Geriatric age group patients with poor performance status and advanced stage cancer are often denied chemotherapy. In this series of cases, we demonstrated that systemic anti‐cancer therapy can be ...considered in these patients after a meticulous modification of the chemo‐protocol.
Urinary bladder cancer (UBC) is among the top ten cancers worldwide. Incidence is rising mainly attributed to environmental contamination due to chemical carcinogens and smoking habits. Recently, we ...have seen a higher number of UBC patients and thus aim to study the associated epidemiological parameters. This was a single-center retrospective analysis that involved histology-proven UBC patients presented from the inception of medical oncology services. Clinical, demographic data and history of exposure to potential risk factors were noted. A telephonic interview with the patient or family members was conducted for the missing data. Mean age of patients was 60.36 ± 10.33 years. More than half of the patients were of the geriatric age group. Males were affected 7.5 times more as compared to females. Sixty-four percent of the patients were smokers. Seventy-three percent of the patients had a residence in the plains or Terai region. Thirty percent of the patients reported farming as their occupation. Anthranilic diamide, chlorpyriphos cypermethrin, lesenta (imidacloprid + fipronil), and tricyclazole were the commonly used insecticides/pesticides. Untreated groundwater, river, or pond was the source of drinking water for 68% of the patients. The insecticides/pesticides used in agriculture and the subsequent contamination of food and water serving as the vehicle for the potential carcinogens need a critical review and are hypothesis-generating.
Background
Noncommunicable diseases (NCDs) contribute significantly to global morbidity and mortality, with cancer being one of the leading causes. In this prospective observational study, we aimed ...to investigate the prevalence and impact of endocrine disorders, specifically diabetes and thyroid dysfunction, in patients with advanced metastatic cancer undergoing cancer‐directed therapy.
Methods
Over 15 months, we recruited 100 histologically proven advanced metastatic cancer patients from the Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, and conducted institutional‐based prospective observational study. All participants over 18 years of age, treatment‐naive, and potential candidates for systemic chemotherapy with an expected clinical survival of at least 6 months were included in the study. Patients with prior therapy, secondary neoplasms, and those unable to complete 3 months of palliative chemotherapy were excluded. Patients were assessed for diabetes and thyroid function at presentation, after 3 and 6 months of cancer‐directed standard therapy. These data were analyzed, processed, and presented as results.
Results
The mean age of participants was 50.45 years, with a near‐equal distribution of males and females. At baseline, 10% of the study population had preexisting endocrine disorders (2% hypothyroidism, 8% diabetes). By the end of 6 months, the prevalence increased to 18%, with females being more affected. Notably, the prevalence of new‐onset endocrine disorders during cancer‐directed therapy was only 3% for diabetes and 4% for thyroid dysfunction.
Conclusion
Analysis of sociodemographic and cancer‐related characteristics showed no significant association with changes in diabetic and thyroid status at 3 and 6 months. However, substance use, particularly smoking, was associated with an increased risk of diabetes development (p < .05). Cancer type and treatment regimen did not show statistically significant correlations with endocrine dysfunction.
Implications
Our study highlights the importance of considering endocrine disorders in advanced metastatic cancer patients undergoing therapy. The prevalence of diabetes and thyroid dysfunction increased during cancer‐directed therapy, particularly in females. Careful monitoring and timely intervention are essential to improve the quality of life for these patients. Further research is warranted to explore the long‐term effects of cancer‐directed therapy on endocrine health and develop tailored management strategies for this vulnerable population.
Solid organ cancers infrequently metastasize to bone marrow (BM). BM involvement by cancer in adults leads to poor prognosis and it becomes difficult to provide appropriate treatment. We aimed to ...study the clinical, pathological and radiological characteristics of adult patients with BM involvement at our institute. Eleven adult patients diagnosed with BM involvement associated with solid organ cancer were included in the study. Clinical, laboratory, radiological and treatment details were analysed. Carcinoma of the breast accounted for majority of the cases. Most of the patients had poor performance status (PS) at diagnosis. Serum lactate dehydrogenase (LDH) was found to be elevated in all cases. Serum alkaline phosphatase (ALP) was elevated in all except 1 case. Median overall survival (OS) was 91 days. BM involvement from solid organ cancer in adults predicts a poor outcome. Serum LDH and serum ALP can serve as a marker of BM involvement.
Cancer-associated deep venous thrombosis (DVT) and venous thromboembolism (VTE) are exceedingly common in patients with cancer. One-fifth of DVT events occur in patients with cancer and it is the ...second leading cause of death in patients with cancer after cancer itself. Data on DVT in cancer patients on medical therapy, especially from Indian experiences, are sparse. Here, we present our experience in ambulatory patients with solid organ cancer. The purpose of the study was to study the incidence of DVT in cancer patients on medical therapy and to analyze probable DVT risk factors. This study was a hospital-based single-arm retrospective collection and analysis of hospital records from patients receiving medical therapy on an outpatient and short-stay basis. From January 2016 to February 2017, adult solid organ cancer patients attending the medical oncology outpatient department (OPD), receiving active anticancer treatment, either oral or injectable, were included. The data was retrieved from the medical records department and the department of radiology. Descriptive statistics were used to analyze the data. Twenty-nine out of 1190 patients were documented to have developed DVT during the study period. The incidence of DVT in the outpatient settings was 2.4%, and DVT associated with venous access device in situ was seen in 4.05% (20/493) of the patients. Gynecological, breast, and hepatobiliary malignancies comprised most of the cases. Cancer patients are clearly at increased risk for DVT, but this risk is highly variable. It differs between subgroups of cancer patients. Five points Khorana risk model can predict risk for DVT in the ambulatory cancer patients receiving chemotherapy; however, the routine use of thromboprophylaxis in all cancer patients is not recommended. High-risk patients especially those with venous access devices need careful evaluation and counseling for prompt reporting and recognition of venous thrombosis.
Chemoport (totally implantable venous access device) and its catheter system are used to administer long-term chemotherapy in cancer patients. The objective of this study was to analyze the ...complications associated with chemoport insertion in various cancer patients.
A total number of 168 chemoports along with polyurethane catheters were inserted in various cancer patients over a period of 3 years. 9.6 F polyurethane catheters were put by a team of surgical oncologists in operation theater under general or local anesthesia. Analysis of the complications was done until the chemoport was removed due to any reason.
Out of 168 patients, 30 (17.85%) developed complications. Complications included arterial puncture, malposition of the catheter tip, pneumothorax, hematoma, seroma, deep vein thrombosis, fracture of the catheter, a reversal of port, infections, and thrombosis of the catheter. Only a few required premature port and catheter removal.
There was a low rate of complications associated with chemoport using a polyurethane type of catheter system. However, infection-related complications were comparatively more common in our series. Chemoport requires expert handling, patient education, strict follow-up, and dedicated teamwork to minimize complications.
Cancer as a malady is perspicacious and molds itself just before we reach to stab it, on the other hand, COVID-19, an entity with limited genetic material is affecting entire humanity in such a ...florid way is overwhelming and the mechanism is so simple yet so authoritative.COVID-19 pandemic is affecting all dimensions of mankind with maximum impact on the healthcare system and economy. We the oncologists are so constrained and helpless due to a blooming pandemic, which we have never seen in recent history. We wish to highlight certain issues pertaining to cancer care, which became relevant in such vacillating anticipation. Another dimension needs consideration for limited resources countries; they will always be in the state of prolonged waitlists, limited availability of quality care centers, and hence inferior cancer outcome. Closing the machinery of radiotherapy, surgical and medical oncologists sitting idle is a big loss for sure. We here discuss and suggest a few need of the hour interventions.
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