Indian Cancer Patients Research Articles

Exploring onco-fertility perceptions in India: a narrative review of psychosocial factors and implications for patients well-being

Onco-fertility, the confluence of cancer and fertility preservation, is vital in modern healthcare. As global cancer survival rates rise, more patients aim to overcome cancer and safeguard their reproductive potential. This review explores onco-fertility in India, emphasizing psychosocial factors. It acknowledges cancer's profound implications on fertility, stressing informed decision-making and comprehensive care for dual challenges. The review explores various preservation options for both genders, highlighting India's evolving landscape. India's onco-fertility landscape, driven by rising cancer diagnoses and disparities, needs tailored services. Understanding psychosocial factors is crucial for addressing emotional distress, cultural contexts, and communication barriers. This review delves into factors influencing decisions and well-being, informing practices to better serve Indian cancer patients. Examining psychological distress and decision-making in balancing treatment and fertility preservation, it explores cultural, religious, and ethical considerations. It underscores the need for comprehensive psychosocial support. Addressing psychosocial factors is vital for enhancing cancer survivors' quality of life. The review emphasizes bridging information gaps, providing emotional support, promoting informed decision-making, and fostering collaboration. It calls for further research and initiatives to advance onco-fertility support, considering India's diverse psychosocial landscape.

Exploring the diversity of vaginal microbiota between healthy women and cervical cancer patients in India.

Introduction. Cervicovaginal diversity has been reported as a predictive biomarker for cervical cancer risk. We recently reported the bio-therapeutic potential of vaginal probiotics from healthy Indian women against vaginal pathogens, isolated from the invasive cervical cancer (ICC) patients.Gap Statement. The cervicovaginal microflora from cervical cancer patients has not yet been reported from Indian population.Aim. The present study aimed at comparing the cervicovaginal microbiome between healthy controls (HC) and ICC patients from the Indian population.Methodology. In total, 30 vaginal swabs (15 from HC and 15 from ICC) were subjected to 16S rRNA gene sequencing. Alpha diversity was evaluated by Shannon and Chao1 index; and beta diversity by principle coordinate analysis (PCoA) of weighted and unweighted UniFrac distances. The relative abundance of the microbial taxa was done according to linear discriminant analysis effect size (LEfSe).Results. Predominance of Staphylococcus spp. in ICC and Lactobacillus gasseri in HC groups was observed. Alpha-diversity was found to be higher in ICC as compared to HC but was statistically non-significant. LEfSe analysis revealed Bacteroides fragilis and Escherichia coli as the marker genera in ICC with a marked decrease in Lactobacillus sp. Contrarily, in HC, L. gasseri, L. iners and L. fermentum were found to be abundant.Conclusion. Differences in the vaginal microbiome between healthy and ICC women could help in the early prediction of cervical cancer risk and thus in designing prevention strategies.

Abstract 997: Bringing the first prehabilitation program to American Indian cancer patients

Abstract Purpose. American Indian/Alaska Native (AI/AN) people have the worst cancer survival rates of any US racial group, are underrepresented in clinical trials and research, and have never been recruited for participation in any published prehabilitation (prehab) intervention conducted prior to cancer surgery. Description of Procedure. We are collaborating with tribal partners to design the first prehab translational clinical trial for AI patients diagnosed with obesity-related cancer, to be implemented prior to surgical resection of the tumor. Program components have been developed with community input through semi-structured interviews and guidance from the sponsoring tribal health facility, the San Carlos Apache Healthcare Corporation. Patients preparing for cancer surgery will engage in a 3-week multimodal intervention that entails home-based exercise, supervised fitness sessions, promotion of anti-inflammatory foods, and health education materials adapted for and by community members. Serum and tissue biomarkers, as well as lifestyle behavioral measures, will be compared pre and post intervention to assess responsiveness. In respect of tribal sovereignty, the experimental procedure includes protocol refinement and approval by the tribal health facility’s IRB and tribal council. Summary of Data. Our qualitative data reveal AI cancer survivors from the partnering tribal community have high interest in prehab and attest they would have participated if offered (100%). Their consensus feedback fashioned the specifics of the prehab translational clinical trial: 30 minutes daily walking, 60 minutes supervised resistance training twice weekly, 2 ounces walnut consumption daily, nutrition counseling, transportation assistance, and education/encouragement from staff and peers. Biospecimen sampling can be a sensitive topic for AI audiences, which we addressed early and found 75% of the interviewed survivors agreed to biospecimen collection without stipulation; this increased to 100% support once the rationale for biospecimens was explained. Conclusions: Published prehab studies in other populations administered for 3-5 weeks between diagnosis and surgery have shown improvements in functional capacity, attenuation of surgery-induced losses, alterations of inflammatory biomarkers, and patient safety. Our community-informed prehab translational clinical trial for AI patients is the first of its kind, and anticipated to demonstrate feasibility, patient acceptability, behavioral changes in lifestyle, and the potential to modulate inflammatory biomarkers. Citation Format: Jennifer Erdrich, Adriena Hernandez, Jennifer W. Bea, Cynthia A. Thomson. Bringing the first prehabilitation program to American Indian cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 997.

317 (PB-133) Poster - Linking the dots of breast cancer modifiable risk factors in pre- and post-diagnosis period among breast cancer patients in India

317 (PB-133) Poster - Linking the dots of breast cancer modifiable risk factors in pre- and post-diagnosis period among breast cancer patients in India

190P Prevalence of germline variants in Indian non-small cell lung cancer patients with family history of cancer

190P Prevalence of germline variants in Indian non-small cell lung cancer patients with family history of cancer

Real world study of safety and efficacy of lorlatinib as second line and beyond in ALK-rearranged advanced non-small cell lung cancer patients in India - a multicentre chart review study (ROSELAND).

Lorlatinib, an anaplastic lymphoma kinase (ALK)-inhibitor, is approved as frontline as well as subsequent line of therapy in ALK-rearranged advanced non-small cell lung cancer (NSCLC). There is limited literature about safety and efficacy of lorlatinib in Indian patients. This was a retrospective multicentre study on patients with ALK-rearranged advanced NSCLC received lorlatinib as second line and beyond between May 2017 and December 2021. ALK was tested either by immunohistochemistry or fluorescent in-situ hybridisation. Clinicopathologic features, treatment details, toxicity and outcomes were analysed. A total of 38 patients were enrolled with a median age of 54 years (range: 30-72) and male: female ratio of 20:18. Fifteen (44%) patients had brain metastases at baseline. Lorlatinib use was - second line in 11 (29%), third line in 21 (55%) and fourth line in 4 (11%) of patients, respectively. The best radiologic response to lorlatinib was - complete response in 9 (24%), partial response in 17 (46%), stable disease in 9 (24%) and progressive disease in 2 (5%) of patients, respectively. After a median follow-up of 76.6 months (95% CI: 68.9-100), the median progression-free survival (PFS) of lorlatinib was not reached (95% CI: 24.3-not reached) and median overall survival (OS) of the whole cohort was 93.1 months (95% CI: 62-not reached). Both median PFS (p = 0.48) and median OS (p = 0.74) was similar between second line and later line use of lorlatinib. Thirty-three (87%) patients experienced treatment-related toxicity and six (16%) patients required dose modification. Lorlatinib was highly efficacious in terms of overall response rate, median PFS and median OS in this small real-world cohort of advanced ALK+ve NSCLC with a manageable safety profile.

In Vitro Assessment of Antimicrobial Activity of Novel Fluoroquinolone, Levonadifloxacin (WCK 771) Against Multi-Drug-Resistant Clinical Isolates from Cancer Patients in India.

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.

Role of Symptomatic Management in Understanding Effects of Early Integration of Palliative Care among Nonmetastatic Lung Cancer Patients on Psychological Well-Being

Aim. The impact of early referral to palliative care on quality of life for patients with lung cancer has already been discussed. However, the benefits of early integration of palliative care service (EIPCS) combined with standard oncology care for nonmetastatic lung cancer patients remain unclear. Hence, we designed a study to assess the impact of EIPCS among nonmetastatic cancer patients in India. Methods. In this randomized controlled trial study, we divided the data from 115 patients with diagnosed nonmetastatic lung cancer between age group of >18 years to ≥65 years. Following clinicopathological and radiology diagnosis, patients were referred to pain and palliative medicine department. Patients were randomly assigned by palliative physicians into two groups: Group A (N = 64), those who were receiving standard oncology care (chemotherapy or radiation or both) along with EIPCS, and Group B (N = 51), receiving standard oncology care. Patients were followed up every 3 weeks up to 3 months. Primary outcomes, symptoms’ burden, and psychological well-being were measured by validated tools. To define the impact of EIPCS, appropriate statistics were calculated as the mean ± standard deviation of the score of validated tools. Statistical significance was defined at p<0.005. Results. From the beginning, we had taken 115 patients, and on 42 days’ follow-up, the number of dropout patients for Group A was 3 (due to unable to contact), and for Group B, 9 (due to physical condition). This was followed by a reassessment after 126 days where dropout patients for Group A was 4 (due to unable to contact), and for Group B, 7 (due to physical condition). Following statistical report compliance at 126 days by WEMWBS was 21.16 ± 3.65 in Group A versus 16.1 ± 1.93 versus in Group B and by ESAS 51.84 ± 0.01 in Group A versus 97.64 ± 2.18 in Group B. Conclusion. The findings of this study showed that patients with nonmetastatic lung cancer who received standard oncology care combined with EIPCS had increased the psychological well-being and reduced symptoms burden.

Outcomes of 3-year follow up with induction vs first line chemotherapy in oral cancer patients: An observational hospital-based study.

Our study aims to analyse and compare the efficacy, adverse effect profile and survival among the Paclitaxel/Cisplatin/5-Flurouracil (TPF) induction chemotherapy and Paclitaxel/carboplatin (PC) first line or cisplatin chemotherapy in a high-volume tertiary care cancer centre. 215 patients with oral cavity cancer were recruited in this study. Patients with stages I-IIc underwent surgical resection or radiation therapy 66-74 GY/fraction. Patients of Stages III-IV were administered with either induction chemotherapy TPF or PC or cisplatin regimen. Treatment responses were assessed by CT and MRI. Response rates, survival and adverse effects data were tabulated and analysed. The mean age was 49.2 ± 11.68 years. Symptoms were ulceration (33.5%), growth (20.5%), pain (13%), ulcer-proliferative growth (8.4%) and swelling (13, 6%). The tumour site was found at the base of the tongue, C01 (42.2%) followed by C06 (35.8%), C08 (6.5%), C07 (5.2%) and C05 (4.6%). There were no significant differences (P > 0.05) in efficacy and survival outcomes between the different groups of treatment. Median survival was achieved within 36 months. The major side effect observed were anaemia (15.81%), diarrhoea (36.2%), dyspepsia (28.8%), fever (33.95%), mucositis (28.85%), myalgia (33.95%) and nausea (7.9%). Survival among the responder categories (CR, PR and NR) was significantly different as per Log-rank analysis (P = 0.015). TPF induction therapy and PC first line chemotherapy showed similar efficacy, safety profile and survival whereas cisplatin shows poor efficacy and safety and survival in Indian oral cancer patients.

Development of a question prompt list for Indian cancer patients receiving radiation therapy treatment and their primary family caregivers.

We aimed to develop two question prompt lists (QPLs), one for Indian cancer patients undergoing radiation therapy and the second for their primary family caregivers. The study comprised three phases: (1) qualitative interviews with patients (n=65) and PFCs (n=39) to identify their information needs, queries and concerns regarding RT; (2) development of draft QPLs using conventional content analysis and translation into Hindi and Marathi using European Organisation Research and Treatment of Cancer guidelines; and, (3) A readability analysis, and acceptability study with patients (n=22), PFCs (n=26) and Radiation Oncology (RO) staff (n=20) exploring barriers to QPL implementation. Analysis in Phase I identified questions patients and PFCs asked or wanted to ask their physician. A list of 125 and 136 questions were generated for patients and PFCs, respectively. After five iterations, the draft QPLs were finalised, translated, and back-translated from English into Hindi and Marathi (Phase II). In Phase III, most patients and PFCs reported the QPLs were easy to read, they did not find it difficult to ask the questions, and the questions were not emotionally upsetting. Conversely, RO staff reported concerns that patients may find it difficult to discuss the questions with their physician. The study highlights the need to empower patients and PFCs to ask questions and for staff to feel comfortable answering them. Implementing physician-endorsed QPLs could achieve these aims.

Impact of Rural-Urban Differences in Acceptance and Meaning of Life among Breast Cancer Patients in India

India is a land of unity in diversity and it is not only true about its sociocultural but also holds residential areas too. Rural and urban areas associated with different sociostructural characteristics may contribute variation in behavioural adaptation. We studied the impact of rural-urban differences on the acceptance level and meaning of life among breast cancer patients in India. The present analytical descriptive cross-sectional study was conducted under superspecialty hospital, West Bengal, India. We compared the acceptance capability and meaning in life in breast cancer patients from rural areas (N = 122) and urban areas (N = 99). Patient-reported data concerning selected psychological (acceptance ability and the meaning of life), sociodemographic, and biological factors were collected by using validated tools. To identify the impact of sociocultural variation, descriptive statistics were calculated as the mean ± standard deviation of the score of validated tools based on acceptance and meaning of life. Patients from urban areas perceived meaning of life significantly worse than rural individuals (33.1 ± 2.44 vs. 24.2 ± 1.02). Education ( p = < 0.01 ), family per capita income ( p = 0 < 0.01 ), and family structure ( p = 0.004 ) factors were evaluated for being predictors of acceptance levels, whereas the educational level ( p = < 0.01 ) has significantly interacted with the meaning of life among both areas’ patients. Disease acceptance levels were found to be significantly higher in urban area’s patients than rural ones (38.6 ± 1.9 vs. 32.7 ± 1.92). The current study demonstrates that the patients of rural background and low education are more likely than their respective counterparts to have a lower level of acceptance capability and meaning of life.

Exploring the relationship between air quality index and lung cancer mortality in India: predictive modeling and impact assessment

The Air Quality Index (AQI) in India is steadily deteriorating, leading to a rise in the mortality rate due to Lung Cancer. This decline in air quality can be attributed to various factors such as PM 2.5, PM 10, and Ozone (O3). To establish a relationship between AQI and Lung Cancer, several predictive models including Linear Regression, KNN, Decision Tree, ANN, Random Forest Regression, and XGBoost Regression were employed to estimate pollutant levels and Air Quality Index in India. The models relied on publicly available state-wise Air Pollution Dataset. Among all the models, the XGBoost Regression displayed the highest accuracy, with pollutant level estimations reaching an accuracy range of 81% to 98% during training and testing. The second-highest accuracy range was achieved by Random Forest. The paper also explores the impact of increasing pollution levels on the rising mortality rate among lung cancer patients in India.

SIOG2023-4-P-301 - Prevalence of Malnutrition and its contributing factors in Indian elderly cancer patients

SIOG2023-4-P-301 - Prevalence of Malnutrition and its contributing factors in Indian elderly cancer patients

396P Exploring the nexus: Self-efficacy for decision-making participation and patient outcomes in Indian advanced cancer patients

396P Exploring the nexus: Self-efficacy for decision-making participation and patient outcomes in Indian advanced cancer patients

SIOG2023-5-P-352 - Baseline assessment of cognitive functions in Indian elderly cancer patients.

SIOG2023-5-P-352 - Baseline assessment of cognitive functions in Indian elderly cancer patients.

31P Identification of proteins associated with mRNA processing and maturation by quantitative proteomic analysis in Indian cervical cancer patients

31P Identification of proteins associated with mRNA processing and maturation by quantitative proteomic analysis in Indian cervical cancer patients

Indocyanine green guided sentinel lymph node biopsy may have a high sensitivity for early (T1/T2) colon cancer: A prospective study in Indian patients.

Indocyanine green (ICG) dye guided near infrared fluorescence (NIR) imaging is a promising tool for mapping lymphatics. The aim of this study was to evaluate the role of ICG guided SLN biopsy in Indian colon cancer patients. Forty-eight patients of clinically staged T1-T3 node negative colon cancer underwent laparoscopic/open resection. Patients received colonoscopic peritumoral submucosal ICG injections for laparoscopic (n= 32) and subserosal injections for open resections (n= 16) followed by the detection of SLN using NIR camera. SLNs underwent conventional hematoxylin and eosin (H & E) staging with additional serial sectioning and immunohistochemistry for pancytokeratin antibody (ultra-staging). Detection rate and upstaging rate were the primary end points. Forty-eight patients were recruited. An average of 2.08 ± 1.27 SLNs were identified in 45 patients at a mean time of 8.2 ± 3.68 minutes with a detection rate of 93.75%. Mean age and mean BMI were 59.7 ± 12.54 years and 24.8 ± 4.09 kg/m2 , respectively. Eighteen patients had node positive disease, and SLN was false negative in four of these patients resulting in a sensitivity of 77.77% with a trend towards higher sensitivity for T1-T2 tumours (90% vs. 62.5%, p= 0.068). Upstaging rate was 10%. Negative predictive value (NPV) and accuracy of the procedure were 87.09% and 91.11%, respectively. ICG guided SLN biopsy can identify metastatic lymph nodes in colon cancer patients that can be missed on H & E staging with relatively higher sensitivity for early (T1/T2) tumours.

Influence of ABCB1 genetic polymorphisms on the antiemetic response to ondansetron-based medication for cisplatin-based chemotherapy in South Indian cancer patients in a tertiary care hospital

Abstract Genetic variations in the receptor, metabolizing enzymes and transporters may explain a part of the variation in anti-emetic response to ondansetron among cancer patients. This study assesses the role of ABCB1 genetic polymorphisms in the anti-emetic efficacy of ondansetron-based medication for cisplatin-based chemotherapy in South Indian cancer patients. The frequencies of common ABCB1 polymorphisms (rs1045642; C>T, rs1128503; C>T and rs2032582; G>T/A) were studied in 234 South Indian cancer patients receiving cisplatin-based chemotherapy. Comparison of nausea and vomiting with respect to number of episodes and severity by Visual Analogue Scale (VAS), and Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv4.0) was made across genotype groups of each polymorphism. TT genotype carriers of all three polymorphisms had significantly lesser incidence of nausea and vomiting when compared to other genotypes of the respective polymorphisms during 2-24 hours and on days 2-5. Median VAS score for nausea and vomiting was also lower for TT genotype carriers at each time point except for nausea on days 2-5 (p=0.057) of C3435T. As per CTCAEv4.0, TT genotype carriers had less severe grade at each time point except for days 2-5 nausea (p=0.278) and vomiting (p=0.219) of C3435T and nausea on days 2-5 (p=0.068) of G2677T/A: TT genotype of ABCB1 genetic polymorphisms was associated with anti-emetic response to ondansetron-based medication in the population studied. Hence, genotyping for ABCB1 polymorphisms may be used as a tool to predict response to ondansetron.

Awareness and experiences of side effects and infections during chemotherapy treatment: a cross sectional survey among family caregivers of cancer patients in India

Background: Adequate understanding of side effects and infections is essential for family caregivers to ensure proper management for cancer patients during chemotherapy. The present paper describes the family caregivers' awareness of the symptoms of possible side effects and infections during chemotherapy treatment. Methods: Family caregivers were identified through the lodging facilities near the cancer treatment centres in Thiruvananthapuram and Mumbai. The cross-sectional survey was conducted using a structured interview schedule formulated in the Kobo-collect toolbox and analyzed using IBM-SPSS-Statistics-25. Results: Among the 217 family caregivers aged between 19 to 76 years, 83% were close relatives of the patients. The majority of the family caregivers were able to identify conditions such as hair loss (95%), appetite change (88%), and nausea/vomiting (88%) as side effects of chemotherapy. At the same time, participants recognized the symptoms of infections were less. Unusual vaginal discharge/irritation (57%) and burning/pain with urination (55%) were the commonly recognized symptoms of infections. From the list of symptoms, more than six out of the thirteen side effects and more than three out of seven infections were correctly identified by 82% and 42% of family caregivers, respectively. Conclusions: The family caregivers were largely aware of side effects but not much about infections. Since chemotherapy is an immune suppressive treatment, infection awareness among family caregivers is essential to avoid any serious complications during the treatment period. Communication with family caregivers on 'the symptoms and management' of 'side effects and infections' and when to seek treatment is crucial for cancer treatment success.

COVID-19 and Cancer: A Comparison of the Two Important Pandemic Waves in an Indian Cancer Patients' Cohort

It is well known that patients with cancer are at an increased risk of severe COVID-19. There are no reports that depict the differences in outcomes in cancer patients between the two waves of the pandemic. This is a real-world experience aimed at characterizing the differences in demographics, clinical features, treatment details, and outcomes in COVID-19-positive cancer patients between the two pandemic waves. This was a prospective study of all COVID-19-positive cancer patients attending our specialty out-patient department at Rajiv Gandhi Cancer Institute and Research Centre between March 2020 and November 2020 (1st wave) and April 2021 and June 2021 (second wave). All patients diagnosed to have COVID-19 by real-time polymerase chain reaction (RT-PCR) with a biopsy-proven solid organ malignancy attending the medical oncology out-patient department were included during both the waves. A total of 300 patients with proven SARS-CoV-2 infection by either RT-PCR or cartridge based nucleic acid amplification test were encountered, of which 123 were encountered during the first wave of the pandemic and 177 during the second wave. The case fatality rate of the first wave was 9.8%, with a 15-day case fatality rate of 5.6%, whereas for the second wave, it was 13% and 7.2%, respectively. Twelve patients succumbed to COVID-19 disease in the first wave and 23 succumbed in the second. There were no statistically significant correlations; however, the death in the second wave tended to occur more in younger male patients, with comorbidities and history of smoking. There was no relation with ongoing cancer-directed treatment or chemotherapy. Our study is unique in comparing characteristics of the two most important COVID-19 waves and treatment patterns in cancer patients from a single center. The second wave showed a higher CFR, hospital admission rate, and higher frequency of respiratory complications; however, there was no relation to cancer-directed therapy and COVID-19, thus reiterating the fact that cancer treatment should not be halted in the event of a COVID-19 infection.