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OBJECTIVE: Cancer patients in India prefer full information regarding diagnosis and prognosis, but evidence suggests poor insight. This study aimed to identify the role of health literacy among adult patients living with cancer, their families and health professionals in decision-making and treatment outcomes in India. METHODS: This cross-sectional in-depth study recruited patients, families and clinicians from three centers. Inductive thematic analysis informed a novel conceptual model. RESULTS: We recruited n = 34 cancer patients, n = 33 family members, n = 11 doctors and n = 14 nurses (N = 92). Principle emergent themes were the following: (1) Preferences and dynamics of diagnosis and prognosis disclosure, for example, the dominant preference was for families who held hope for cure to discourage disclosure; clinicians sometimes disclosed in line with perceived ability to pay for treatment. (2) Understanding of disease and its treatment options (etiology, potential trajectory, treatment options), for example, lay understandings of cancer etiology as contamination from outside the home, and reluctance of patients to ask questions of clinicians. (3) Priorities in decision-making, for example, not engaging patients due to fear of patient distress, patients initiated on anticancer treatments without knowledge or consent, pursuing futile treatments. (4) Anxieties over finances and outcomes (disclosure, decision-making, care pathways), for example, clinicians attempting to reduce families pursuing expensive and inappropriate treatment options with patients who have poor insight, catastrophic spending based on poor decisions. CONCLUSION: The novel evidence-based health literacy model offers potential for feasible and acceptable intervention to support families in communication, disclosure and decision-making. This may improve patients access to informed, appropriate care pathways.

Cervical cancer (CC) is a key contributor to cancer‐related mortality in several countries. The identification of molecular markers and the underlying mechanism may help improve CC management. We studied the regulation and biological function of the chromosome 14 microRNA cluster (C14MC; miR‐379/miR‐656) in CC. Most C14MC members exhibited considerably lower expression in CC tissues and cell lines in The Cancer Genome Atlas (TCGA) cervical squamous cell carcinoma and endocervical adenocarcinoma patient cohorts. Bisulfite Sanger sequencing revealed hypermethylation of the C14MC promoter in CC tissues and cell lines. 5‐aza‐2 deoxy cytidine treatment reactivated expression of the C14MC members. We demonstrated that C14MC is a methylation‐regulated miRNA cluster via artificial methylation and luciferase reporter assays. C14MC downregulation correlated with poor overall survival and may promote metastasis. C14MC activation via the lentiviral‐based CRISPRa approach inhibited growth, proliferation, migration, and invasion; enhanced G2/M arrest; and induced senescence. Post‐transcriptional regulatory network analysis of C14MC transcriptomic data revealed enrichment of key cancer‐related pathways, such as metabolism, the cell cycle, and phosphatidylinositol 3‐kinase (PI3K)–AKT signaling. Reduced cell proliferation, growth, migration, invasion, and senescence correlated with the downregulation of active AKT, MYC, and cyclin E1 (CCNE1) and the overexpression of p16, p21, and p27. We showed that C14MC miRNA activation increases reactive oxygen species (ROS) levels, intracellular Ca2+ levels, and lipid peroxidation rates, and inhibits epithelial–mesenchymal transition (EMT). C14MC targets pyruvate dehydrogenase kinase‐3 (PDK3) according to the luciferase reporter assay. PDK3 is overexpressed in CC and is inversely correlated with C14MC. Both miR‐494‐mimic transfection and C14MC activation inhibited PDK3 expression. Reduced glucose uptake and lactate production, and upregulation of PDK3 upon C14MC activation suggest the potential role of these proteins in metabolic reprogramming. Finally, we showed that C14MC activation may inhibit EMT signaling. Thus, C14MC is a tumor‐suppressive and methylation‐regulated miRNA cluster in CC. Reactivation of C14MC can be useful in the management of CC. [ABSTRACT FROM AUTHOR]

Background: In planning radiotherapy treatments, computed tomography (CT) has become a crucial tool. CT scans involve exposure to ionizing radiation, which can increase the risk of cancer and other adverse health effects in patients. Ionizing radiation doses for medical exposure must be kept "As Low As Reasonably Achievable". Very few articles on guidelines for radiotherapy-computed tomography scans are available. This paper reviews the current literature on radiation dose optimization based on the effective dose and diagnostic reference level (DRL) for head, neck, and pelvic CT procedures used in radiation therapy planning. This paper explores the strategies used to optimize radiation doses, and high-quality images for diagnosis and treatment planning. Methods: A cross-sectional study was conducted on 300 patients with head, neck, and pelvic region cancer in our institution. The DRL, effective dose, volumetric CT dose index (CTDIvol), and dose-length product (DLP) for the present and optimized protocol were calculated. DRLs were proposed for the DLP using the 75th percentile of the distribution. The DLP is a measure of the radiation dose received by a patient during a CT scan and is calculated by multiplying the CT dose index (CTDI) by the scan length. To calculate a DRL from a DLP, a large dataset of DLP values obtained from a specific imaging procedure must be collected and can be used to determine the median or 75th-percentile DLP value for each imaging procedure. Results: Significant variations were found in the DLP, CTDIvol, and effective dose when we compared both the standard protocol and the optimized protocol. Also, the optimized protocol was compared with other diagnostic and radiotherapy CT scan studies conducted by other centers. As a result, we found that our institution's DRL was significantly low. The optimized dose protocol showed a reduction in the CTDIvol (70% and 63%), DLP (60% and 61%), and effective dose (67% and 62%) for both head, neck, and pelvic scans. Conclusions: Optimized protocol DRLs were proposed for comparison purposes. [ABSTRACT FROM AUTHOR]

Aim: Grid size and Statistical Uncertainty (SU) settings have an impact on the efficiency and accuracy of the treatment plans. Hence, it is very important, to find an optimum combination of the two-dose calculation parameters for efficient treatment planning. This study aims to study the impact of Grid Size and SU on Head and Neck cancer plans which were planned using the Volumetric-Modulated Arc Therapy (VMAT) technique. Materials and Methods: 15 patients were selected for this retrospective study who had undergone radiation therapy at KMC, Manipal for various Head and Neck cancers. VMAT plans were generated for each case in Monaco 5.11 Treatment Planning System (TPS) using the Monte Carlo algorithm. For each patient, nine plans were generated in which the Grid size values were taken as 2 mm, 3 mm, and 5 mm and for each Grid size, SU settings were varied as 1%, 2%, and 5%. The plans were analysed and evaluated using outcome measures such as the Homogeneity Index (HI) and the Conformity Index (CI). Results: The plans were evaluated as per the ICRU guidelines. In all the plans, PTV coverage achieved was above 95% with the maximum coverage (97.009) achieved with the 3 mm/1% combination. Overall, the effect of varying Grid Size and SU was insignificant in the plans generated, but there were few variations in the dose calculation parameters. For 2 mm/1%, 2 mm/2%, 2 mm/5%, 3 mm/1%, 3 mm/2%, 3 mm/5%, 5 mm/1%, 5 mm/2%, 5 mm/5%, the mean values of HI were 1.073, 1.078,1.078, 1.075, 1.0805, 1.0805, 1.068, 1.079, 1.089, and the mean values of CI were 0.968, 0.967, 0.967, 0.968, 0.958, 0.96, 0.954, 0.946, 0.948, respectively. Among all the combinations, the results for 5 mm/1% yielded more homogeneity, whereas 2 mm/1% and 3 mm/1% combinations resulted in better conformity. The 3 mm/1% combination gave maximum target coverage and quite fewer Monitor Units (MU) as well. Conclusion: 3 mm Grid Size and 1% SU is suggested for the Head and Neck carcinomas planned using the VMAT technique. [ABSTRACT FROM AUTHOR]