Tertiary Cancer Center In India Research Articles

Financial Impact of Complex Cancer Surgery in India: A Study of Pancreatic Cancer.

PurposeThe rapidly increasing burden of cancer in India has profound impacts on health care costs for patients and their families. High out-of-pocket (OOP) expenditure, lack of insurance, and low government expenditure create a vicious cycle, leading to household impoverishment. Complex cancer surgery is now increasingly important for emerging countries; however, little is understood about the macro- and microeconomics of these procedures. After the Lancet Oncology Commission on Global Cancer Surgery, we evaluated the OOP expenditure for patients undergoing pancreatico-duodenectomy (PD) at a government tertiary cancer center in India.MethodsProspective data from 98 patients who underwent PD between January 2014 and June 2015 were collected and analyzed. The time frame for consideration of expenses, including all preoperative investigations, was from the first hospital visit to the day of discharge. Catastrophic expenditure was calculated by assessing the percentage of households in which OOP health payments exceeded 10% of the total household income.ResultsThe mean expenditure for PD by patients was Rs.295,679.57 (US$74,420, purchasing power parity corrected). This amount was significantly higher among those admitted to a private ward and those with complications. Only 29.6% of the patients had insurance coverage. A total of 76.5% of the sample incurred catastrophic expenditure, and 38% of those with insurance underwent financial catastrophe compared with 93% of those without insurance. The percentage of patients facing catastrophic impact was highest among those in semiprivate wards, at 86.7%, followed by those in public and private wards.ConclusionThe cost of PD is high and is often unaffordable for a majority of India’s population. A review of insurance coverage policies for better coverage must be considered.

End-of-Life Treatments in Pediatric Patients at a Government Tertiary Cancer Center in India

The primary objective of this study was to describe demographics and end-of-life treatments of children with cancer at a government tertiary cancer center in India. A retrospective review was undertaken of medical charts of all children younger than 18 years, who died as inpatients while undergoing treatment at the pediatric oncology department between April and September 2016. Data were collected on demographics, diagnosis, treatments, survival, palliative care involvement, and symptoms at end of life. There were 44 pediatric oncology patients who died in the hospital during the study period. The most frequent diagnoses were hematological malignancies (n = 29). Tumor-specific treatment was given to 38/44 (86%) patients in the last 30 days of life, and 13 patients in the last day of life or 1 day before. Of all deaths, 23/44 (52%) occurred within 30 days of admission to the pediatric ward and 34/44 (77%) within 90 days. Of the 44 patients, 25 (57%) were referred to palliative care. The median number of days between referral and death was 14 (0-78) days. Frequent symptoms documented were bleeding (11/44), dyspnea (10/44), pain (7/44), seizures (7/44), and delirium (5/44), with each patient having one or more of these symptoms. Only patients with a palliative care referral received opioid analgesics or benzodiazepines at the end of life. This study highlights the demographics of suffering, death, and end-of-life care in children with cancer at a government tertiary cancer center in India.

Abstract No. 561 Percutaneous endoluminal brush cytology in patients suspected of malignant biliary obstruction: Experience from a tertiary cancer center in India

To evaluate endoluminal brush cytology during percutaneous biliary drainage in patients suspected of malignant biliary obstruction. From January 2010 to December 2016, 106 consecutive patients with obstructive jaundice secondary to suspected malignant biliary obstruction underwent 136 endoluminal brush cytology procedures, during or after percutaneous transhepatic biliary drainage in presence of on-site cytologist. The data was collected retrospectively and analysed. The lesions involved the common bile duct (n-21), common hepatic duct (n-22) and hilum with right or left intrahepatic ducts (n-63). In each patient, upto three (mean-1.3) brush cytology specimens were taken with 8F double lumen brush. Definitive diagnosis in each case was established by the Brush cytology, exploratory laparotomy, biopsy/cytology from any other metastatic site or combination of tumour markers, radiological or clinical suspicion and increase in size or metastasis in follow-up. Statistical analysis was performed using chi-square test and Z-test of significance to compare sensitivity and p-value ≤0.05 was considered statistically significant. 66 out of 106 patients had correct diagnoses of malignancy on brush cytology. 3 diagnoses proved to be true-negative & 37 were false-negative. 9 out of 22 patients (40.1%) had malignancy diagnosed in 2nd attempt and 1 of 3 patients (33.3%) had malignancy diagnosed with 3rd attempt. Diagnostic sensitivity and specificity brush cytology for malignant nature of biliary strictures was 64.1% and 100% respectively with accuracy of 65.1%. The sensitivity of brush cytology was highest in proximal hilar block 67.8% as against 38.5% noted for lower CBD block, this difference was statistically significant (p-value ≤0.034). Anastomotic site recurrence had a sensitivity of 46.1% in diagnosing malignant nature of disease. No complications were related to the procedure. Percutaneous endoluminal brush cytology is relatively accurate procedure that is safe & easy to perform through a transhepatic biliary drainage tract. Sensitivity to diagnose malignant stricture was higher in primary and proximal hilar block as against lower CBD block & anastomotic site strictures.

Outcomes and complications of surgery in patients with intermediate-risk neuroblastoma: experience from an Indian tertiary Cancer Centre.

The treatment of intermediate risk (IR) neuroblastoma has evolved with the focus now on reducing the drugs, dosage, and duration of chemotherapy. The aim of this study is to present the outcomes of treatment and the complications of surgery in patients with IR neuroblastoma treated at a tertiary cancer center in India. All eligible patients with IR neuroblastoma treated between April 2005 and August 2016 were identified. The presence and number of image-defined risk factors (IDRF) before and after neoadjuvant chemotherapy were retrospectively analyzed as were the extent of surgery, complications, and outcomes. Of 282 neuroblastoma patients treated during the study period, 54 had IR neuroblastoma. Complete excision was achieved in 25 patients. There were 26 surgical complications in 22 patients with a similar incidence in patients with complete (n = 13) or incomplete (n = 13) resection (p = 0.78). After a median follow-up of 47 months, the 4-year overall and event-free survival was 91.5% and 75%, respectively. There was no difference in survival between patients who underwent complete resection versus those with incomplete resection (p = 0.9). Outcomes of IR neuroblastoma are favorable. The extent of resection does not affect the survival and complications can occur even when the resection is incomplete.

Buccal Fat Pad a Forgotten Option of Reconstruction in Oral Cancer.

The buccal fat pad (BFP) originally described as an anatomic structure without any obvious function. For long period it was considered to be surgical nuisance. However during the last four decades buccal fat is successively used tool for maxillofacial surgery for reconstruction of small to medium sized acquired or congenital soft tissue and bony defect in oral cavity. The aim of present article is to review the database available regarding BFP including its anatomy, clinical usage in oral malignancy as tool of reconstruction after ablative procedures it's success and its adoptability with other loco-regional flap for oral reconstruction in different scenario and our experience with it in tertiary cancer centre in India.

Hepatoblastoma: 16-years’ experience from a tertiary cancer centre in India

BackgroundHepatoblastoma is a rare pediatric tumor arising from the liver. The present study was conducted to ascertain the clinical profile and survival outcomes of patients with hepatoblastoma treated at our centre. MethodsWe collected the case records of patients with hepatoblastoma treated between January 2000 to December 2016 and analysed the baseline characteristics, treatment details and outcomes. Survival was analysed using Kaplan Meier method. ResultsTwenty-seven patients with hepatoblastoma received treatment at our centre during the study period. Median age of the patients was 12 months and 76% were males. The commonest presenting symptom was abdominal mass and the median Alpha Fetoprotein (AFP) level at the time of diagnosis was 40,000 ng/ml. PRETEXT stage II was documented in 11 and III in 11 patients. High risk disease (PRETEXT IV or metastatic disease or portal venous invasion or AFP < 100 ng/ml) was documented in 8/27 (30%) patients. Neoadjuvant chemotherapy (NACT) was given to 23/27 patients and complete surgical resection was possible in 15/23 (65%) after NACT. Infusional cisplatin and doxorubicin (PLADO) was given in 24/27 patients. Liver transplantation was done in 1 patient. The median follow-up was 51 months and the 5-year overall survival for standard risk and high-risk patients was 78.8% and 40% respectively. ConclusionPatients with standard risk hepatoblastoma have survival outcomes comparable to Western countries, however, outcomes in patients with high risk non-metastatic inoperable disease remains low due to financial constraints in performing liver transplantation. Multimodality treatment including NACT with PLADO based regimens followed by resection is a feasible strategy.

Surgical outcomes of thyroid cancer patients in a tertiary cancer center in India.

Surgery is the mainstay in the management of thyroid cancer. Surgical outcomes need to be tempered against the excellent prognosis of the disease. This study aims to study the surgical outcomes including the 30-day morbidity and 5-year survival of thyroid cancer patients. Retrospective analysis of a prospectively maintained surgical database in a tertiary cancer center in India. We analyzed 221 surgically treated patients in the year 2012. Used IBM SPSS 24.0 (Armonk, NY) with p < 0.05. The median age was 40 years with predominantly papillary thyroid carcinoma (55%). Localized disease in 47% of cases, locoregional disease in 42.5% and distant metastasis in 10.2% of cases at presentation was noted. Treatment naïve patients were 71% and revision surgeries were done in 29% patients. Extended thyroidectomy constituted 11% of the surgeries. Temporary hypocalcemia was seen in 30.8% of patients, 5% requiring intravenous calcium supplementation. Vocal cord palsy as per nerve at risk and chyle leak were seen in 4.5% and 3.1%, respectively. Aggressive histology, extended thyroidectomy, and inadvertent parathyroidectomy were significant factors associated with complications. Five year estimated overall survival with median follow-up of 50 months was 98%, and event-free survival was 84.8%. Advanced age, distant metastasis at presentation and aggressive histology connoted poor outcomes. Thyroid cancer, irrespective of the extent of disease, has good prognosis. Aggressive histology, the extent of thyroid surgery, distant metastasis and age are important factors, which should be factored in the algorithm of thyroid cancer management.

Outbreak of Burkholderia cepacia catheter-related bloodstream infection in cancer patients with long-term central venous devices at a tertiary cancer centre in India

Background: Different central venous devices are required in cancer patients for long duration, especially in hematological malignancies. In this new era of highly developed long-term central venous devices such as port and peripherally inserted central catheter line, incidence of catheter-related bloodstream infection (CRBSI) is low. However, immunocompromised cancer patients may acquire catheter-related opportunistic infections frequently including Burkholderia cepacia. B.cepacia can cause various bloodstream infections, pneumonias, and wound infections etc. Methodology and Result: We analyzed an outbreak of 14 cases of B. cepacia infection in patients with long-term central venous lines at a tertiary oncology care center. Febrile neutropenia was the only clinical presentation at the time of detection of infection in almost all patients, and the catheter had to be removed in 10 patients owing to partial response to susceptible antibiotic therapy. The source of infection that led to the outbreak could not be identified. Nevertheless, all possible measures to prevent cross-contamination including training of the staff to maintain hand hygiene and aseptic precautions were taken. Although resecuring central venous access is difficult in these patients due to bleeding diathesis, timely decision to remove the catheter based on standard guidelines can prevent complications. To the best of our knowledge, this is the first outbreak of B. cepacia-positive CRBSI reported in this specific subgroup of patients in North India. Conclusion: The opportunistic infection (B. cepacia) of central venous devices during chemotherapy being resistant to commonly used antibiotics could be an important factor in increasing morbidity and mortality in cancer patients.

Molecular Heterogeneity in Acute Promyelocytic Leukemia - a Single Center Experience from India.

Atypical breakpoints and variant APL cases involving alternative chromosomal aberrations are seen in a small subset of acute promyelocytic leukemia (APL) patients. Over seven different partner genes for RARA have been described. Although rare, these variants prove to be a diagnostic challenge and require a combination of advanced cytogenetic and molecular techniques for accurate characterization. Heterogeneity occurs not only at the molecular level but also at clinico-pathological level influencing treatment response and outcome. In this case series, we describe the molecular heterogeneity of APL with a focus on seven variant APL cases from a single tertiary cancer center in India over a period of two and a half years.We discuss five cases with ZBTB16-RARA fusion and two novel PML-RARA variants, including a Bcr3 variant involving fusion of PML exon4 and RARA exon3 with an additional 40 nucleotides originating from RARA intron2, another involving exon 6 of PML and exon 3 of RARA with addition of 126 nucleotides, which mapped to the central portion of RARA intron 2. To the best of our knowledge, this is the first case series of this kind from India.

Breast cancer in a tertiary cancer center in India - An audit, with outcome analysis.

Survival studies may serve as benchmarks to develop cancer-related policies and estimate baseline survival rates in a given patient population. We carried out a retrospective audit of cases managed in 2009 and now report the disease-free survival (DFS) in early breast cancer (EBC) and locally advanced breast cancer (LABC) in patients registered at a tertiary cancer center in India. The study included 2192 patients with breast cancer with ages ranging from 18 years to 94 years with a median of 50 years. Of these, 888 (40.5%) were EBCs Stage I and II, 833 (38%) were LABCs (Stage III), and 471 (21.5%) were de novo metastatic or relapsed cancers at presentation. The 5-year DFS in the women with EBC was 85.5% and in LABC, it was 67.7%, P < 0.001. The factors adversely affecting DFS in EBC were node metastasis (P < 0.001), higher metastatic nodes (P < 0.001), hormone receptor negativity (P = 0.001), and human epidermal growth factor receptor 2 (Her2neu) positivity (P = 0.033). In the multivariate Cox regression analysis in EBC, node-positive status (hazard ratio [HR] 2.28, 95% confidence interval [CI] 1.51-3.45, P < 0.001) and hormone receptor negative tumors (HR 1.96, 95% CI 1.30-2.94, P = 0.001) significantly affected DFS in EBC. The factors adversely affecting DFS in LABC in the univariate analysis were node metastasis (P < 0.001), increasing numbers of nodes (P < 0.001), presence of lymphovascular emboli (LVE) (P < 0.01), mastectomy (P < 0.001), and Her2neu positivity (P = 0.03). In the multivariate Cox regression analysis, node positivity (HR 2.96, 95% CI 2.04-4.29, P < 0.0001), presence of LVE (HR 1.47, 95% CI 1.06-2.04, P = 0.023), and mastectomy (HR 1.49, 95% CI 1.06-2.10, P = 0.023) adversely impacted DFS in LABC. The survival rates in this study are equal to the documented global rates; nodal disease burden emerged as the most important prognostic factor. In addition, in EBCs, a lack of hormone receptor expression and in LABC, Her2neu overexpression appear to worsen the outcome.

Chemotherapy-induced cardiotoxicity: Preliminary report from a tertiary cancer centre in India

Cancer has emerged as a major public health issue in India owing to significant epidemiological and demographic transition. As per literature, the overall ten-year survival rate for cancer is at 50% across the 20 most common malignancies. However, the ten-year survival rate is even more high, i.e. approximately 80% or higher for breast, melanoma, lymphoma, and uterine cancers. Contrary to the improved long-term cancer survival rates there has been an increase in adverse cardiac effects of cancer treatment. A retrospective analysis of patients admitted at HCG Manavata Cancer Centre, Nashik was conducted. The study was conducted at a single center comprising of 115 participants. Anthracyline chemotherapy has remained a mainstay treatment approach for cancer patients. Cardiotoxic side-effects of anthracyline chemotherapy regimens often limits their dosing. Although anthracylines have been associated with improved cancer outcomes, there remains an increased risk of cardiovascular morbidity and mortality. Doxorubicin-induced cardio toxicity was 5.45% while trastuzumab cardio toxicity was 5.26% (Table 4). The estimated cardio toxicity rate for our two-year follow-up was 4.08% for all specified chemotherapy regimens. The early detection of cardio toxicity by appropriate follow-up and monitoring is essential. Evaluation of patients using LVEF as a key parameter would help prevent irreversible cardio toxic events. Our preliminary report may act as a base for researchers and academicians to conduct and review ongoing chemotherapy regimens.

Outcomes with second-line chemotherapy in advanced pancreatic cancers: A retrospective study from a tertiary cancer center in India.

Approximately 40% of patients receiving first-line chemotherapy (CT1) for advanced pancreatic adenocarcinomas (PDACs) receive second-line chemotherapy (CT2). The most appropriate regimen to be used has not been identified, and data regarding CT2 in advanced PDAC from India are scarce. A retrospective analysis of advanced PDAC patients who were evaluated during the period of August 2013 to August 2016 in the Department of GI medical Oncology, at Tata Memorial Hospital was conducted. Patients with histologically proven PDAC and started on CT2 postprogression or recurrence after CT1 were included for analysis. A total of 237 patients received CT1 in the period of study, of which 76 patients (39.66%) received CT2. The median age of patients was 59.5 years (range: 38-82), majority were male (69.7%), and 14 patients (18.4%) had undergone curative pancreatic resection at baseline. The common regimens used as CT2 were modified 5 fluorouracil/leucovorin/irinotecan (mFOLFIRI) (35.5%), gemcitabine-nab paclitaxel (18.4%), and gemcitabine-erlotinib (11.8%). Common grade 3/4 toxicities noted were fatigue (10.3%), anemia (10.3%), neutropenia (7.4%), and vomiting (7.4%). Dose reductions were required in 32.9% of patients. RR, DCR, median event free survival, and median overall survival were 21.1%, 48.7%, and 5.94 months (95% confidence intervals [CI]: 4.68-7.20) and 8.08 months (95% CI: 7.11-9.07) respectively. CT2 in advanced PDAC appears feasible in the Indian setting if the patients are appropriately selected and they can be treated with acceptable toxicities and reasonable outcomes.

279P - Chemotherapy in carcinoma penis: Experience from a tertiary cancer centre in India

Background: Carcinoma penis is more common in India compared to the West. The role of chemotherapy in carcinoma penis is ambiguous. The present study was conducted to analyze the outcomes of patients with carcinoma penis treated with chemotherapy at our institute. Methods: The case files of all patients of carcinoma penis treated at our institute between 2012 and 2015 were analyzed. The treatment of patients was individualized based on the decision of the multidisciplinary tumor board. Analysis was done to ascertain the use of chemotherapy in patients and identify factors influencing the decision to treat patients with chemotherapy. Event free and overall survival (EFS and OS) were calculated from the time of diagnosis until disease relapse/progression or death. Results: There were 171 patients treated for carcinoma penis, with median age of 55 years (25-91 years). The stage wise distribution of patients was stage I in 51 (30.5%), stage II in 49 (29.3%), stage III in 31 (18.6%), stage IV non-metastatic in 29(17.4%) and metastatic in 7 patients (4.2%). Chemotherapy was given in 42 patients (24.5%); 17/31 patients (40.5%) with stage III, 20/29 patients (47.6%) with stage IV (non-metastatic) and 5/7 patients with metastatic disease received chemotherapy. Neoadjuvant chemotherapy (NACT) was given in 3 patients with stage III and 9 patients with stage IV disease. Of the 12 patients who were given NACT, there was a partial response in 6 patients (46.2%), stable disease in 2 (15.4%) and progressive disease in 4 (30.7%). Cisplatin and 5FU was used in 26/42 (61%) patients and paclitaxel and carboplatin in 16/42(39%).None of the patients received radiotherapy with curative intent. After a median follow up of 20 months, the 2-year OS were 95.7%, 89%, 80.5%,51.9% and 28.6% for stage I, II, III, IV and metastatic disease respectively. The 2-year OS in patients with stage III and IV (non-metastatic) disease who received chemotherapy or did not receive chemotherapy was 59.6% and 74% respectively (P = 0.5). Conclusions: Approximately one-third of patients with carcinoma penis do not receive chemotherapy. Our study did not show any benefit of chemotherapy in patients with advanced disease. However, further prospective trials are required regarding the exact role of chemotherapy in this malignancy. Legal entity responsible for the study: Cancer Institute, Adyar. Funding: None Disclosure: All authors have declared no conflicts of interest.

CT-guided radiofrequency ablation in osteoid osteoma: Result from a tertiary cancer centre in India.

Aims:The aim of this study is to evaluate the clinical efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation as a minimally invasive therapy for osteoid osteoma.Materials and Methods:This is a retrospective analysis of prospectively maintained data of 43 symptomatic osteoid osteoma patients who were treated by radiofrequency ablation (RFA). Forty out of 43 patients were naive cases and underwent primary treatment for osteoid osteoma with RFA, whereas 3 patients included in the study underwent RFA for local recurrence after having undergone surgical treatment. Diagnosis was based on clinical and characteristic imaging findings, and biopsy was done for cases with atypical presentation. Pre and post procedure Visual Analog Score (VAS) was documented in all cases. Monopolar RFA system was used in all patients, and the electrode was placed within the lesion nidus under CT guidance coaxially through 11G introducer needle. Ablation was performed at 90° C for 5 min.Results:Technical success rate of intranidal placement of electrode was 100%. The primary clinical success in our study was 97.7% (42 of 43), and the secondary clinical success was 100%. Pre and postprocedure VAS score in our study group was 7.8 and 0.4, respectively. Mean follow-up period in our study was 48 months (Range: 4–129 months). One patient had recurrence of pain 4 years after treatment and was treated successfully by a second session. Minor complications were seen in 3 patients with two cases of RF pad burns and one case of skin burn at the treatment site, and these were managed conservatively. No patients developed temporary/permanent neurological deficits, and no procedure-related mortality was seen in our study.Conclusion:CT-guided percutaneous RFA is a simple, safe, minimally invasive, and highly effective treatment option for osteoid osteoma with good long-term pain control and potentially low disease recurrence.

Laparoscopic Versus Open Approach for Intersphincteric Resection-Results from a Tertiary Cancer Center in India.

The study aims to compare open intersphincteric resection (OISR) with laparoscopic intersphincteric resection (LISR) in terms of short-term oncological and clinical outcomes. This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent intersphincteric resection (ISR) at Tata Memorial Centre between 1st July 2013 and 30th November 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), distal resection margin involvement, and number of nodes harvested. Perioperative outcomes included blood loss, length of hospital stay and 30-day postoperative morbidity and mortality. Chi-square test was used to compare the results between the two groups. Thirty nine cases of OISR and 34 cases of LISR were included in the study. Median BMI was higher in LISR group; otherwise, the two groups were comparable in all aspects. There were no conversions in LISR group. CRM involvement was seen in four patients (10%) in the conventional group compared to none in the LISR group. Median hospital stay was comparable between the two groups. Laparoscopic ISR is safe and can be performed with low conversion rate in selected group of patients.

Young Vs Old Colorectal Cancer in Indian Subcontinent: a Tertiary Care Center Experience.

This study aims to compare patient, tumor, treatment-related factors and survival between young (<45years) and old (>45years) Indian colorectal cancer (CRC) patients. Total 778 patients of CRC were registered at tertiary cancer center in India between 1 August 2013 and 31 July 2014. Patients were followed up for median period of 27.73months. Data regarding patient, tumor, treatment and survival-related factors were collected. Patients were divided in young (≤45years) and old (>45years) age groups. Statistical analysis was done with SPSS software version 23. Young age group patients presented more commonly with poor histology, node-positive disease, and rectal site. Younger age group patients received multiple lines of neoadjuvant treatment. There was no significant overall survival difference in both groups of patients. On stratified stage-wise analysis, no significant overall survival (OS) difference was found between two groups (young vs old-1- and 3-year OS: 85.2 and 61.5% vs 81.5 and 64.5%, respectively; P=0.881). On univariate analysis, gender, performance status, site, stage, differentiation, TRG, CRM status, signet ring type, and CEA level were significant prognostic factors. In disease-free survival (DFS) analysis, it is found that there is statistically significant difference in DFS (young vs old: 1 and 3years; 77.6 and 62.8% vs 85.8 and 74.1%, respectively; P value, 0.02), but when OS was analyzed for same group of patient, there was no statistical difference (P=0.302). This study confirms the high incidence rates of CRC in young Indian patients. There is no OS difference between two age groups. In operated group of patients, there is higher DFS in older patients but no OS advantage at 3years follow-up. Further long-term follow-up is required to see any OS difference.

Adherence to and Implementation of ASCO Antiemetic Guidelines in Routine Practice in a Tertiary Cancer Center in India.

Nonadherence of antiemetic prescriptions to evidence-based antiemetic guidelines is associated with an increased proportion of chemotherapy-induced nausea and vomiting. The current project was carried out to improve the quality of antiemetic prescriptions at our institute. We initially performed a retrospective analysis of 1,211 consecutive antiemetic prescription records of adult patients with solid tumors who received outpatient chemotherapy regimens. The antiemetic prescription records were classified as either ASCO-guideline adherent or nonadherent, and the impact on emesis was studied. These data were used to educate clinicians regarding the importance of adherence to guidelines. We then revised our antiemetic prescription policies and made their use mandatory. In addition, a double-check system was introduced to ensure implementation. A reaudit was performed to study the impact of these interventions. ASCO-guideline-adherent prescriptions in the initial part of our study were associated with a lower rate of vomiting (6.6% v 21.9%; P < .001), emergency visits (2.6% v 5.8%; P = .006), and hospitalization for emesis (0.9% v 4.9%; P < .001). The proportion of prescriptions classified as ASCO-guideline adherent in the initial audit and the reaudit were 63.6% and 98.5%, respectively ( P < .001). The proportion of patients for whom antiemetic prescriptions were overused was significantly lower on the reaudit (41.3% v 68.3% before the interventions; P = .001). Mandatory, semirigid corrective steps as carried out in this audit led to an improvement in antiemetic-guideline adherence rate.

Survey of return to work of head and neck cancer survivors: A report from a tertiary cancer center in India.

The rates and factors associated with the return to work of head and neck cancer survivors from low- and middle-income countries, such as India, are largely unknown. We conducted a preliminary cross-sectional survey of 250 consecutive eligible head and neck cancer survivors (age <60; ≥6 months posttreatment) to identify return to work rates and sociodemographic, clinical, and quality of life (QOL; European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions [EORTC-QLQ-C30] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Head and Neck 35-questions [EORTC-QLQ-H&N35]) correlates. In our cohort, 92.4% of the patients were employed pretreatment, 65.6% and 81.2% returned to work at 6 months posttreatment and by the time of the survey (median follow-up 19 months), respectively. Family structure (<2 male children, p = .008; eldest child age <20 years, p = .04), a higher level of education (vocational or professional training, p = .013) and female sex (p = .001) were associated with higher return to work. Head and neck cancer survivors who returned to work had better global quality of life (QOL; p = .014) and less coughing (p = .001) but more problems related to sticky saliva (p = .004). Further studies are needed to address the large unmet needs regarding identification and amelioration of barriers to return to work for head and neck cancer survivors in low- and middle-income countries, such as India. © 2017 Wiley Periodicals, Inc. Head Neck 39: 893-899, 2017.

Triple negative breast cancer in Indian population: An analysis from a tertiary cancer center in India

Triple negative breast cancer in Indian population: An analysis from a tertiary cancer center in India

Analysis of 58 Cases of GTT from 2000-2013 at A Tertiary Cancer Center in India

Analysis of 58 Cases of GTT from 2000-2013 at A Tertiary Cancer Center in India