumulation index suggested Co and Pb contamination (each varying from 1 to 2) in the study region. The enrichment factor (EF) showed a moderate to significant enrichment of Co (EF = 8.5) at Kujang and a moderate enrichment of Co (EF = 2.2), Pb (EF = 3.6) and Zn (EF = 2.3) at Subala, indicating anthropogenic pollution, possibly from agriculture land due to heavy use of pesticides in the investigated region. The exposure pathway for both non-carcinogenic and carcinogenic risk was via oral ingestion. The human health risk suggested no significant non-carcinogenic risk for adults and children in the study region. However, the carcinogenic risk in children due to Cr posed a mild threat. Therefore, each day's intake of these chronic metals must be examined as their collective effect could result in various health complications for children and adults. [ABSTRACT FROM AUTHOR]

Objectives: Critically ill cancer patients in the intensive care unit (ICU) did not have any palliative care (PC) intervention as there was no PC referral from the ICU. The project aimed to initiate PC referral for at least 50% of progressive palliative intent cancer patients in intensive care to enhance communication with patients and caregivers. We included PC physicians, oncologists, and psychologists in the team for this project. Material and Methods: We used the A3 problem-solving method of quality improvement (QI) and also used the Plan Do Check Act process. The first baseline assessment over 6 months of ICU deaths of patients who could have benefited from PC referral was collected; this made us realise that PC could have been initiated for some patients. Process maps of patient admission into the ICU and the process of their discharge were constructed. Analysis of root causes that were barriers to referral was examined. We made a PC trigger tool after team consultations and consensus and started using it to initiate PC referrals. PC discharge protocol was also initiated. Educational discussions were held with residents and nurses to ensure the continued use of the trigger tool. Results: PC referral from intensive care slowly went up from 0% to beyond 50% by November 2019 and reached over 70% by March 2020; patients getting discharged had details of PC centres near their homes. Conclusion: Structured QI process and introducing the PC trigger tool led to the outcome of 50% PC referral for critically ill patients in ICU. [ABSTRACT FROM AUTHOR]

Cancer is taken under consideration as a fatal disease. It's caused by a spread of things including unhealthy lifestyles, pollution, stress, radiation exposure, infection, tobacco consumption, and unhealthy food choices. There are several varieties of cancer that affect the chassis and their growth varies depending on the type. Cancer could be a major reason for death after a heart condition. There are 10 million new cases of cancer and approximately 5 million deaths in 2020 were caused by cancer (World Health Organization, 2018)1, and deaths from cancer worldwide are projected to still rise to over 20 million by 2025 (Stewart and Wild. 2014)2. There are several intervention modes to treat cancer patients. Besides medical intervention, there are prominent psychosocial concerns that have a very noticeable impact on intervention in the case of cancer patients. Cancer treatment facilities in India have incorporated psychosocial services into cancer care by routinely assessing patients' levels of distress. For that Music therapy can improve their quality of life by addressing the emotional, spiritual, and physical needs that will arise during this point. Furthermore, music therapy also can be applied to assist relationships throughout the grieving process by providing comfort, continuity, and opportunities for specific feelings of loss (Rossetti et al., 2017)3. Hence, there's a greater need and justification for exploring the scope of using music therapy with cancer patients, especially in low-income countries, including India. [ABSTRACT FROM AUTHOR]

Background: Research studies demonstrate that palliative care can improve patient outcomes such as quality of life, symptom burden and patient satisfaction with care (Gomes B, et al. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2013(6):CD00776) (World Health Organization. Palliative Care. Published 2020.). While 76% of patients who need palliative care live in limited-resource countries, access to high quality palliative services in these countries is minimal (Worldwide Hospice and Palliative Care Association and World Health Organization. Global Atlas of Palliative Care (2nd ed). 2020.). In 2014 the Worldwide Hospice Palliative Care Alliance, with strong endorsement by the WHO, released the Palliative Care Toolkit to provide a training and implementation toolkit for empowering community members to deliver palliative care in resource poor settings (Worldwide Hospice and Palliative Care Association and World Health Organization. Global Atlas of Palliative Care at the End of Life. Geneva, Switzerland 2014.). They encouraged researchers and public health practitioners to conduct rigorous evaluation of the toolkit in diverse settings and contexts. To address this need, we will conduct a pilot randomized controlled trial (RCT) to examine implementation and explore potential effect of an intervention based upon the Palliative Care Toolkit, as adapted and used by community health workers (CHWs) working with a cancer center in Kolkata, India to deliver home-based palliative care for rural patients. Methods: Utilizing a randomized controlled trial design, intervention patients (n = 45) receive home-based palliative services (Pal-Care) delivered by community health workers (CHWs), with comparison against a control group of patients (n = 45) who receive usual cancer-center-based palliative services. Primary outcome measures include evaluation of CHW training outcomes, roles and responsibilities of the CHWS and how they assist patients, trial recruitment, stakeholder perceptions of the intervention, and fidelity to study protocol. Secondary outcomes measure patient self-report of health-related quality of life, symptom burden, palliative needs and patient care experience, outcomes The RE-AIM framework guides our evaluation plan to measure the reach, effectiveness, adoption, implementation and maintenance of the Pal-Care intervention (Gaglio B, et al. The RE-AIM framework: a systematic review of use over time. Am J Public Health. 2013;103(6):e38?46.). Data will be analyzed in SAS. All measures will be evaluated overall and by patient age, gender and cancer type and by CHW caseload. Discussion: Pal-Care is a RCT funded by the NCI to explore utilization of CHWs to deliver a home-based palliative care intervention built upon the WHO Palliative Care toolkit (PCT), as compared to a usual care control group. The long-term goal of this research is to develop an effective and sustainable model for delivering home-based palliative care for cancer patients in underserved areas. Trial registration (TRN): ClinicalTrials.gov ID# NCT04972630. [ABSTRACT FROM AUTHOR]

Background and Aim: Families are crucial in providing comprehensive support to cancer patients, including physical, psychological, spiritual, and financial assistance. Unfortunately, cancer-related myths and stigma can have detrimental effects on those affected and their caregivers. This study aims to remove the misconceptions prevailing in a rural population of Puducherry regarding caregiving for cancer among elderly through a health education campaign. Materials and Methods: A pre- and post-intervention study was conducted among 217 adults above 18 years of age in a rural area of Puducherry. The intervention was delivered through pamphlet distribution, health talks, and discussion. Attitude, beliefs, and knowledge regarding the misconceptions about cancer were assessed in a five-point Likert scale and then the difference in the proportion of subjects with misconceptions about cancer before and after the intervention was tested using the McNemar test. Results: Among the respondents, 77% were females, 15% were illiterate, and 9.6% had a history of cancer in the family. About 23% felt cancer lends a bad name to the family and 24% considered palliative care as not necessary since end-stage cancer patients would die. Post-intervention, the perception that herbal items or diets may treat cancer declined from 45% to 18%, and that a cancer patient in the family lends bad name to the family declined from 23% to 3% (P < 0.001). Conclusions: Community-based intervention can effectively reduce misconceptions related to caregiving for cancer among elderly in rural areas. These interventions can also improve the quality of care and support provided to cancer patients. [ABSTRACT FROM AUTHOR]

Leukoplakia is a white mucosal thickening and perhaps undermining change in the oral mucosa transcendently found in tobacco users. Since the tobacco utilization is extensively higher with the indigenous groups in the Asia Pacific locale, the current examination implicated the prevalence of tobacco consumption and leukoplakial lesions and the relationship between the two. This cross-sectional study was conducted through six tribal hamlets of Chithalayath Forest range at Wayanad district of Kerala, South India. Leukoplakia screening was led by a senior consultant on the basis of a visual investigation and pathological evaluation was not done. An organized questionnaire was utilized to gather data on demographic details and tobacco usage status and frequency. The prevalence of clinical oral lesions among tobacco users and non users was determined using statistical analysis. Clinical oral leukoplakia was diagnosed in 27 (8.5%) subjects among the 317 individuals screened. The prevalence of lesions was considerably higher among tobacco consumers in comparison with non users (11 vs. 3.7%). Also, the tobacco chewers group had a higher percentage of leukoplakia. Another significant finding of this study is that the incidence of provisional leukoplakia was observed to be comparatively high among the most frequent tobacco consumers 15 (65.2%) in comparison with 8 (34.8%) in the frequent and nonfrequent users. Prevalence of abusive habits and clinical oral leukoplakial was substantial among the tribes. The cause and effect relationship and dose-response were also shown to have a significant association. [ABSTRACT FROM AUTHOR]

This study was performed to evaluate the carcinogenic health risk of pesticides used in agricultural field in rural pockets of eastern India. The analysis of pesticide residue in rice grain sample was performed by Gas Chromatography Mass Spectrometry (GC‐MS). It was observed that for pesticide DDT, the HR values was ranging between 0.5 to 3.2 and for lindane HR was 0.4 to 1.1, respectively. The DDT and Lindane exhibited HR values >1 in some sampling sites which revealed the carcinogenic effects and HR <1 in some sampling sites which revealed non carcinogenic effects of same pesticide. These results revealed a clear indication of potential carcinogenic health risk to human health through consumption of contaminated rice in some areas of Bargarh district. DDT has a long half‐life, so it persists in the environment for a longer period of time and induces carcinogenic risk to human health predominantly than other pesticide lindane. A case study on cancer prevalence in Bargarh district was also carried out to support the findings of quantitative analysis. The primary data collected from the cancer affected area by personal questionnaires method to the person concern and the secondary data collected from the Bargarh District Head Quarters Hospital's register. The cancer death reported by the from the year 2015 to 2021 was 320, 380, 293, 323, 278, 409, 346 in the year of 2015, 2016, 2017, 2018, 2019, 2020, 2021 respectively, with the total number of 2349 cases. From the questionnaire data, it was observed that the occurrence of male and female cancer cases was 51.75% and 48.25%, respectively. Therefore, it was concluded that there was no significant difference in gender wise cancer prevalence. The most affected age group was 51–60, that is, 26.92% followed by 41–50, that is, 23.42%. Therefore, it was concluded that the middle‐aged adults (40–60) were more vulnerable to the cancer than young adults (3–40) and old adults (60–100). The most prevalent cancer was breast (22.72%) followed by stomach (14.33%). [ABSTRACT FROM AUTHOR]

In the present study, soil contamination by arsenic, cadmium, chromium, cobalt, copper, iron, lead, manganese, nickel, uranium and zinc; and associated human health risks were assessed at 30 agricultural sites in Ferozepur District, Punjab. Above 90% soil samples had high content of chloride, sodium and potassium. Cadmium, arsenic, zinc and lead in 100%, 76.67%, 76.67% and 66.67% samples exceeded their safe limits (mg/kg; 0.06, 20, 50 and 10, respectively). Individual/multi-elemental indices indicated high PTEs contamination in soils posing low to considerable ecological risk. Principal components PCI and PCII contributed 44.748% and 30.476% variance in data, respectively. PTEs in soils were classified in two categories using cluster analysis (I: Cd, U, Co, Pb, Ni, Cr, As, Cu, Zn and Mn; II: Fe), indicating both geogenic and anthropogenic origins. Health risks due to PTE exposure via dermal contact, inhalation and ingestion were also assessed. Children were found to be highly prone to non-cancer health risk (mean hazard index = 1.30) by As exposure, mainly via ingestion pathway. High total cancer risk was posed to residents via As (7.52E-05) and Cr (9.17E-06) exposure, primarily through ingestion. Bioremediation and efficient disposal of solid and liquid wastes may reduce soil contamination in the study area. [ABSTRACT FROM AUTHOR]

Introduction Children with cancer are immunocompromised due to the disease per se or anticancer therapy. Children are believed to be at a lower risk of severe coronavirus disease 2019 (COVID-19) disease. Objective This study analyzed the outcome of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with cancer. Materials and Methods A retrospective analysis was performed on patients (≤ 14 years) with cancer attending the pediatric oncology services of our institute who tested positive for the SARS-CoV-2 infection and those who had COVID-19 disease between August 2020 and May 2021. Real-time reverse transcriptase-polymerase chain reaction performed on the nasopharyngeal swab identified the SARS-CoV-2 infection. The primary endpoints were clinical recovery, interruption of cancer treatment, and associated morbidity and mortality. Results Sixty-six (5.7%) of 1,146 tests were positive for the SARS-CoV-2 infection. Fifty-two (79%) and 14 (21%) patients had hematolymphoid and solid malignancies. Thirty-two (48.5%) patients were asymptomatic. A mild-moderate, severe, or critical disease was observed in 75% (18/24), 12.5% (3/24), and 12.5% (3/24) of the symptomatic patients. The "all-cause" mortality was 7.6% (5/66), with only one (1.5%) death attributable to COVID-19. Two (3%) patients required ventilation. Two (3%) patients had a delay in cancer diagnosis secondary to COVID-19 infection. Thirty-eight (57.6%) had a disruption in anticancer treatment. Conclusion Children with cancer do not appear to be at an increased risk of severe illness due to SARS-CoV-2 infection. Our findings substantiate continuing the delivery of nonintensive anticancer treatment unless sick. However, SARS-CoV-2 infection interrupted anticancer therapy in a considerable proportion of children. [ABSTRACT FROM AUTHOR]

Tumour cells activate immune checkpoints such as programmed death receptor-1 (PD-1) and cytotoxic T lymphocyte-associated antigen 4 (CTLA-4) signalling pathways to inhibit T lymphocyte activation and thus escape from immune surveillance. Immune checkpoint inhibitors (ICPis) reactivate T lymphocytes to recognize cancer cells by blocking CTLA-4 or PD-1. Autoimmune haemolytic anaemia is a rare, but often severe, complication of ICPis. Therefore, we performed a retrospective clinical case review, including serologic, haematology, and biochemistry laboratory results, of three patients who developed autoantibodies to erythrocytes following treatment with pembrolizumab, an anti-PD-1 inhibitor. Serologic testing of blood samples from these patients showed their red cells were positive for direct antiglobulin test (DAT + for IgG in two cases and IgG with C3d in one case). Antibody detection test was negative. No patient had clinical and laboratory features of haemolysis. There were no additional immune-related adverse events. IgG antibodies coating red cells were neither IgG1 nor IgG3 in class and elution was found negative in all. In conclusion, immunohaematology laboratories should be aware of the possibility of erythroid autoantibodies and their nature in cancer patients receiving ICPis. The result of a positive DAT should be interpreted carefully in these patients to exclude other possible causes of anaemia. [ABSTRACT FROM AUTHOR]

It is well known that exposure to a high concentration of radon-222 causes severe health effects, including cancer. The present article includes a survey on radon-222 in the water bodies of the city Durgapur [non-geothermal area] and nearby Bakreswar hot spring [geothermal province], India. The possible sources of radon from natural radionuclides and industries have been discussed in the article. Durgapur is a densely populated [~ 3680 persons/km2] industrial city with a population of 0.57 million. On the other hand, many tourists and pilgrims usually visit Bakreswar throughout the year. Age-dependent potential health risk assessments of the dwellers at Durgapur and Bakreswar due to radon exposure were performed for the first time. The present work is the first attempt to estimate the mean ingestion /and inhalation dose per annum, total effective dose [TED] per annum and the health risk assessment for cancer in adults, children and infants due to radon exposure at Durgapur and Bakreswar. In some cases, the values of TED exceed the permissible limit of 100 micro Sievert per year [µSv/y] as recommended by EUC and WHO. The radiation profile maps relating to radon concentration and associated contour maps of health risk factors [HRF] for the adults, children and infants were also prepared for the first time. Some areas were identified as high-risk zones, and the dwellers are prone to a high risk of cancer. The article also proposed several techniques to reduce radon in water and buildings. The authors also recommended banning some water sources to protect people from radon risk. This study will help scientists, policymakers, industrialists, farmers, government agencies and public health departments. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer remains a leading cause of unintended death among Indian women. Cancer treatment-induced pain, fatigue, nausea/vomiting, body image, and sexual problems could affect the patient psychosocial well-being and quality of life (QOL). The study aims to determine the QOL and psychosocial well-being among women with breast cancer. Materials and Methods: A cross-sectional survey completed by 244 women with breast cancer at a tertiary level teaching hospital. The European Organisation for Research and Treatment of Cancer QOL Questionnaire C30, the Breast Module (QLQ-BR23), and the Hospital Anxiety and Depression Scale (HADS) is used to measure the QOL, and psychological well-being, respectively. Appropriate descriptive and inferential statistics are applied to compute the results. Results: The total number of women with breast cancer interviewed was 244, with a mean age of 45.06 (standard deviation ± 11.17) years. The mean global health score was 70.97 ± 15.63. As per the QLQ-C30 scale, "physical functioning" scored the highest (70.54 ± 22.00), and "role functioning" reported the lowest (49.45 ± 36.15) mean score. Further, on the QLQ-C30 symptoms scale, "appetite loss" (45.09 ± 35.09) was the worst reported symptom, followed by "nausea and vomiting" (34.97 ± 38.39). On the BR-23 scale, body image said (68.42 ± 22.28) higher score than other domains and experience of arm-related problems (43.80 ± 26.06) were more frequently reported symptom in women. As per the HADS scale, 24.6% and 36.1% of women were in moderate anxiety and depression, respectively. The mean HADS score was 14.39 ± 5.82. Findings on predictors for the individual patient remained the same as that earlier published literature. Conclusions and Recommendations: Women with breast cancer have an overall good QOL and poor psychosocial well-being. However, using a holistic approach, including identifying psychological problems and their time management, signifies the need for the studied population. [ABSTRACT FROM AUTHOR]

Background & Objective: Invasive breast carcinoma (IBC) is the most commonly diagnosed cancer among women in India. The conventional visual method of evaluation of Tumor-Stroma Ratio (TSR) and Stromal Tumor-Infiltrating Lymphocytes (sTIL) appears to be subjective. The present study aims to evaluate the utility of the indigenously designed square grid method for the evaluation of tumor-stroma ratio and stromal tumor-infiltrating lymphocytes in invasive breast carcinoma by assessing the inter-observer variability. Methods: This was a retrospective study conducted at a rural tertiary care referral institute from July 2018 to June 2020. In each case, microphotographs were taken from 10 representative fields in H&E-stained sections for evaluating TSR in low-power and sTIL in high-power. Both the parameters were evaluated employing an indigenously designed square grid applied onto microphotographs in the power-point slides by making use of principles of the Pythagorean theorem. Both parameters were separately evaluated by two pathologists. Cohen kappa statistics was the statistical tool used to analyze inter-observer variability. Results: Thirty cases were analyzed. Invasive breast carcinoma of no special type (IBC-NST) was the most common histopathological type (26 cases (86.67%)). For TRS evaluation, a Kappa value of 0.78 suggested substantial agreement with an agreement of 91.67%. For sTIL evaluation, a Kappa value of 0.51 suggested moderate agreement with an agreement of 88.33%. The P-values were statistically highly significant (P<0.001). Conclusion: Square grid method is a novel technique for evaluating TSR and sTIL in invasive breast carcinoma. It can be considered an example of the application of Pythagoras' theorem in Pathology. [ABSTRACT FROM AUTHOR]