Oncology Department Research Articles

A Descriptive Study to Assess the Anxiety Level among Caregivers of Cancer Patients Admitted to the Medical Oncology Department of SKIMS Soura

Introduction: Family caregivers for cancer patients may experience severe strain, worry, and sadness as a result of their work, which may affect their mental and physical health. There is little data on the degree of stress, worry, and depression experienced by cancer caregivers, as well as their involvement in helping patients and other factors that may help or worsen the prognosis. With an emphasis on patient and caregiver-related characteristics, this study examined the prevalence of depression, anxiety, and caregiving stress among cancer family caregivers. Aim: To assess the anxiety level among the caregivers of cancer patients admitted to the medical oncology department at SKIMS Soura, using the anxiety rating scale. Methodology: A quantitative approach and descriptive research design were adopted to assess the anxiety levels among caregivers of cancer patients admitted to the medical oncology department of SKIMS Soura Srinagar Kashmir. The demographic variables were age, gender, educational background, per capita income, marital status, number of children, duration of caregiving, and relation with the patient. The permission for data collection was accorded by Medical Superintendent SKIMS Soura, who guided and forwarded the application to all concerned for needful. The sample size was 30 caregivers selected using the purposive convenience sampling technique. The tool used for the study was the Anxiety Self Rating scale, with 10 items, each with five responses ranging from never (0) to always (4). Results: The study revealed that 7 (23.3%) of the study subjects depicted moderate anxiety, equal number 7 (23.3%) of the study subjects also showed high anxiety, 6 (20%) of the study subjects depicted mild anxiety, and 0 (0.0%) of the study subject showed extreme anxiety. The calculated (Mean ± SD) score of the anxiety level of 30 subjects was (15.4 ± 8.6). The study revealed that there is no significant association between anxiety levels among study subjects with selected demographic variables viz age (p=0.21), educational background (p=0.10), per capita income (p=0.13), marital status (p=0.19), number of children (p=0.10) and duration of caregiving (0.39), relation with the patient (p=0.19) at 0.05 level of significance except for gender (p=0.02). Conclusion: The study concluded that caregivers always suffer from some form or level of anxiety that affects them as an individual and their families as a whole. The caregivers are prone to other mental health issues that can be explored, anxiety being the leading cause and symptom of the same.

Multidrug Resistant Enteric Bacteria from Cancer Patients Admitted in Douala Laquintinie Hospital, Littoral Region of Cameroon.

Patients with cancer have weakened immune systems, making them more vulnerable to infections. This study was carried out to determine the bacterial origins of enteric disorders in cancer patients and noncancer patients at the Oncology Department of Laquintinie Hospital in Douala. A cross-sectional study was conducted from October 2021 to March 2023. Stool samples from 307 cancer patients with enteric disorders and 200 noncancer patients with enteric disorders were examined to diagnose the presence of bacteria using various techniques. Among all participants in this study, 62.13% were female and 37.87% were male. The average age of the participants was 46.38 ± 15.81 years, with a minimum age of 10 years and a maximum age of 84 years. The average age of participants was significantly higher (p < 0.000) in cancer patients (49.54 ± 14.65 years) compared to noncancer patients (41.53 ± 16.33 years). Proteus mirabilis, Proteus vulgaris, Salmonella typhi, Enterobacter cloacae, Klebsiella pneumoniae, Yersinia intemedia, and Klebsiella oxytoca were more frequently isolated in cancer patients than in noncancer patients, with the respective percentages of 56.25% versus 43.75%, 50.00% versus 50.00%, 61.66% versus 38.34%, 66.66% versus 33.34%, 72.22% versus 27.78%, 80.00 versus 20.00%, and 100% versus 0.00%. Most isolates were sensitive to imipenem (IMP), gentamicin (GEN), and amikacin (AMK). Proteus vulgaris, the most prevalent isolate, showed significantly high resistance (with p < 0.05) in cancer patients compared to noncancer patients at amoxicillin/clavuranic acid (AMC) (89.13% versus 41.30%), ceftriaxone (CTR) (63.04% versus 39.13%), ciprofloxacin (CIP) (65.22% versus 34.18%), and tetracycline (TET) (93.48% versus 63.04%). Multidrug resistance was observed in cancer patients compared to noncancer patients for Klebsiella pneumoniae (85.00% versus 60.00%), Salmonella typhi (84.62% versus 60.00%), and Klebsiella oxytoca (86.49% versus 43.48%). The increase in the number of Gram-negative infections among cancer patients, as shown in the present study, highlights the need for broad-spectrum therapy and effective planning of control programs to reduce bacterial diseases among cancer patients.

Clinico-epidemiological study of central nervous system tumors at clinical oncology department Tanta University Hospitals

Clinico-epidemiological study of central nervous system tumors at clinical oncology department Tanta University Hospitals

Hematological indicator-based machine learning models for preoperative prediction of lymph node metastasis in cervical cancer.

Lymph node metastasis (LNM) is an important prognostic factor for cervical cancer (CC) and determines the treatment strategy. Hematological indicators have been reported as being useful biomarkers for the prognosis of a variety of cancers. This study aimed to evaluate the feasibility of machine learning models characterized by preoperative hematological indicators to predict the LNM status of CC patients before surgery. The clinical data of 236 patients with pathologically confirmed CC were retrospectively analyzed at the Gynecology Oncology Department of the First Affiliated Hospital of Bengbu Medical University from November 2020 to August 2022. The least absolute shrinkage and selection operator (LASSO) was used to select 21 features from 35 hematological indicators and for the construction of 6 machine learning predictive models, including Adaptive Boosting (AdaBoost), Gaussian Naive Bayes (GNB), and Logistic Regression (LR), as well as Random Forest (RF), Support Vector Machines (SVM), and Extreme Gradient Boosting (XGBoost). Evaluation metrics of predictive models included the area under the receiver operating characteristic curve (AUC), accuracy, specificity, sensitivity, and F1-score. RF has the best overall predictive performance for ten-fold cross-validation in the training set. The specific performance indicators of RF were AUC (0.910, 95% confidence interval [CI]: 0.820-1.000), accuracy (0.831, 95% CI: 0.702-0.960), specificity (0.835, 95% CI: 0.708-0.962), sensitivity (0.831, 95% CI: 0.702-0.960), and F1-score (0.829, 95% CI: 0.696-0.962). RF had the highest AUC in the testing set (AUC = 0.854). RF based on preoperative hematological indicators that are easily available in clinical practice showed superior performance in the preoperative prediction of CC LNM. However, investigations on larger external cohorts of patients are required for further validation of our findings.

A quasi-experimental study to Effect of Educational Bundle on Pediatric Oncology Nurses’ Knowledge and Attitudes about the Implementation of Atraumatic Care

Background Atraumatic care plays a significant role in reducing the noxious effect of hospitalization on children and their families. Providing atraumatic care should be a basic premise in pediatric nursing care. Aim To evaluate the effect of an educational bundle on pediatric oncology nurses’ knowledge and attitudes about the implementation of atraumatic care. Method A quasi-experimental research design was used. The study was carried out at the Pediatric Oncology Department at Oncology Center Mansoura University. A convenient sample of 27 nurses was elected. A Structured Interview Questionnaire Sheet consisting of four parts was used for data collection. Results Preintervention, 26.0% of the nurses had good total knowledge while postintervention and at follow-up this percentage increased to 77.8 and 70.3%, respectively. Moreover, 44.4% of the studied nurses had an overall supportive attitude preintervention but the percentage improved to 81.5% postintervention and 77.8% at follow-up. Conclusion The educational bundle positively affected pediatric oncology nurses’ knowledge and attitude postimplementation with good retention of knowledge and sustained holding supportive attitudes three months later. Recommendations Scheduled regular update sessions and refreshment courses are strongly recommended to maintain and further improve the knowledge and attitudes of nurses over a longer period.

Clinical Utilisation of Cryoprecipitate at a Tertiary Care Centre in Telangana, India: A Quasi-experimental Study

Introduction: Cryoprecipitate is a slushy product derived from Fresh Frozen Plasma (FFP) through centrifugation at specific temperatures and speeds. It is rich in factor VIII or antihaemorrhagic factor, fibrinogen, and minor amounts of other clotting factors. Cryoprecipitate is primarily used to correct hypofibrinogenaemia or replenish depleted fibrinogen levels. Aim: To examine the appropriate clinical utilisation of cryoprecipitate (cryo) by various departments in the Institute and evaluate the improvement in patients through laboratory tests. Materials and Methods: A single group quasi-experimental study was conducted in the Department of Immunohaematology and Transfusion Medicine (IHBT) at Nizam’s Institute of Medical Sciences (NIMS), Hyderabad, Telangana, India. The duration of the study was over a period of six years, from May 2016 to April 2022.. A total of 486 cases where cryoprecipitate was requested were included in the present study. The results were analysed using Prothrombin Time (PT) and International Normalised Ratio (INR). Percentages and means were used to assess various parameters in this study. All statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 25.0. Results: The mean age of the study participants was 52.7 years. A total of 486 cases were included over a period of six years, with 3375 cryoprecipitate transfusions performed. The youngest patient was a 9-year-old male, the oldest patient was an 83-year-old male. Most of the cryoprecipitate was appropriately utilised by the Medical Oncology Department (995 cases, 995 units, 20-25 mL per unit-29.48%), while the Cardiology Department had the lowest utilisation (12 cases, 12 units-0.35%). Utilisation by other departments ranged between 45 and 564 cases or units (1.33% to 16.71% per department). The majority of cryoprecipitate units were issued for multiple myeloma and acute leukaemias (new cases and relapse)-28.38% (958 units), while the least were issued for minor surgery and medical cases (29 cases or 29 units- 0.85%). Conclusion: Cryoprecipitate should be used appropriately to achieve desired results and avoid unnecessary transmission. Clinicians, residents, and surgeons should adhere to comprehensive regulatory guidelines for the appropriate usage of cryoprecipitate or any other blood products, as outlined by their hospital transfusion committee.

Adapting to change: exploring perceptions and demands of the coronavirus (COVID-19) workforce changes - an Australian multi-institutional radiation oncology survey.

Objective To evaluate the perceptions of the coronavirus disease 2019 (COVID-19) initiated workplace strategies implemented in radiation oncology departments across Australia. Methods A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies on areas such as patient care, staff education, well-being, flexible working arrangements, and research. The survey was conducted from November 2020 to April 2021. Results Out of 210 respondents from seven institutions, 45% reported burnout and 57% experienced work work-related stress. A significant majority of respondents were in favour of continued remote work (86%, 131/153). Radiation oncologists identified administrative or non-clinical work (92%, 34/37), telehealth clinics (32%, 12/37), or radiation therapy planning (22%, 8/37) as suitable for remote work. Additionally, 54% (21/39) of the radiation oncologists plan to use telehealth more frequently, with 67% (26/39) feeling more confident with the technology. The majority (81%, 171/210) of participants favoured continuation of hybrid in-person and virtual meetings. Virtual solutions were adopted for quality assurance activities (72%, 118/165) and 52% (60/116) indicated preference for ongoing utility of virtual platforms. However, 38% (79/210) of the respondents expressed concerns about the negative impact on junior staff training. Conclusion These findings reveal a strong inclination towards technological advancements and remote work arrangements to enable flexible working conditions. Our study suggests the need for ongoing reforms, focusing on improving clinical service delivery efficiencies and enhancing job satisfaction among clinicians.

Prevalence and risk factors for anxiety in patients with early- and middle-stage lung cancer: a cross-sectional study.

Lung cancer is a leading cause of cancer-related morbidity and mortality worldwide, with patients frequently experiencing significant psychological distress, particularly anxiety. Despite the high prevalence of anxiety in patients with cancer, there is limited comprehensive research focusing on the specific factors influencing anxiety in patients with early- and middle-stage lung cancer within the context of Chinese medicine hospitals. Therefore, we aimed to investigate the epidemiology and factors influencing anxiety disorders in patients with early- and middle-stage primary bronchial lung cancer through a cross-sectional study. A total of 340 patients with early and middle-stage lung cancer admitted to the outpatient ward of the oncology department at Guang'anmen Hospital from June 2023 to December 2023 were included in this study. Survey data, including the patients' general condition questionnaire, Generalized Anxiety Scale (GAD-7), Hospital Anxiety and Depression Scale (HADS), and Mental Toughness Scale (CD-RISC-10), were collected and recorded in a database using a two-person input format. Data analysis was performed using SPSS 27.0 software. Out of the 340 patients with early- and middle-stage lung cancer included in this study, 133 had anxiety, resulting in an overall anxiety detection rate of 39.12%. The chi-square test showed that statistically significant differences in religion, marital status, surgical treatment, tobacco use, and alcohol history between the anxious and non-anxious groups (p < 0.05). Moreover, statistically significant differences were observed in per capita annual family income, pathological type, VAS score, targeted therapy, treatment stage, and mental toughness level (p < 0.001). Other factors were not significantly correlated with anxiety onset. Multivariate logistic regression analysis showed that higher per capita family income and completed treatment independently acted as protective factors against anxiety onset in patients with early- and middle-stage lung cancer. Conversely, rare pathological types, increased pain severity, and lower levels of mental toughness were identified as independent risk factors for anxiety onset in these patients. Anxiety was prevalent in patients with early- and middle-stage lung cancers. Rare pathological types, increased pain severity, and lower levels of mental toughness were independent risk factors for anxiety. Therefore, clinicians and psychologists should pay more attention to patients with rare types of tumors, actively manage their pain symptoms, and consider implementing mental resilience training to improve patients' mental toughness.

Factors linked to the late diagnosis of breast cancer and the initiation of treatment.

Breast cancer is the first cancer in women in terms of incidence and mortality. In Morocco, it is a public health problem. Its prognosis is strongly linked to the stage at which it is diagnosed. It is a pathology for which diagnosis means are highly developed today, ranging from early detection to the demonstration of infra-clinical lesions, which has markedly improved the prognosis in developed countries. This work aims to identify the factors that lead patients to consult at an advanced stage in our daily practice. It is a retrospective study carried out from January 2018 to December 2018 including 525 patients with breast cancer followed in the medical oncology department of the Mohammed VI University Hospital in Marrakech. The average age was 54. The average time for consultation was 10.3 months. 63% of patients were from rural areas. Delayed diagnosis affected women above 35 years of age (80%). The most common method of detection was self-examination in 74% of cases. Inflammation (2.66%), ulceration (1.14%), signs of metastases (17.14%), and isolated breast nodes (79.4%) were other reasons for consultation. 82.2% of patients were locally advanced at the time of diagnosis. The time for treatment in our study was 3.7 weeks. In our practice, it is the conjunction of ignorance, poverty, socio-cultural habits, and difficult geographical access that are the essential factors in the late diagnosis of breast cancer.

The Effects of Foot Reflexology and Simple Foot Massage on Fatigue and Pain in Children With Leukemia: A Randomized Control Trial

Background and Purpose: Chemotherapy is one of the main options in treating childhood cancers. Fatigue and pain are common symptoms of cancer and one of the major complications experienced during chemotherapy. This study aimed to determine the effect of foot reflexology and simple foot massage on fatigue and pain in children with leukemia. Materials and Methods: This randomized clinical trial was performed on 99 children with leukemia aged 4-14 years, undergoing chemotherapy in the oncology departments of Hazrat Ali Asghar Hospital and Children’s Medical Center, Tehran City, Iran, in 2019. The sampling was sequential, and participants were assigned into three groups by block randomization: Foot reflexology, simple foot massage, and control group. The foot reflexology and simple foot massage were performed for 5 consecutive days. Participants were asked to report the intensity of pain and fatigue over the past 48 hours using the pain visual and child fatigue scales. Statistical analysis was conducted with SPSS software, version 22. Quantitative variables were reported as the Mean±SD. The chi-square test, analysis of variance, and repeated measures tests were used for data analysis. Results: Demographic characteristics in three groups were not significantly different except for gender (P=0.011). There was no significant difference in pain (P=0.67) and fatigue (P=0.45) before the intervention. The Mean±SD pain scores on the third day in foot reflexology, simple foot massage, and control group were 4.4±1.9, 5.2±1.79, and 6.3±1.76, respectively (P&lt;0.001). The Mean±SD pain scores on the fifth day in foot reflexology, simple foot massage, and control group were 2.7±1.4, 3.9±1.83, and 6.7±1.5, respectively (P&lt;0.001). The Mean±SD fatigue scores on the third day in foot reflexology, simple foot massage, and control group were 2.36±0.55, 2.95±0.6, and 3.65±0.32, respectively (P&lt;0.0001). The Mean±SD fatigue scores on the fifth day in foot reflexology, simple foot massage, and control group were 2.14±0.42, 2.67±0.73, and 4.12±0.16, respectively (P&lt;0.0001). Conclusion: Our results showed that foot reflexology and simple foot massage can decrease pain and fatigue in children with leukemia. Performing foot reflexology could be recommended as a complementary intervention to reduce pain and fatigue in children with leukemia.

Clinico-epidemiological study of hematological malignancies at clinical oncology department Tanta university hospitals

Clinico-epidemiological study of hematological malignancies at clinical oncology department Tanta university hospitals

The Department of Surgery and Oncology is 40 years old

The article traces the main stages of formation and development of the Department of Surgery and Oncology of the Saratov State Medical University named after V. I. Razumovsky, whose first head was Professor Pavel A. Belyaev. Over the 40-year period, the clinical base of the department has significantly expanded. Every year, about 30 residents and more than 150 students are trained at the department in various areas of surgery and oncology.

Metastatic Neuroblastoma with Initial Orbital Presentation

Neuroblastoma, also called sympathoblastoma, is a malignant embryonal tumor developed at the expense of neural crest cells, the most frequent solid tumor in children under 5 years of age. The objective is to recall the clinical variability and the importance of evoking neuroblastoma in a child presenting with an ophthalmological symptom. We report the case of a 5-year-old child who presented with a right orbital metastatic neuroblastoma, whose ophthalmologic complaint led to the diagnosis. An ophthalmologist in the emergency room for a VAD and eye pain first saw the child. On examination, true exophthalmos with palpebral edema was found on the right. Cerebral and orbital CT revealed a right latero-orbital osteolytic mass of secondary appearance with endocranial extension. The workup showed lymph node involvement, unilateral right adrenal, osteomedullary, hepatic, and pancreatic involvement. The child was admitted to a specialized pediatric oncology department and received chemotherapy. The patient was then declared under palliative treatment.

Gamma Irradiation Doses reduce Cooking time and Improve Nutritional Profile of selected Pigeon pea [Cajanus cajan (L.) Millsp] Genotypes in Nigeria

Pigeon Pea (Cajanus cajan L.) is a self-pollinating perennial legume shrub with over 30,000 accessions deposited world-wide. Despite the nutritional importance of pigeon peas, its detrimental traits such as its long cooking time, has led to low cultivation of the crop and inhibit its consumers’ request. Concerted efforts to improve both the quality and quantity of this crop through mutation breeding informed this research. It was based on this premise that the study was aimed to evaluate gamma irradiation influences on the nutrient quality and cooking duration of selected pigeon pea varieties in Nigeria. Four accessions of pigeon peas (‘NG/SA/11/08/108’, ‘NG/AO/MAY/00/021/01’, ‘TCC-2’ and ‘NG/SA/07/191’) were obtained from National Centre for Genetic Resources and Biotechnology (NACGRAB), Ibadan. They were irradiated at the Oncological Department ABU Teaching Hospital, Shika, Zaria, using Cobalt-60 (60CO) irradiation source. Standard procedures were followed to determine the effects of the irradiation on cookability and nutritional profile of the M1 plants and their respective controls. It was established that all the parameters tested were irradiation dose dependent. In NG/AO/MAY/00/021/01, 100 Gy produced the highest protein (20.40 %) and highest carbohydrate (68.93 %) contents. Anti-nutritional factors such as cyanide were lower (48.83, 46.22, 43.65 and 44.75 mg/kg in NG/AO/MAY/00/021/01, NG/SA/11/08/108, NG/SA/07/191 and TCC-2) at 400 Gy than those of their respective controls (54.83, 56.83, 53. and 53.55 mg/kg). The amount of Magnesium increased with higher doses of gamma irradiation (1.37 g/100 g for 200 Gy NG/AO/MAY/00/021/01; 1.03 g/100g for 400 Gy NG/SA/11/08/108 and 1.13 g/100 g for TCC-2). There were significant reductions in cooking time in 400 Gy treatments for all the genotypes. The differences between the control and the least cooking time in 400 Gy were 11, 16, 22 and 15 minutes for NG/AO/MAY/00/021/01, NG/SA/11/08/108, NG/SA/07/191 and TCC-2, respectively. It was therefore concluded that these variations could be exploited for further improvement of the crop for food security. Keywords: Cooking time, Mutation breeding, Gamma irradiation, Cookability, Dose dependent

Multiple Malignancies in Relation to Vitamin D Levels Among Women of Reproductive Age

The global burden of cancer, with deaths projected to increase from 7.6 million to 13.1 million by 2030, calls for urgent research into potential mitigating factors, such as Vitamin D levels. This study specifically addresses the correlation between Vitamin D and cancer prevalence among women of reproductive age, scrutinizing variables like age, socioeconomic background, and geographic location. Conducted at Fauji Foundation Hospital's Oncology department through detailed questionnaires, the study analyzes Vitamin D levels in newly diagnosed female cancer patients. While a significant direct association with cancer occurrence was not established, an alarming rate of Vitamin D deficiency and high obesity risk were noted. Furthermore, the study indicates an inverse relation between Vitamin D levels, sun exposure, and certain patient demographics. These findings underscore the necessity of considering environmental and lifestyle factors in cancer prevention strategies.

The current spectrum of infections in cancer patients with chemotherapy related neutropenia

Background: New cancer treatments have improved patient survival but also bring side effects like weakened immunity and higher infection risk. The present study aimed to assess the pattern of blood stream infections and antimicrobial resistance in blood isolates of neutropenic patients. Material and Methods: This Cross-sectional, observational study was conducted at Department of Oncology, Jinnah Postgraduate Medical Centre, Karachi, Pakistan between August 2019 to August 2020. Malignant patients who underwent chemotherapy and presented with fever, neutropenia, and positive bacterial blood culture were enrolled in the study. Patients with a recent history of blood transfusion were excluded. The spectrum of bacterial infections and the antimicrobial resistance patterns of causative organisms isolated from blood were studied. The CLSI standard antimicrobial panel was used for each microorganism. Findings were presented in tabular form. Results: During the study period 95 organisms were isolated from the blood cultures. Strains of E. Coli, Klebsiella, Pseudomonas, S. Aureus, S. Pneumoniae, were found in 27 (28.4%), 18 (18.9%), 13 (13.7%), 17 (17.9%), and 2 (2.1%) patients, respectively. 44.0% of E. coli, 68.8% of Klebsiella, and 38.5% of Pseudomonas were resistant to tazobactam. 92.6% of E. coli, 88.2% of Klebsiella, 100% of Pseudomonas were resistant to Co-amoxiclav. 52.9% of Staph aureus were resistant to methicillin. 23 (92.0%) strains of E. coli, 15 (83.3%) strains of Klebsiella, 6 (46.2%) strains of Pseudomonas, and 11 (68.8%) of Staph aureus were resistant to ciprofloxacin. Conclusion: Resistance to the majority of the commonly used antimicrobial drugs was noted. Continuous antimicrobial resistance surveillance of the everchanging spectrum of causative organisms and their characterization is very important to treat the bloodstream infections (BSI) in cancer patients with chemotherapy induced neutropenia. Keywords: Neutropenia Infection, Fever, Antimicrobial resistance, Chemotherapy.

Frequency of FLT3/ITD Mutation in Patients with Acute Myeloid Leukaemia presenting at Combined Military Hospital, Rawalpindi

Objective: To assess the frequency of FLT3/ITD mutation in patients of Acute myeloid leukaemia presenting at Combined Military Hospital, Rawalpindi Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Oncology Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan to Jun 2020. Methodology: A sample of 46 patients with acute myeloid leukaemia was included using a non-probability, consecutive sampling technique. Genetic testing was done on all blood samples to identify FLT3-ITD mutation. Results: Out of 46, 10(21.7%) were females and 36(78.3%) were males. The FLT3/ITD mutation frequency in our study sample was 10(21.7%), with all in de-novo AML patients and none in secondary AML. White cell count (55x109), bone marrow blasts (85%) and peripheral smear blasts (75%) were high in the FLT3-ITD mutated group in comparison to the non-mutated group. Conclusion: Timely detection of FLT3/ITD mutation and an amplification of induction therapy would benefit this group of patients.

Prevalence of Lymphedema and Associated Risk Factors Following Multimodal Breast Cancer Treatment

Background: Breast cancer related Lymphedema (BCRL) in the respective arm is a common but serious negative sequel of breast cancer management. Risk factors include dissection of Axillary lymph nodes and irradiation of Regional lymph nodes. Nearly 20% of patients receiving treatment of breast cancer develop this complication and it has a negative impact on quality of life of the patient. Objective: Current study aims to equip the medical professionals with all the details needed for prevention, early detection, intervention and management of this hazardous late treatment related complication. Material and Methods: Total 350 breast cancer patients (with their consent) treated at Government Cancer Hospital, Indore in the Radiotherapy and Oncology Department, in period from January 2019till December 2021, with chest wall radiotherapy following subsequent hormonal therapy, as needed. Patients then analysed for occurrence of lymphedema. Subsequently, efforts were given for finding out the correlation between lymphedema and related treatment modality like adjuvant radiotherapy following definitive surgery with number of excised lymph nodes and number of involved lymph nodes, chemotherapy, hormonal therapy, subjective co-morbid condition (obesity, diabetes mellitus and high blood pressure). Results: Current study demonstrate a significant correlation of adjuvant radiotherapy, including progressive involvement of the lymph node stations, with radical or conservative breast surgery with lymph node dissection represents a statistically significant risk factor, with relative risk, RR=1.49 (95% CI=0.72–3.05), p&lt;0.001. Subsequent increase in number of dissected lymph nodes shown a risk factor with statistical significance as relative risk for more than 25 removed lymph nodes, demonstrated significant risk of lymphedema than for 16-25 removed lymph nodes. Other analysed risk factors, which did not influence lymphedema development like, associated chemotherapy, hormonal therapy or presence of co-morbid illnesses. Conclusions: Arm lymphedema is a late sequel associated with carcinoma breast treatment using radiation or surgery, and quite capricious occurrence that can happen years after axillary clearance surgery. With the use of sentinel node sampling, could reduce the need of frank axillary clearance by showing either involvement of lymph node in axilla, so as to manage only by radiotherapy. That significantly reduces the risk of lymphedema from 16% with axillary clearance to 5% without dissection. Keywords: Lymphedema, Breast cancer, Risk factors, Axillary lymph node

Malnutrition as a predictor of adverse outcomes of febrile neutropenia in children with acute lymphoblastic leukemia during induction phase chemotherapy

Background: Adequate nutrition is an important concern in children with leukemia. Malnutrition impairs immune function, leading to increased incidence of infection, poor quality of life, as well as death. Febrile neutropenia (FN) has a high prevalence in children with acute lymphoblastic leukemia (ALL) and a poor outcome as well. Methods: This prospective observational study was done in the department of pediatrics hematology and oncology (PHO), BSMMU, from January 2021 to October 2021. A total of 60 patients of ALL were selected purposively. Patients were evaluated by taking anthropometric parameters before getting chemotherapy and were prospectively followed up for the development and outcome of FN until recovery. Statistical analysis was performed by using SPSS (Statistical package for the social sciences) for Windows version 26.0. Result: Analysis of nutritional status as a risk factor for FN based on anthropometric indices, was found statistically significant for, weight for height (≤5 years) p=0.036, OR=0.24 (95% CI= 0.06-0.958), weight for age p=0.006, OR=0.23 (95% CI=0.07-0.67), but for BMI for age (&gt;5 years) p=0.28, OD=0.28 (95% CI=0.02-3.19), and height for age p=0.513, OD=0.66 (95% CI=0.18-2.33) no statistically significant value was found. In this study, we found mortality rate was 15%. The mortality rate was significantly worse (27.3%) for patients who were malnourished at diagnosis as compared to those who were well nourished (7.9%) at diagnosis. Conclusions: FN and its complications are more common in malnourished children with ALL. Malnutrition is associated with adverse outcomes of FN in children with ALL.

Multidisciplinary diagnosis and treatment nutritional support intervention for gastrointestinal tumor radiotherapy: Impact on nutrition and quality of life.

Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem. This study aims to provide a scientific basis for improving clinical treatment effects, quality of life, and prognosis of patients with gastrointestinal tumors. To explore the clinical effect of the multidisciplinary diagnosis and treatment (MDT) nutrition intervention model on patients with gastrointestinal tumors. This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023. Using a random number table, 120 patients were randomly divided into MDT and control groups with 60 patients in each group. To analyze the effect of MDT on the nutritional status and quality of life of the patients, the nutritional status and quality of life scores of the patients were measured before and after the treatment. Albumin (ALB), transferrin (TRF), hemoglobin (Hb), and total protein (TP) levels significantly decreased after the treatment. The control group had significantly lower ALB, TRF, Hb, and TP levels than the MDT group, and the differences in these levels between the two groups were statistically significant (P < 0.05). After the treatment, the MDT group had significantly more well-nourished patients than the control group (P < 0.05). The quality of life total score, somatic functioning, role functioning, and emotional functioning were higher in the MDT group than in the control group. By contrast, pain, fatigue, nausea, and vomiting scores were lower in the MDT group than in the control group (P < 0.05). MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients. The study provides a rigorous theoretical basis for improving the prognosis of cancer patients. In the future, we intend to provide additional treatment methods for improving the quality of life of patients with cancer.