Tertiary Care Cancer Hospital Research Articles

Incidence of acute kidney injury and its associated risk factors in patients undergoing elective oesophagectomy surgeries at a tertiary care cancer institute – A pilot prospective observational study

Background and Aims: Acute kidney injury (AKI) is a significant postoperative complication. Multiple perioperative factors are implicated in the causation of AKI in the postoperative period in patients with oesophageal cancer. The study aimed to find out the incidence, causes and effects of AKI following oesophagectomy surgery. Methods: A prospective observational study was conducted in consecutive adult patients undergoing elective oesophagectomy at a tertiary cancer care hospital. Patients with preoperative chronic renal insufficiency (serum creatinine >1.5 mg/dl), AKI in the past and a history of renal replacement therapy were excluded. Serum creatinine values were measured on postoperative days 1, 3, 5, the day of discharge or day 15 and on the day of first follow-up or day 28, following oesophagectomy surgery. The incidence of AKI was measured using the ‘Kidney Disease Improving Global Outcome’ (KDIGO) criteria. Results: The incidence of AKI was 14.7% [95% confidence interval (CI) 9.9%, 20.7%] (i.e., 27/183) in patients who underwent elective oesophagectomy. AKI was associated with prolonged hospital stay [median- 13 days (interquartile range {IQR} 11–21.5) versus 9 days (IQR 8–12), P < 0.001] and increased in-hospital mortality (14.8% versus 1.3%, P 0.004, odds ratio = 13.2, 95% CI 2.3, 77.3). After multivariate analysis, age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI. Conclusion: The incidence of AKI was 14.7% after elective oesophagectomy. AKI was associated with prolonged hospital stay and in-hospital mortality. Higher age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI.

Validity and reliability of the 9-item shared decision-making questionnaire (SDM-Q-9) among Indian oncology patients in a tertiary care hospital

BackgroundThe SDM-Q-9 is a widely used and reliable tool for assessing patient involvement in shared decision-making. However, there is a dearth of validated information regarding this tool among the Indian population. Therefore, the current study aimed to evaluate the validity and reliability of the Hindi version of the SDM-Q-9 questionnaire in Indian oncology patients. Methodology: This study was conducted between August 2022 to March 2023 at a tertiary cancer care hospital in India. The sample comprised 150 patients. The scale was initially translated into the Hindi language and later back-translated by experts. Item characteristics were measured using the difficulty index, corrected item-total item correlation, and internal consistency. Factor analysis was conducted using both exploratory factor analysis and confirmatory factor analysis to validate the scale in SPSS v.27 and IBM AMOS v.26. ResultsThe Cronbach alpha value was found to be significantly good (0.841), indicating high internal consistency. Additionally, the Kaiser-Mayer-Olkin value was 0.825, which suggested that the sample adequacy was satisfactory. Bartlett's test (x2 = 461.209 (df = 36), p = 0.000) also showed that the data were suitable for factor analysis. EFA resulted in an uni-factorial model extraction similar to the developed version, with acceptable model fit indices including CFI (0.861), GFI (0.891), AGFI (0.818), RMSEA (0.122), SRMR (0.119), and TLI (0.815). The CFA resulted in better model fit indices. ConclusionThe study suggests that the Hindi version of the SDM-Q-9 questionnaire is a suitable tool for measuring patient-reported involvement in clinical decision-making among Indian oncology patients.

Analytical and clinical evaluation of the cobas Epstein–Barr virus test at a tertiary care cancer hospital

BackgroundEpstein–Barr Virus (EBV) viral loads in hematopoietic stem cell transplant (HSCT) recipients are typically monitored using quantitative molecular assays. The Cobas EBV test (Roche Molecular, Pleasanton, CA) has recently been FDA-cleared for the monitoring of EBV viral loads in plasma samples of transplant patients. In this study, we compared the viral loads obtained by a laboratory-developed test (EBV LDT) using Altona Analyte specific reagents (ASR) to those obtained on the Cobas EBV test. MethodsThe analytical performance of the assay was established using the EBV verification panel from Exact Diagnostics and the EBV ATCC strain B95-8. The clinical evaluation was performed using 343 plasma samples initially tested on the EBV LDT. ResultsThe analytical sensitivity (<18.8 IU/mL), precision (SD < 0.17 log) and linear range (35.0 IU/mL to 1E + 08 IU/mL) of the Cobas EBV assay established by the manufacturers were confirmed. The strength of the qualitative agreement was substantial between the cobas EBV and the EBV LDT (85.6 %; κ = 0.71) and almost perfect when discordant results were resolved (96.4 %; κ = 0.93). The quantitative agreement was moderate (82.9 %; κ = 0.53) with the viral load obtained on the Cobas EBV test being lower across the linear range of the two tests (mean log difference of 1.0). While the absolute values of the viral loads were markedly different, the overall trends observed in patients with multiple consecutive results were similar between the two tests. ConclusionsThe Cobas EBV test provides an accurate and valid, in vitro diagnostic (IVD) option for monitoring of EBV viral loads in transplant patients and should provide an opportunity for increased standardization and commutability of tests results across laboratories.

A comparison of port-site infiltration with bupivacaine alone vs. bupivacaine plus dexemedetomidine after diagnostic staging laparoscopy

Objective: To compare the effects of bupivacaine alone and in combination with dexmedetomidine following staging laparoscopies. Method: The triple-blinded, prospective study was conducted from June to September 2021 at a tertiary care cancer hospital in Lahore, Pakistan, and comprised adult patients having American Society of Anaesthesiologists (grade I-III, weighing &gt;30kg and undergoing diagnostic staging laparoscopy. The subjects were randomised into two equal groups. Group A received 6ml of 2mg/kg bupivacaine at each of the four laparoscopic port sites before skin closure, while group B additionally received 2µg/kg dexmedetomidine. The presence and severity of pain were recorded and assessed at 15 min, 1, 2 and 4 hours as well as at the time of discharge from the post-anaesthesia care unit. The time to first request for rescue analgesia, total morphine consumption, and the occurrence of any side effects during their stay were also recorded. Data was analysed using SPSS 23. Results: Of the 30 patients, 15(50%) were in group A; 10(66.6%) males and 5(33.3%) females with mean age 43.27±7.59 years. There were 15(50%) patients in group B; 12(80%) males and 3(20%) females with mean age 41.36±12.42 years (p&gt;0.05). Of the total, 29(96.66%) patients were classified as American Society of Anaesthesiologists grade II, and 1(3.33%) patient in group A was grade III. There was no significant difference between the groups in any of the outcome measures assessed (p&gt;0.05), and none of the patients experienced any side effect throughout the post-operative stay. Conclusion: The combination of dexmedetomidine and bupivacaine had no significant improvement in pain relief compared to bupivacaine alone. Key Words: Diagnostic laparoscopy, Staging laparoscopy, laparoscopy, Dexmedetomidine, Bupivacaine, Local infiltration, Regional anaesthesia.

Study of behavioral and psychosocial factors relating to needle stick injuries in nursing staff of a tertiary care cancer hospital of Punjab, India

Background and Objectives: Needle stick injury (NSI) is the most dreaded occupational health hazard affecting a health- care worker (HCW) psychologically and physically. The risk of infection post needle stick injury ranges between 1.9% to greater than 40% for HBV infections, 2.7-10% for HCV and 0.2-0.44% for HIV infections. As per National AIDS Control Organisation (NACO) records, nursing staff is at highest risk (43%) followed by physicians (28%). The main objective of this study was to evaluate knowledge of nursing staff about needle stick injuries and to study factors leading to such incidents in their working areas, impart them knowledge regarding the same and fill gaps in knowledge.&#x0D; Materials and Methods: This is a cross-sectional retrospective analysis involving nursing staff and students. p values were calculated using SPSS software.&#x0D; Results: Overall NSI prevalence among nursing staff and students was 51.6% whereas in more exposed and less exposed group was 47.45% and 10.16% respectively (p=0.2056). The most common cause of NSI incident was recapping of needle (38.5%) followed by transferring needle to sharp container (35%).&#x0D; Conclusion: Consequences of NSI are serious and this study has tried to emphasize on the need to study the factors leading to NSI.&#x0D;

Histopathological Spectrum of Thyroid Neoplasm - A Retrospective Study Done at Tertiary Cancer Care Hospital

Thyroid lesions are fairly common &amp; have a wide spectrum of diseases ranging from functional, immune mediated to neoplastic lesions. All thyroidectomy specimens were included in the study period of 1.5 years from September 2019 to February 2021 at our institute, a total of 10,200 biopsies were sent to our department for histopathological examination, out of which 7200 were diagnosed as malignant cases, of which 408 (5.6%) cases were thyroid cancer (TC) cases. One hundred forty-five (35.53%) out of 408 TC cases underwent thyroid surgeries, fifty consecutive cases who fulfilled the inclusion criteria were registered in our study. All grossed, processed, stained sections of haematoxylin and eosin were reviewed and observed under microscope. Average age of the patients suffering from TC was found 44.80 years. Female preponderance seen with F:M-1.38:1. Most common location of tumor was Right lobe of thyroid (32%) followed by Left Lobe (26%). Malignant lesions (96%) predominated over Benign lesions (4%). Papillary carcinoma thyroid was the most common malignancy (72%) followed by Follicular carcinoma (14%). Both benign cases were of Trabaecular Adenoma (4%). Majority of tumors were Unifocal (62%) followed by Mutlifocal (38%). Keywords: Thyroid Neoplasm, Benign and Malignant lesions

An observational prospective study of mucocutaneous adverse effects of chemotherapeutic drugs and radiotherapy

Background There is an enormous advancement in chemotherapeutic drugs and radiotherapy. With the advancement, the adverse effects in patients receiving chemotherapeutic drugs and radiotherapy have also increased. Hence identifying and treating adverse effects of chemotherapeutic drugs and radiotherapy is of utmost importance for patients. This study will help us to find out the various mucocutaneous adverse effects associated with various new chemotherapeutic drugs and radiation. Our objective is to find out the frequency of mucocutaneous manifestation in patients receiving chemotherapy and radiotherapy and also to know and assess the various patterns and severity of mucocutaneous involvement in chemotherapy and radiotherapy. Methods This will be an observational prospective study that will be conducted in a tertiary care cancer hospital [Siddharth Gupta Memorial Cancer Hospital] and patients coming to OPD of AVBRH in the Department of Dermatology from 15th December 2023 to 15 September 2024, who will be presenting with the mucocutaneous adverse effects. Detailed History and Cutaneous examination will be performed and graded according to Common Terminology Criteria for Adverse Events v5. The various mucocutaneous adverse effects will be compiled and grading will be done. This study will help us to find out the various mucocutaneous adverse effects associated with various new chemotherapeutic drugs and radiation. Results We will study the various mucocutaneous manifestations in patients with solid organ malignancy or hematological malignancy receiving chemotherapy and radiotherapy.

Depression and anxiety among cancer patients visiting a tertiary care cancer hospital.

Cancer patients frequently experience psychological problems related to reactions to cancer diagnosis, cancer type and stage, treatment effects, recurrence, fear of end-of-life, survivorship, and financial burden. Depression and anxiety are both psychological and physiological disturbances among cancer patients. To assess the prevalence of depression and anxiety among cancer patients attending a tertiary care cancer hospital. A cross-sectional study was conducted at Bhaktapur Cancer Hospital in Kathmandu Valley among 220 cancer patients aged from 18 years to 70 years. Ethical approval was taken from the Institutional Review Committee of CiST College. Convenient sampling was used to interview patients with the standardized Patient-Health Questionnaire (PHQ-9) for Depression and Hospital Anxiety and Depression sub-scale (HADS-A) for anxiety. Epi-Data was used for data entry and transferred to SPSS Version 25 for analysis. The study revealed that of 220 patients, most of the respondents belonged to the age group 51-60 years. More than half 131 (59.6%) of the respondents were female, most of them had depression, and one-third had anxiety. Among the respondents, 124 (56.4%) had mild depression, 70 (31.8%) had moderate depression, and 3 (1.3%) had severe depression; 79 (35.9%) had mild anxiety, 64 (29.1%) had moderate anxiety, and 4 (1.8%) had severe anxiety. Most respondents were depressed and one-third had anxiety. More than half and nearly one-third had mild and moderate depression, respectively, and nearly one-third had mild and moderate anxiety, which is higher than other studies.

Posttraumatic stress symptoms during treatment in parents of children diagnosed with cancer

The study aimed to study the presence of PTSS in parents of children with cancer currently on treatment and the association of PTSS in parents with cancer during treatment with length of time since diagnosis and treatment intensity. The study was conducted on 360 parents at a Tertiary Care Government Medical College and Cancer Hospital. The participants were subjected to the questionnaire PTSD Checklist Civilian Version (PCL-C) scale, to assess PTSS and Oncologists rated the intensity of each child's treatment. The most common age group in the parents was of young adults 25-34years [255(71%)]. Majority of parents were male 288(80%). It was found that PTSD was present in majority of parents [235(65.27%]. On statistical analysis, no significant relationship was found between PTSS in mothers and fathers (p=0.1664). There was no significant relationship between PTSS and the length of time since diagnosis in both mothers (P=0.85) and fathers (P=0.32). No significant relationship was found between the intensity of treatment and PTSD in mothers on statistical analysis (p&amp;#60;0.3). While PTSD in fathers showed significant correlation with the intensity of treatment of the child (p&amp;#60;0.05). There are very few studies regarding examining emotional distress of parents of children with malignancies in our country. Hence, studying PTSS in parents of children with cancer seems to be significant and more research needs to be done in this area.

Identification of CT Features to Differentiate Pulmonary Sarcoma from Carcinoma

Abstract Background Primary lung sarcoma (PLS) differs in management protocols and prognosis from the more common primary lung carcinoma (PLC). It becomes imperative to raise a high index of suspicion on radiological and pathological features. Purpose The aim of this study is to highlight the variable imaging appearances of PLS compared with PLC, which impacts radiologic - pathologic correlation. Materials and Methods A retrospective observational study of 68 patients with biopsy-proven lung tumors who underwent baseline imaging at our tertiary care cancer hospital was conducted between January 2018 and March 2022. The patient details and imaging parameters of the mass on contrast-enhanced computed tomography (CECT) were recorded and analyzed for patients with PLS and compared with PLC. Follow-up imaging was available in 9/12 PLS and 52/56 PLC patients. Results Among 12 patients with PLS, 5 patients had synovial sarcoma on histopathology. PLS was seen in patients with a mean age of 40.8 years; the mass showed a mean size of 13.2 cm, lower lobe (75%), parahilar (75%), hilar involvement (41.7%), oval shape (41.7%), circumscribed (25%) or lobulated (75%) margins, lower mean postcontrast attenuation of 57.3 HU, fissural extension (50%), calcification (50%), and no organ metastasis other than to the lung. PLC (56 patients) was seen in the elderly with a mean age of 54.8 years; the mass showed a mean size of 5.7 cm, irregular shape (83.9%), spiculated margins (73.2%), higher mean postcontrast attenuation (77.3 HU), chest wall infiltration (30.4%), and distant metastasis (58.9%) at baseline imaging. A statistically significant difference (p &lt; 0.05) was seen between sarcoma and carcinoma in the mean age, size, site, shape, margins, postcontrast attenuation, presence of calcifications, fissural extension, and distant metastasis. Conclusion The distinct imaging features of sarcoma help in differentiating it from carcinoma. This can also be used to corroborate with histopathology to achieve concordance and guide clinicians on further approach.

Expression of PD-L1 clones (22C3 and 28-8) in hepatocellular carcinoma: a tertiary cancer care hospital experience

BackgroundHepatocellular carcinoma (HCC) is a highly aggressive and rapidly progressing form of cancer with a poor prognosis. Recent advances in the management of HCC focused on the novel immunotherapeutic modalities for patients with advanced disease. PD-L1 has emerged as a promising immunotherapeutic approach for HCC. The evaluation of PD-L1 expression aids in identifying patients who can derive maximum benefits from these therapies. This study aims to examine and compare the expression of PD-L1 using two clones (22C3 and 28-8) in HCC patients.MethodsForty-six patients with HCC were selected between 2005 and 2022 from the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan. The patients' formalin-fixed paraffin-embedded (FFPE) tissue samples were retrieved from the department of pathology to conduct immunohistochemical analysis. Moreover, the clinicopathological data of these patients were gathered from the hospital information system (HIS). To assess the relationship between variables, bivariate analysis was carried out using either the chi-square test or Fisher exact test when necessary.ResultsAmong the 46 tissue specimens analyzed, the presence of clone 22C3 was detected in 20 HCC patients, with 10 patients showing high expression (21.7%) and another 10 patients showing low expression (21.7%). 22C3 expression was not observed in 26 patients (56.5%). On the other hand, clone 28-8 was expressed in 10 patients, all of whom exhibited low expression (21.7%), while no expression of clone 28-8 was observed in 36 patients (78.3%). An association was found between the expression of 22C3 and 28-8 PD-L1 clones (p-value 0.01). Furthermore, upon closer examination, it was revealed that 12 cases exhibited positive results for 22C3 but negative results for 28-8. Interestingly, two cases displayed positive results for 28-8 but negative results for 22C3.ConclusionWe obserevd that the PD-L1 clones, 22C3 and 28-8, are comparable. If PD-L1 expression using 22C3 is negative, considering the use of 28-8 for evaluating expression in HCC patients may be beneficial. However, further validation in a larger cohort is necessary.

Out-of-pocket payment and financial risk protection for breast cancer treatment: a prospective study from India

Available data on cost of cancer treatment, out-of-pocket payment and reimbursement are limited in India. We estimated the treatment costs, out-of-pocket payment, and reimbursement in a cohort of breast cancer patients who sought treatment at a publicly funded tertiary cancer care hospital in India. A prospective longitudinal study was conducted from June 2019 to March 2022at Tata Memorial Centre (TMC), Mumbai. Data on expenditure during each visit of treatment was collected by a team of trained medical social workers. The primary outcome variables were total cost (TC) of treatment, out-of-pocket payment (OOP), and reimbursement. TC included cost incurred by breast cancer patients during treatment at TMC. OOP was defined as the total cost incurred at TMC less of reimbursement. Reimbursement was any form of financial assistance (cashless or repayment), including social health insurance, private health insurance, employee health schemes, and assistance from charitable trusts, received by the patients for breast cancer treatment. Of the 500 patients included in the study, 45 discontinued treatment (due to financial or other reasons) and 26 died during treatment. The mean TC of breast cancer treatment was ₹258,095/US$3531 (95% CI: 238,225, 277,934). Direct medical cost (MC) accounted for 56.3% of the TC. Systemic therapy costs (₹50,869/US$696) were higher than radiotherapy (₹33,483/US$458) and surgery costs (₹25,075/US$343). About 74.4% patients availed some form of financial assistance at TMC; 8% patients received full reimbursement. The mean OOP for breast cancer treatment was ₹186,461/US$2551 (95% CI: 167,666, 205,257), accounting for 72.2% of the TC. Social health insurance (SHI) had a reasonable coverage (33.1%), followed by charitable trusts (29.6%), employee health insurance (5.1%), private health insurance (4.4%) and 25.6% had no reimbursement. But SHI covered only 40.1% of the TC of treatment compared to private health insurance that covered as much as 57.1% of it. Both TC and OOP were higher for patients who were younger, belonged to rural areas, had a comorbidity, were diagnosed at an advanced stage, and were from outside Maharashtra. In India, the cost and OOP for breast cancer treatment are high and reimbursement for the treatment flows from multiple sources. Though many of the patients receive some form of reimbursement, it is insufficient to prevent high OOP. Hence both wider insurance coverage as well as higher cap of the insurance packages in the health insurance schemes is suggested. Allowing for the automatic inclusion of cancer treatment in SHI can mitigate the financial burden of cancer patients in India. This work was funded by an extramural grant from the Women's Cancer Initiative and the Nag Foundation and an intramural grant from the International Institute of Population Sciences, Mumbai.

Breast Carcinoma among Patients Undergoing Breast Diagnostic Ultrasonography in a Tertiary Care Hospital in Nepal

Background Ultrasonography (US) is an important modality for investigating breast lesions, as it lacks radiation exposure, differentiates between solid tumor and fluid-filled cysts, and is particularly-useful for young females with dense breast tissue. This study aimed to determine test characteristics (sensitivity, specificity, positive and negative predictive values, and accuracy), and the prevalence of breast cancer, among patients undergoing diagnostic breast US for clinically-detected abnormalities in a tertiary care cancer hospital in Nepal, comparing US findings with histopathology and cytopathology.Data and Methods A cross-sectional study was conducted among a convenience sample of 418 female patients who underwent diagnostic breast US between April 15 and September 10, 2022. Data were entered and analyzed on SPSS 25.0. Prevalence of cancer was determined among US patients who were referred for tissue diagnosis on the basis of clinical or US findings. Sensitivity, specificity, positive and negative predictive values, and accuracy of US in detecting breast lesions in comparison to histopathology and cytopathology findings were calculated. Results The study respondents’ age ranged from 13 to 75 (±11.8) years. Among 97 patients who underwent fine needle aspiration or biopsy based on US findings, 52 (12.4% of total) were diagnosed with breast carcinoma. The sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of US to detect breast cancer were 94%, 100%, 93.7%, 100%, and 96.9%, respectively. Conclusion Among women with breast complaints or physical examination findings, diagnostic US revealed a high prevalence in the population investigated and demonstrated very good sensitivity, specificity, and accuracy to detect breast cancer. This study confirms the important role of ultrasound in the evaluation of breast lesions, particularly in underdeveloped countries.

Neo adjuvant chemotherapy in locally advanced oral cancers -A prospective study at a tertiary cancer care hospital

Oral squamous cell carcinoma (OSCC) is the most prevalent type of cancer found in the oral cavity. Approximately 30% of these tumours are detected at an early stage, while the majority are diagnosed as locally advanced tumours. Extensive research has been conducted on neoadjuvant chemotherapy (NACT) in head and neck cancers, aiming to reduce surgical margins, decrease distant metastasis rates, and improve overall outcomes. In this prospective study conducted at the Department of surgical oncology, Tirunelveli Medical College, 60 patients with unresectable locally advanced oral cancers were staged based on the AJCC TNM (8th edition). The period of study was from October 2018 to March 2023. Here the selected patients are examined both clinically and radiologically, measurements of the target lesions are made. These patients are subjected to neoadjuvant chemotherapy (TPF regimen) upto three cycles based on the clinical response after each cycle. reassessment done prior to surgery as done during the prechemotherapy. Adjuvant therapy post-surgery is based on the histopathology. Among the 60 patients enrolled in this study, 33 of 60 (55.0 %) were males and 27 of 60 (45%) were females. Based on age distribution 8.3% of patients were less the 40 years of age, 41.7% were between 51 to 60 years. The common risk factors were tobacco / pan chewing in 66.7% of patients, smoking in 40% of patients and alcoholism in 38.3% of patients. All the 60 patients received TPF regimen as a neo-adjuvant chemotherapy for two or three cycles and the clinical responses were recorded after NACT prior to definitive therapy (surgery vs RT. The mean and median of survival was calculated in 33 patients who had completed treatment by 2021 in view of the follow up period of at least for 24 months were mandatory to analyse the treatment outcome and disease free survival. The overall survival in surgery group was 35.1 months and RT group was 21.8 months. The disease free survival in surgery group was 28 months whereas in RT group was 16 months.Patients who have oral cavity cancers that cannot be surgically amenable up-front may experience a response rate of approximately 25% when treated with an aggressive three-drug regimen (TPF) and these patients may derive benefits from subsequent surgical treatment.

Long-term clinical outcomes of combined modality therapy for advanced-stage Hodgkin lymphoma in the PET era: A retrospective study.

The role of consolidation radiation therapy (CRT) after complete metabolic response to chemotherapy in advanced-stage (stage III and IV) Hodgkin lymphoma (HL) is controversial. This study was undertaken to assess the clinical outcomes in terms of event free survival, local failure free survival and overall survival in individuals with advanced HL treated with chemotherapy and CRT. A retrospective review was conducted to study the long-term clinical outcomes in individuals diagnosed with HL and treated with chemotherapy and CRT from 2012 to 2016 at a tertiary cancer care hospital in India. Data from 203 study participants with advanced-stage HL were analyzed. Positron emission tomography-computed tomography (PET-CT) was done at baseline and after 2 cycles for response assessment. The median age at presentation was 32 yr [interquartile range (IQR): 26-46]. Early metabolic response (after 2 cycles) and delayed metabolic response (after 4 or 6 cycles) were observed in 74.4 and 25.6 per cent of individuals, respectively. With a median follow up of 52 months (IQR: 40-67), the five-year event-free survival (EFS), local failure-free survival (LFFS) and overall survival (OS) were 83.2, 95.1 and 94.6 per cent, respectively. On univariate analysis, extranodal disease was associated with inferior EFS (P=0.043). Haemoglobin <10.5 g/dl (P=0.002) and Hasenclever index >3 (P=0.00047) were associated with poorer OS. Relapses were observed in 28/203 (13.8%) study participants with predominance at central nodal stations. The median time to relapse was 19.4 months (IQR: 13-33). Local relapse alone (at the irradiated site) was observed in 5/28 study participants, systemic (distant) relapse in 14/28 individuals, while both systemic and local relapse was observed in 9/28 participants. Extranodal disease (P=0.05), bulky disease (P=0.005) and haemoglobin concentration ≤10.5 g/dl (P=0.036) were significant predictors for disease relapse. Individuals with advanced-stage HL treated with anthracycline-based chemotherapy (anthracycline-based chemotherapy with doxorubicin, bleomycin, vinblastine and dacarbazine regimen) and CRT had excellent long-term outcomes. As isolated infield failures are uncommon, selective consolidation with conformal RT to high-risk sites improves final disease outcomes.

Impact of SSO-ASTRO Margin Guidelines on Re-excision Rate in Breast-conserving Surgery: A Single-center Experience.

Breast-conserving surgery (BCS) has been historically linked with a high rate of re-excision. To address this issue, the Society of Surgical Oncology (SSO) and the American Society for Radiation Oncology (ASTRO) developed consensus guidelines in 2014 to standardize practices and improve clinical outcomes for BCS patients. In our tertiary cancer care hospital, we assessed the impact of these guidelines on the re-excision rate following BCS. We conducted a retrospective study on breast cancer patients who underwent BCS at the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan. The study compared the re-excision rate before the implementation of the SSO-ASTRO consensus guidelines (November 2015-July 2017) and after the implementation (January 2018-August 2019). Margins were considered positive if "ink on tumor" was present and negative if "no ink on tumor" was present. Fisher's exact test or Chi-square test was used to compare the re-excision rates between the pre- and post-guideline periods. A total of 919 patients were identified, with 533 from the pre-guideline period and 386 from the post-guideline period. Of the 919 patients, 31 with ductal carcinoma in situ (DCIS) were excluded from the re-excision analysis because the guidelines were not implemented on the DCIS. Furthermore, the overall rate of re-excision in our data was 4.3%. The re-excision rate decreased from 71.1% to 28.9% (P ≤ 0.05) following the adoption of the guidelines. We observed a statistically significant decrease in the re-excision rate after implementing the SSO-ASTRO guidelines. Implementation of the SSO-ASTRO margin guidelines led to a notable decrease in the overall re-excision rate in our data set. These findings suggest that continued adherence to the guidelines may lead to a further reduction in the re-excision rate in the future.

Ring Finger 43 Hot-spot Frameshift Mutation G659V in Colorectal Cancer Patients: Report from a Tertiary Cancer Care Hospital in North India.

The Ring Finger 43 (RNF43) is a tumor suppressor gene that negatively regulates the Wnt/β-catenin signaling. The p.G659fs is a recurrent RNF43 C-terminal truncating variant frequent in colorectal cancer (CRC) patients. We aimed to identify this hotspot variant in CRC patients and assessed the relationship between the mutation, clinical characteristics, and tumor β-catenin localization. Formalin-fixed, paraffin-embedded tissue samples of upfront, surgically resected, sporadic colorectal adenocarcinoma cases were selected. The p.G659fs mutation was determined by capillary sequencing with sequence-specific primers. Tissue microarray and immunohistochemistry were employed to analyze nuclear β-catenin expression and the expression of mismatch repair (MMR) proteins, respectively. In addition, clinical details were retrieved from the hospital medical records and data were analyzed. The RNF43 p.G659fs mutation was observed in 8% of CRC patients. In total, 25% of tumors showed a loss of immunostaining for one or more MMR proteins and 14.6% of tumors showed positive nuclear β-catenin staining. The p.G659fs variant was significantly enriched in MMR-deficient tumors (P = 0.04). Importantly, no correlation was observed between the variant and nuclear β-catenin localization (P = 0.48), indicating a Wnt-independent role of this variant in CRC tumors. To the best of our knowledge, this is the first study from North India to show the involvement of RNF43 p.G659fs variant in CRC patients. The mutation correlated with MMR protein deficiency and seems to be conferring tumorigenicity independent of the Wnt pathway.

Reduction in Average Length-of-Stay in Emergency Department of a Low-Income Country's Cancer Hospital.

Prolonged length of stay (LOS) in emergency departments (ED) is a widespread problem in every hospital around the globe. Multiple factors cause it and can have a negative impact on the quality of care provided to the patients and the patient satisfaction rates. This project aimed to ensure that the average LOS of patients in a tertiary care cancer hospital stays below 3 hours. The Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) approach was followed. The average LOS was 166 minutes before implementing interventions. The two primary reasons for the increased length of stay were delays secondary to physician assessment and diagnostic lab reports. Strategies were defined to control these factors, which helped reduce the average length of stay to 142 minutes, a 30% reduction. A process improvement model similar to this project is recommended to enhance the quality of hospital services. It will provide valuable insights into the process flow and assist in gathering precise data on the various steps involved. The data collected can then be analyzed to identify potential causes and make informed decisions that can significantly improve hospital processes.

Audit of Pain Management After Colorectal Surgeries in a Tertiary Care Cancer Hospital.

Surgery for gastrointestinal malignancy is associated with severe post-operative pain, which if inadequately treated, can lead to pulmonary complications and, in addition, delayed mobilization leading to delayed recovery and discharge. We audited our practices looking at the various pain modalities used and their effects on the post-operative recovery in colorectal surgeries, in a tertiary care cancer centre during the era of ERAS. The primary aim of the study was to assess the average pain score on movement in the first 72 h of post-operative period among patients. The secondary aim was to study the various modalities of pain management used and complications, perioperative vasopressor requirement, post-operative resumption of enteral feeding, ambulation, duration of hospital stay, duration of ICU/HDU stay, and worst pain scores in the first 72 h. We analyzed a total of 174 patients who underwent colorectal surgeries for the period of 1 year from 1st January 2018 till 31st December 2018. Out of the 174 patients, 86 (49.4%) patients received epidural analgesia and 88 (50.6%) patients who did not receive epidural analgesia, belong to the non-epidural group. Average pain scores on movement at 72 h in the epidural group was 2 [2, 3] and 2 [1, 2] in the non-epidural group (p < 0.001). Worst pain score at post-operative 72 h in epidural group was 3 [3, 4] and 3 [2, 4] in the non-epidural group (p = 0.016). In conclusion, we conclude, that the analgesic efficacy of epidural analgesia was not found to be superior in our study in patients undergoing major colorectal surgeries.

Clinicopathological profile of Papillary thyroid carcinoma in a tertiary cancer hospital in Nepal

Background: Differentiated thyroid cancers (DTC), including papillary thyroid carcinoma (PTC), are on the rise. This study provides a detailed examination of PTC cases in a tertiary care cancer hospital in Nepal, aiming to understand its clinical characteristics and treatment patterns. We conducted a retrospective analysis of PTC, including demographics, features of tumor, and treatment modalities. Methods: A retrospective cross-sectional study assessed cases of PTC from January 2022 to December 2022. Patient data were collected and analyzed, focusing on demographics, tumor attributes, and treatment approaches. Results: Among 105 patients, females were predominant (female-to-male ratio 5.2:1), and ethnic diversity was observed. Most patients were from Lumbini Pradesh. The mean age was 40.78 years. Fine-needle aspiration cytology (FNAC) showed Bethesda VI as the most common classification. Primary treatment involved total thyroidectomy (76.25%). Classical PTC was the major histopathological variant (78.1%). Tumors were frequently located in the right lobe (55.25%). Unifocal tumors were prevalent (74.28%), with an average size of 2.74 cm. Lymph node metastasis occurred in 49.5% of patients. Intermediate-risk patients constituted the majority (53.5%). Conclusion: This study offers crucial insights into PTC's clinical spectrum in Nepal, aiding in tailored patient care strategies. The findings contribute to informed decision-making for enhanced treatment outcomes.