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Budukh A, Dora T, Sancheti S, Singh V, Goel A, Bagal S, Kaur A, Manchanda I, Kaur G, Gulia A, Chaturvedi P, Badwe R. Outcome of early detection approach in control of breast, cervical, and oral cancer: Experience from a rural cancer center in India. Int J Cancer 2024; 155:894-904. [PMID: 38642029 DOI: 10.1002/ijc.34966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/22/2024]
Abstract
In low- and middle-income countries most of the cancer patients attend the hospital at a late stage and treatment completion of these cases is challenging. The early detection program (EDP), in rural areas of Punjab state, India was initiated to identify breast, cervical, and oral cancer at an early stage by raising awareness and providing easy access to diagnosis and treatment. A total of 361 health education programs and 99 early detection clinics were organized. The symptomatic and self-interested (non-symptomatic individuals who opted for screening) cases visited the detection clinic. They were screened for breast, cervical, and/or oral cancer. Further diagnosis and treatment of screen-positive cases were carried out at Homi Bhabha Cancer Hospital (HBCH), Sangrur. Community leaders and healthcare workers were involved in all the activities. The EDP, Sangrur removed barriers between cancer diagnosis and treatment with the help of project staff. From 2019 to 2023, a total of 221,317 populations were covered. Symptomatic and self-interested individuals attended the breast (1627), cervical (1601), and oral (1111) examinations. 46 breast (in situ-4.3%; localized-52.2%), 9 cervical (localized-77.8%), and 12 oral (localized-66.7%) cancer cases were detected, and treatment completion was 82.6%, 77.8%, and 50.0%, respectively. We compared cancer staging and treatment completion of cases detected through EDP with the cases attended HBCH from Sangrur district in 2018; the difference between two groups is statistically significant. Due to the early detection approach, there is disease down-staging and improvement in treatment completion. This approach is feasible and can be implemented to control these cancers in low- and middle-income countries.
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Affiliation(s)
- Atul Budukh
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Tapas Dora
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Sankalp Sancheti
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Vikram Singh
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Alok Goel
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Sonali Bagal
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Amandeep Kaur
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Ishan Manchanda
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Gurwinder Kaur
- Centre for Cancer Epidemiology (CCE), Tata Memorial Centre (TMC), Navi Mumbai, India
| | - Ashish Gulia
- Department of Radiation Oncology, Pathology, Surgical Oncology and Medical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Pankaj Chaturvedi
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
| | - Rajendra Badwe
- Homi Bhabha National Institute, Mumbai, India
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
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S S KD, Joga R, Srivastava S, Nagpal K, Dhamija I, Grover P, Kumar S. Regulatory landscape and challenges in CAR-T cell therapy development in the US, EU, Japan, and India. Eur J Pharm Biopharm 2024; 201:114361. [PMID: 38871092 DOI: 10.1016/j.ejpb.2024.114361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/02/2024] [Accepted: 06/10/2024] [Indexed: 06/15/2024]
Abstract
Chimeric Antigen Receptor-T cell (CAR-T) therapy has evolved as a revolutionary cancer treatment modality, offering remarkable clinical responses by harnessing the power of a patient's immune system to target and eliminate cancer cells. However, the development and commercialization of CAR-T cell therapies are accompanied by complex regulatory requirements and challenges. This therapy falls under the regulatory category of advanced therapy medicinal products. The regulatory framework and approval tools of regenerative medicine, especially CAR-T cell therapies, vary globally. The present work comprehensively analyses the regulatory landscape and challenges in CAR-T cell therapy development in four key regions: the United States, the European Union, Japan, and India. This work explores the unique requirements and considerations for preclinical studies, clinical trial design, manufacturing standards, safety evaluation, and post-marketing surveillance in each jurisdiction. Due to their complex nature, developers and manufacturers face several challenges. In India, despite advancements in treatment protocols and government-sponsorships, there are still several difficulties regarding access to treatment for the increasing number of cancer patients. However, India's first indigenously developed CAR-T cell therapy, NexCAR19, for B-cell lymphoma or leukemia, approved and available at a low cost compared to other available CAR-T therapies, raises great hope in the battle against cancer. Several strategies are proposed to address the identified hurdles from global and Indian perspectives. It discusses the benefits of aligning regulatory requirements across regions, eventually facilitating international development and enabling access to this transformative therapy.
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Affiliation(s)
- Kirthiga Devi S S
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana 500037, India
| | - Ramesh Joga
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana 500037, India
| | - Saurabh Srivastava
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Kalpana Nagpal
- Amity Institute of Pharmacy, Amity University, Noida, Uttar Pradesh 201303, India
| | - Isha Dhamija
- Department of Pharmacology, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad, Telangana 500037, India
| | - Parul Grover
- KIET School of Pharmacy, KIET Group of Institutions, Delhi-NCR, Ghaziabad 201206, India
| | - Sandeep Kumar
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research, Hyderabad, Telangana 500037, India; Department of Pharmaceutics, NIMS Institute of Pharmacy, NIMS University Rajasthan, Jaipur, Rajasthan 303121, India.
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Srivastava G, Mukherjee E, Mittal R, Ganjewala D. Geraniol and citral: recent developments in their anticancer credentials opening new vistas in complementary cancer therapy. Z NATURFORSCH C 2024; 79:163-177. [PMID: 38635829 DOI: 10.1515/znc-2023-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/03/2024] [Indexed: 04/20/2024]
Abstract
About 10 million people are diagnosed with cancer each year. Globally, it is the second leading cause of death after heart disease, and by 2035, the death toll could reach 14.6 million. Several drugs and treatments are available to treat cancer, but survival rates remain low. Many studies in recent years have shown that plant-derived monoterpenes, particularly geraniol and citral, are effective against various cancers, including breast, liver, melanoma, endometrial, colon, prostate, and skin cancers. This trend has opened new possibilities for the development of new therapeutics or adjuvants in the field of cancer therapy. These monoterpenes can improve the efficacy of chemotherapy by modulating many signaling molecules and pathways within tumors. Analysis of reports on the anticancer effects published in the past 5 years provided an overview of the most important results of these and related properties. Also, the molecular mechanisms by which they exert their anticancer effects in cell and animal studies have been explained. Therefore, this review aims to highlight the scope of geraniol and citral as complementary or alternative treatment options in cancer therapy.
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Affiliation(s)
- Gauri Srivastava
- Amity Institute of Biotechnology, 77282 Amity University , Sector-125, Noida 201303, Uttar Pradesh, India
| | - Esha Mukherjee
- Amity Institute of Biotechnology, 77282 Amity University , Sector-125, Noida 201303, Uttar Pradesh, India
| | - Ruchika Mittal
- Amity Institute of Biotechnology, 77282 Amity University , Sector-125, Noida 201303, Uttar Pradesh, India
| | - Deepak Ganjewala
- Amity Institute of Biotechnology, 77282 Amity University , Sector-125, Noida 201303, Uttar Pradesh, India
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Michelon I, Vilbert M, do Rego Castro CE, Stecca C, Dacoregio MI, Rizzo M, Cláudio Cordeiro de Lima V, Cavalcante L. EGFR-Tyrosine Kinase Inhibitor Retreatment in Non-Small-Cell Lung Cancer Patients Previously Exposed to EGFR-TKI: A Systematic Review and Meta-Analysis. J Pers Med 2024; 14:752. [PMID: 39064005 PMCID: PMC11277985 DOI: 10.3390/jpm14070752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
We performed a systematic review and meta-analysis to assess the efficacy of EGFR-tyrosine kinase inhibitors (TKI) retreatment in advanced/metastatic non-small-cell lung cancer (NSCLC) patients. We systematically searched PubMed, Embase, Cochrane databases, ASCO, and ESMO websites for studies evaluating EGFR-TKI retreatment in advanced/metastatic NSCLC patients. All analyses were performed using R software (v.4.2.2). We included 19 studies (9 CTs and 10 retrospective cohorts) with a total of 886 patients. In a pooled analysis of all patients during retreatment with TKI, median OS was 11.7 months (95% confidence interval [CI] 10.2-13.4 months) and PFS was 3.2 months (95% CI 2.5-3.9 months). ORR was 15% (95% CI 10-21%) and DCR was 61% (95% CI 53-67%). The subanalysis by generation of TKI in the rechallenge period revealed a slightly better ORR for patients on 3rd generation TKI (p = 0.05). Some limitations include the high heterogeneity of some of the analyses and inability to perform certain subanalyses. Our results unequivocally support the benefit of EGFR-TKI rechallenge in EGFR-mutated NSCLC patients progressing on TKI treatment after a TKI-free interval. These findings may be especially valuable in areas where access to novel therapeutic drugs and clinical trials is limited.
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Affiliation(s)
- Isabella Michelon
- Department of Medicine, Catholic University of Pelotas, Pelotas 96015-560, Brazil
| | - Maysa Vilbert
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;
| | | | - Carlos Stecca
- Department of Medicine, Parana Oncology Center, Curitiba 80030-200, Brazil;
| | - Maria Inez Dacoregio
- Department of Medicine, University of Centro Oeste, Guarapuava 85040-167, Brazil;
| | - Manglio Rizzo
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Cientificas y Tecnologicas (CONICET), Buenos Aires 1428, Argentina;
- Clinical Oncology Unit, Hospital Universitario Austral, Av. Presidente Perón 1500, (B1629ODT) Derqui-Pilar, Buenos Aires 1428, Argentina
| | | | - Ludimila Cavalcante
- Department of Hematology and Medical Oncology, University of Virginia Comprehensive Cancer Center, Charlottesville, VA 22903, USA;
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Thakkar AB, Subramanian RB, Thakkar SS, Thakkar VR, Thakor P. Isolation, identification, and characterization of α- asarone, from hydromethanolic leaf extract of Acorus calamus L. and its apoptosis-inducing mechanism in A549 cells. J Biomol Struct Dyn 2024; 42:5515-5535. [PMID: 37357434 DOI: 10.1080/07391102.2023.2227712] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/12/2023] [Indexed: 06/27/2023]
Abstract
Due to the presence of several active secondary metabolites, the traditional Indian and Chinese medicinal herb Acorus calamus L. has been utilized for both medical and culinary purposes since ancient times. A recent report has underscored the promising cytotoxic effect of A. calamus leaves extract against non-small cell lung cancer A549 cells. Thus, we want to separate the bioactive substance from the hydromethanolic extract of A. calamus leaves in the current investigation. Thin-layer chromatography was used to separate the compounds and different spectroscopic methods (UV, FTIR, NMR, and LCMS/MS) were used for the structure prediction. α-asarone was found to be the main bioactive compound present and it was isolated from A. calamus leaves extract. It exerted a good cytotoxic effect with an IC50 value of 21.43 ± 1.27 μM against A549 cells and IC50 value of 324.12 ± 1.32 μM against WI-38 cells. The induction of apoptosis in A549 cells by α-asarone was reaffirmed by the diverse differential staining methods including DAPI, Acridine Orange/Ethidium Bromide, and Giemsa staining. Additionally, α-asarone induced mitochondrial membrane potential (ΔΨm) dissipation with a concomitant increase in the production of ROS. Furthermore, it also increased expressions of caspase-3, caspase-9, caspase-8, DR4, and DR5 genes in A549 cells. In conclusion, α-asarone-induced apoptotic cell death in non-small lung cancer cells (A549) as a result of loss of mitochondrial function, increased ROS production, subsequent activation of an internal and extrinsic caspase pathway, and altered expression of genes controlling apoptosis. As a whole, α-asarone is a plausible therapeutic agent for managing lung cancer. HIGHLIGHTSIsolation of bioactive compound from hydromethanolic leaves extract of Acorus calamus L. by thin layer chromatography.Structural elucidation of the bioactive compound was carried out using different methods like UV analysis, FTIR, NMR, and LC-MS/MS analysis.A plausible mode of action revealed that α-asarone can induce apoptosis in lung cancer cells (A549).Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Anjali B Thakkar
- P. G. Department of Biosciences, Sardar Patel University, Vallabh Vidyanagar, India
- P. G. Department of Applied and Interdisciplinary Sciences (IICISST), Sardar Patel University, Vallabh Vidyanagar, India
| | - R B Subramanian
- P. G. Department of Biosciences, Sardar Patel University, Vallabh Vidyanagar, India
| | - Sampark S Thakkar
- AKASHGANGA, Shree Kamdhenu Electronics Pvt. Ltd, Vallabh Vidyanagar, India
| | - Vasudev R Thakkar
- P. G. Department of Biosciences, Sardar Patel University, Vallabh Vidyanagar, India
| | - Parth Thakor
- Bapubhai Desaibhai Patel Institute of Paramedical Sciences, Charotar University of Science and Technology, Changa, India
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Laxane N, Yadav KS. QbD-based co-loading of paclitaxel and imatinib mesylate by protamine-coated PLGA nanoparticles effective on breast cancer cells. Nanomedicine (Lond) 2024:1-17. [PMID: 38934510 DOI: 10.1080/17435889.2024.2353557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/07/2024] [Indexed: 06/28/2024] Open
Abstract
Aim: Paclitaxel and imatinib mesylate are drugs used in the treatment of breast cancer. Conventional drug-delivery systems have limitations in the effective treatment of breast cancer using the drugs. Materials & methods: Combination index studies were used to identify the optimum ratio of both drugs showing maximum synergistic effect. Using a systematic quality-by-design approach, protamine-coated PLGA nanoparticles co-loaded with paclitaxel and imatinib mesylate were formulated. Further characterization and cell line evaluations were performed. Results: Encapsulation efficiency obtained was 92.54% for paclitaxel and 75.12% for imatinib mesylate. A sustained (24 h) and controlled zero-order drug release was obtained. Conclusion: Formulated nanoparticles had a low IC50 value and enhanced cellular uptake.
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Affiliation(s)
- Neha Laxane
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's, NMIMS Deemed to be University, Mumbai, 400056, India
| | - Khushwant S Yadav
- Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, SVKM's, NMIMS Deemed to be University, Mumbai, 400056, India
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Kulothungan V, Ramamoorthy T, Sathishkumar K, Mohan R, Tomy N, Miller GJ, Mathur P. Burden of female breast cancer in India: estimates of YLDs, YLLs, and DALYs at national and subnational levels based on the national cancer registry programme. Breast Cancer Res Treat 2024; 205:323-332. [PMID: 38433127 PMCID: PMC11101532 DOI: 10.1007/s10549-024-07264-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE Female breast cancer (BC) is the leading cause of cancer incidence and mortality in India, and accounted for 13.5% of new cancer cases and 10% of cancer-related deaths in 2020. This study aims to estimate and report the female BC burden in India at state level from 2012 to 2016 in terms of years of life lost, years lived with disability, and disability-adjusted life years (DALYs), and to project the burden for the year 2025. METHODS The cancer incidence and mortality data from 28 population-based cancer registries were analysed. The mean mortality to incidence ratio was estimated, and mortality figures were adjusted for underreporting. The burden of female BC was estimated at national and subnational levels using Census data, World Health Organisation's lifetables, disability weights, and the DisMod-II tool. A negative binomial regression is employed to project burden for 2025. RESULTS The burden of BC among Indian women in 2016 was estimated to be 515.4 DALYs per 100,000 women after age standardization. The burden metrics at state level exhibited substantial heterogeneity. Notably, Tamil Nadu, Telangana, Karnataka, and Delhi had a higher burden of BC than states in the eastern and north-eastern regions. The projection for 2025 indicates to a substantial increase, reaching 5.6 million DALYs. CONCLUSION The female BC burden in India was significantly high in 2016 and is expected to substantially increase. Undertaking a multidisciplinary, context-specific approach for its prevention and control can address this rising burden.
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Affiliation(s)
- Vaitheeswaran Kulothungan
- Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan - ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Thilagavathi Ramamoorthy
- Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan - ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Krishnan Sathishkumar
- Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan - ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Rohith Mohan
- Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan - ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Nifty Tomy
- Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan - ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - G J Miller
- Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan - ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Prashant Mathur
- Indian Council of Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan - ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India.
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Stokkevåg CH, Journy N, Vogelius IR, Howell RM, Hodgson D, Bentzen SM. Radiation Therapy Technology Advances and Mitigation of Subsequent Neoplasms in Childhood Cancer Survivors. Int J Radiat Oncol Biol Phys 2024; 119:681-696. [PMID: 38430101 DOI: 10.1016/j.ijrobp.2024.01.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/17/2023] [Accepted: 01/13/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE In this Pediatric Normal Tissue Effects in the Clinic (PENTEC) vision paper, challenges and opportunities in the assessment of subsequent neoplasms (SNs) from radiation therapy (RT) are presented and discussed in the context of technology advancement. METHODS AND MATERIALS The paper discusses the current knowledge of SN risks associated with historic, contemporary, and future RT technologies. Opportunities for research and SN mitigation strategies in pediatric patients with cancer are reviewed. RESULTS Present experience with radiation carcinogenesis is from populations exposed during widely different scenarios. Knowledge gaps exist within clinical cohorts and follow-up; dose-response and volume effects; dose-rate and fractionation effects; radiation quality and proton/particle therapy; age considerations; susceptibility of specific tissues; and risks related to genetic predisposition. The biological mechanisms associated with local and patient-level risks are largely unknown. CONCLUSIONS Future cancer care is expected to involve several available RT technologies, necessitating evidence and strategies to assess the performance of competing treatments. It is essential to maximize the utilization of existing follow-up while planning for prospective data collection, including standardized registration of individual treatment information with linkage across patient databases.
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Affiliation(s)
- Camilla H Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Physics and Technology, University of Bergen, Bergen, Norway.
| | - Neige Journy
- French National Institute of Health and Medical Research (INSERM) Unit 1018, Centre for Research in Epidemiology and Population Health, Paris Saclay University, Gustave Roussy, Villejuif, France
| | - Ivan R Vogelius
- Department of Clinical Oncology, Centre for Cancer and Organ Diseases and University of Copenhagen, Copenhagen, Denmark
| | - Rebecca M Howell
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
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Gao P, Chen J, Hong Z, Choi M, Morgan A, Petushkov A, Lall R, Liu C, Muddu VK, Arroju V, Sunkavalli C, Kim G, Reddy BY. Landscape of cancer clinical trials in India - a comprehensive analysis of the Clinical Trial Registry-India. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 24:100323. [PMID: 38756153 PMCID: PMC11096683 DOI: 10.1016/j.lansea.2023.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/12/2023] [Accepted: 10/30/2023] [Indexed: 05/18/2024]
Abstract
Background Cancer is one of the leading causes of morbidity and mortality in India. Clinical trials are critical for driving innovation in cancer therapy, diagnosis, and prevention. This study aims to depict the evolving landscape of cancer clinical trials in India by analysing the clinical trials registered in Clinical Trial Registry-India (CTRI). Methods We identified cancer trials registered in CTRI (between 2007 and 2021) using search terms adapted from the cancer types defined by the National Cancer Institute (USA). We then collated and analysed the publicly available information from CTRI (cancer subtypes, type of trial, treatment intent, type of intervention, sponsor type, recruitment countries) and used descriptive statistics to illustrate the overall as well as year-to-year trend. Findings In total, we identified 1988 cancer trials, the majority of which focused on treating cancer (63%) and rest of the trials aimed at optimising the operational aspects of surgery (19%), mitigating treatment-related toxicity (10.6%), or treating cancer-related symptoms (7.8%). Focusing on trials with the intent of treating cancer, we found that most were investigating solid tumours as opposed to haematological malignancies with the most prominent cancer subtypes being breast cancer (17%), head and neck cancer (9.8%), lung cancer (9.6%), and cervical cancer (6.6%). The number of trials conducted in a given cancer subtype from our analysis overall correlated to the incidence, mortality, and 5-year prevalence of the respective cancer subtype in India; however, head and neck cancer and cervical cancer were underrepresented in trials as compared with the disease burden. The most common type of intervention was investigational drugs. The most common sponsor types were global pharmaceutical industry (26%) and research institution and hospital (26%). Despite a relatively high cancer burden, the availability of cancer trials in the Northeastern states of India was limited. Interpretation There is a pressing need for clinical cancer research in India to be better aligned with the nation's healthcare needs and disease burden, focusing on prevalent and deadly cancers while ensuring the availability of clinical trials across geographic regions and underserved populations. Funding Pi Health USA, a fully owned subsidiary of BeiGene Ltd.
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Affiliation(s)
- Peng Gao
- Pi Health USA, Cambridge, MA, USA
| | | | | | | | | | - Anton Petushkov
- Pi Health USA, Cambridge, MA, USA
- College of Engineering, University of Michigan, Ann Arbor, USA
| | | | - Chao Liu
- Pi Health USA, Cambridge, MA, USA
| | - Vamshi K. Muddu
- Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, Telangana, India
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James ND, Tannock I, N'Dow J, Feng F, Gillessen S, Ali SA, Trujillo B, Al-Lazikani B, Attard G, Bray F, Compérat E, Eeles R, Fatiregun O, Grist E, Halabi S, Haran Á, Herchenhorn D, Hofman MS, Jalloh M, Loeb S, MacNair A, Mahal B, Mendes L, Moghul M, Moore C, Morgans A, Morris M, Murphy D, Murthy V, Nguyen PL, Padhani A, Parker C, Rush H, Sculpher M, Soule H, Sydes MR, Tilki D, Tunariu N, Villanti P, Xie LP. The Lancet Commission on prostate cancer: planning for the surge in cases. Lancet 2024; 403:1683-1722. [PMID: 38583453 DOI: 10.1016/s0140-6736(24)00651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/28/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Nicholas D James
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - Ian Tannock
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | - Felix Feng
- University of California, San Francisco, USA
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Syed Adnan Ali
- University of Manchester, Manchester, UK; The Christie Hospital, Manchester, UK
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Eva Compérat
- Tenon Hospital, Sorbonne University, Paris; AKH Medical University, Vienna, Austria
| | - Ros Eeles
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Áine Haran
- The Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | | | | | - Stacy Loeb
- New York University, New York, NY, USA; Manhattan Veterans Affairs, New York, NY, USA
| | | | | | | | - Masood Moghul
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Michael Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Declan Murphy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | | | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Türkiye
| | - Nina Tunariu
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Li-Ping Xie
- First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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11
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Dixit J, Gupta N, Kataki A, Roy P, Mehra N, Kumar L, Singh A, Malhotra P, Gupta D, Goyal A, Rajsekar K, Krishnamurthy MN, Gupta S, Prinja S. Health-related quality of life and its determinants among cancer patients: evidence from 12,148 patients of Indian database. Health Qual Life Outcomes 2024; 22:26. [PMID: 38481231 PMCID: PMC10938809 DOI: 10.1186/s12955-024-02227-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/02/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Cancer survivors experience a decrement in health-related quality of life (HRQoL) resulting from the disease as well as adverse effects of therapy. We evaluated the HRQoL of cancer patients, stratified by primary cancer site, stage, treatment response and associated adverse events, along with its determinants. METHODS Data were collected from 12,148 patients, sampled from seven purposively chosen leading cancer hospitals in India, to elicit HRQoL using the EuroQol questionnaire comprising of 5-dimensions and 5-levels (EQ-5D-5L). Multiple linear regression was used to determine the association between HRQoL and various socio-demographic as well as clinical characteristics. RESULTS Majority outpatients (78.4%) and inpatients (81.2%) had solid cancers. The disease was found to be more prevalent among outpatients (37.5%) and inpatients (40.5%) aged 45-60 years and females (49.3-58.3%). Most patients were found to be in stage III (40-40.6%) or stage IV (29.4-37.3%) at the time of recruitment. The mean EQ-5D-5 L utility score was significantly higher among outpatients [0.630 (95% CI: 0.623, 0.637)] as compared to inpatients [0.553 (95% CI: 0.539, 0.567)]. The HRQoL decreased with advancing cancer stage among both inpatients and outpatients, respectively [stage IV: (0.516 & 0.557); stage III (0.609 & 0.689); stage II (0.677 & 0.713); stage I (0.638 & 0.748), p value < 0.001]. The outpatients on hormone therapy (B = 0.076) showed significantly better HRQoL in comparison to patients on chemotherapy. However, palliative care (B=-0.137) and surgery (B=-0.110) were found to be associated with significantly with poorer HRQoL paralleled to chemotherapy. The utility scores among outpatients ranged from 0.305 (bone cancer) to 0.782 (Leukemia). Among hospitalized cases, the utility score was lowest for multiple myeloma (0.255) and highest for testicular cancer (0.771). CONCLUSION Older age, lower educational status, chemotherapy, palliative care and surgery, advanced cancer stage and progressive disease were associated with poor HRQoL. Our study findings will be useful in optimising patient care, formulating individualized treatment plan, improving compliance and follow-up.
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Affiliation(s)
- Jyoti Dixit
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Gupta
- Department of Radiation Oncology, Government Medical College and Hospital, Chandigarh, India
| | - Amal Kataki
- Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Partha Roy
- Dr. B. Booroah Cancer Institute, Guwahati, Assam, India
| | - Nikita Mehra
- Department of Medical Oncology, Adyar Cancer Institute, Chennai, Tamil Nadu, India
| | - Lalit Kumar
- Department of Medical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Pankaj Malhotra
- Department of Clinical Haematology and Medical Oncology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Dharna Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Aarti Goyal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kavitha Rajsekar
- Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India
| | | | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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12
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Sonowal S, Gogoi U, Buragohain K, Nath R. Endophytic fungi as a potential source of anti-cancer drug. Arch Microbiol 2024; 206:122. [PMID: 38407579 DOI: 10.1007/s00203-024-03829-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 02/27/2024]
Abstract
Endophytes are considered one of the major sources of bioactive compounds used in different aspects of health care including cancer treatment. When colonized, they either synthesize these bioactive compounds as a part of their secondary metabolite production or augment the host plant machinery in synthesising such bioactive compounds. Hence, the study of endophytes has drawn the attention of the scientific community in the last few decades. Among the endophytes, endophytic fungi constitute a major portion of endophytic microbiota. This review deals with a plethora of anti-cancer compounds derived from endophytic fungi, highlighting alkaloids, lignans, terpenes, polyketides, polyphenols, quinones, xanthenes, tetralones, peptides, and spirobisnaphthalenes. Further, this review emphasizes modern methodologies, particularly omics-based techniques, asymmetric dihydroxylation, and biotic elicitors, showcasing the dynamic and evolving landscape of research in this field and describing the potential of endophytic fungi as a source of anticancer drugs in the future.
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Affiliation(s)
- Sukanya Sonowal
- Microbiology Laboratory, Department of Life Sciences, Dibrugarh University, Dibrugarh, Assam, 786004, India
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, 786004, India
| | - Urvashee Gogoi
- Microbiology Laboratory, Department of Life Sciences, Dibrugarh University, Dibrugarh, Assam, 786004, India
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, 786004, India
| | - Kabyashree Buragohain
- Microbiology Laboratory, Department of Life Sciences, Dibrugarh University, Dibrugarh, Assam, 786004, India
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, 786004, India
| | - Ratul Nath
- Microbiology Laboratory, Department of Life Sciences, Dibrugarh University, Dibrugarh, Assam, 786004, India.
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, 786004, India.
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13
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Baral S, Silwal SR, Lamichhane D, Adhikari A, Bhattarai N. Understanding of disease status, prognosis and estimated cost of treatment among cancer patients: experience from a tertiary cancer centre in Nepal. Ecancermedicalscience 2024; 18:1668. [PMID: 38439816 PMCID: PMC10911673 DOI: 10.3332/ecancer.2024.1668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Indexed: 03/06/2024] Open
Abstract
Purpose Lack of adequate knowledge about the disease is one of the key factors that misguide cancer patients and patients' caregivers in choosing a better management plan. The purpose of the study was to assess the patients' and caregivers' knowledge about the disease status and estimated treatment cost. Understanding of disease may improve adherence to treatment plans and quality of care. Methods It was a cross-sectional study where 120 cancer patients were selected based on convenience sampling and the availability of record files and relevant data. The site, stage and prognosis of disease recorded from patients and caregivers were compared with the record of outpatient department and inpatient files with the help of the Fisher's exact test. The patients' knowledge about their financial estimates was also recorded. Three patients were selected for in-depth interviews based on purposive sampling to further support the findings. Results Among 120 analysed patients, 60.83% were female. Around two-thirds of male patients (69.2%) and male caregivers (62.2%) knew about the site but only one-third of female patients (30.8%) and female caregivers (37.8%) knew the same. The primary responsibility for managing financial issues was caregivers in 89.16%. Only 7.5% knew the estimated cost. Nepali as the primary language and better education level is correlated with knowledge of disease status, among both patients and caregivers but was statistically significant only in knowing prognosis among native Nepali speaker caregivers (p < 0.001), and better-educated patients (p < 0.001). As per the in-depth interview, all three patients knew the site of their disease, but only the patient with breast cancer was aware of the stage of the disease. None of the patients were aware of their disease prognosis, treatment plan or the estimated cost of their treatment. Conclusion The level of understanding is low for most patients and their immediate caregivers, particularly among those who are female, not literate and whose primary language is not Nepali. Appropriate strategy should be adopted to enhance basic understanding among patients and caregivers in our setting.
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Affiliation(s)
- Shweta Baral
- Bhaktapur Cancer Hospital, Kathmandu 44800, Nepal
- https://orcid.org/0000-0002-6284-1775
| | - Sudhir Raj Silwal
- Bhaktapur Cancer Hospital, Kathmandu 44800, Nepal
- https://orcid.org/0000-0002-6284-1775
| | - Deep Lamichhane
- Bhaktapur Cancer Hospital, Kathmandu 44800, Nepal
- https://orcid.org/0000-0002-6284-1775
| | - Abish Adhikari
- Bhaktapur Cancer Hospital, Kathmandu 44800, Nepal
- https://orcid.org/0000-0002-6284-1775
| | - Nancy Bhattarai
- Bhaktapur Cancer Hospital, Kathmandu 44800, Nepal
- https://orcid.org/0000-0002-6284-1775
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14
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Nararyanan RC, Sebastian BT, Sulaikha SH, Augustine C, Thomas T, Sudhakaran A. Computer-Assisted Morphometric Comparative Analysis of Argyrophilic Nucleolar Organizer Regions (AgNORs) in Leukoplakia With Dysplasia and Oral Squamous Cell Carcinoma. Cureus 2024; 16:e54471. [PMID: 38510852 PMCID: PMC10951783 DOI: 10.7759/cureus.54471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Background Oral squamous cell carcinoma (OSCC) and oral leukoplakia (OL) with dysplasia are closely linked conditions in the oral cavity, with the latter often indicating precancerous changes, underscoring the urgency of early detection and intervention. Histopathological confirmation is crucial for accurate diagnosis. The nucleolar organizer region (NOR), specifically analyzed through silver-staining (argyrophilic NORs), provides insights into nuclear changes associated with the lesion. Computer-assisted morphometric analysis enhances precision and objectivity in evaluating AgNOR-related parameters. Aim To conduct a computer-assisted morphometric comparison of AgNORs using various NOR-related parameters in cases of OSCC and leukoplakia with dysplasia and to evaluate their diagnostic significance. Materials and methods A computer-assisted morphometric analysis was conducted using various NOR-related parameters, such as nuclear profile area, single AgNOR profile area per nucleus, total AgNOR profile area per nucleus, and number of AgNOR profiles per nucleus on a total sample of 90 specimens, which includes leukoplakia with dysplasia (30), OSCC (30), and a control group, including 30 samples of normal oral mucosa. A comparison was conducted on the morphometric values between the groups under investigation. Tukey's multiple comparison tests and ANOVA were used to analyze the data and determine the differences between the groups. Results The present investigation revealed a significant difference in all four AgNOR-related parameters between leukoplakia and OSCC in comparison to the control group (normal oral mucosa). Comparing OL (41.78 ± 0.46) and OSCC (62.78 ± 0.47) to the control group (35.93 ± 0.99), the mean value of nuclear profile area (A Nuc) was significantly greater. In comparison to the control group (3.40 ± 0.09), the mean value of a single AgNOR profile area per nucleus (A NOR) was found to be relatively lower in both research groups, OL (2.00 ± 0.02) and OSCC (1.39 ± 0.01). The total AgNOR profile area per nucleus (TA NOR) had a mean value of 10.61 ± 0.69 in OL and 12.05 ± 0.28 in OSCC, respectively, compared to 7.82 ± 0.38 in the control group. The study found that there was more number of profiles of AgNORs per nucleus (n NOR) in the study groups of OL (5.30 ± 0.29) and OSCC (8.69 ± 0.19) than in the control group (2.32 ± 0.11). Conclusion The parameters linked to the NOR are biologically informative and easy to check regularly in a pathology lab. Additionally, AgNORs give us important information that enables us to study the range of nuclear changes in malignant and potentially malignant lesions.
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Affiliation(s)
- Roshin C Nararyanan
- Oral Pathology and Microbiology, Mahe Institute of Dental Sciences & Hospital, Mahe, IND
| | - Bastian T Sebastian
- Oral Pathology and Microbiology, Mahe Institute of Dental Sciences & Hospital, Mahe, IND
| | - Suhana H Sulaikha
- Oral Pathology and Microbiology, Mahe Institute of Dental Sciences & Hospital, Mahe, IND
| | - Cimmy Augustine
- Prosthodontics, Mahe Institute of Dental Sciences & Hospital, Mahe, IND
| | - Teenu Thomas
- Public Health Dentistry, Mahe Institute of Dental Sciences & Hospital, Mahe, IND
| | - Anjali Sudhakaran
- Oral and Maxillofacial Surgery, Mahe Institute of Dental Sciences & Hospital, Mahe, IND
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15
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McLeod M, Torode J, Leung K, Bhoo-Pathy N, Booth C, Chakowa J, Gralow J, Ilbawi A, Jassem J, Parkes J, Mallafré-Larrosa M, Mutebi M, Pramesh CS, Sengar M, Tsunoda A, Unger-Saldaña K, Vanderpuye V, Yusuf A, Sullivan R, Aggarwal A. Quality indicators for evaluating cancer care in low-income and middle-income country settings: a multinational modified Delphi study. Lancet Oncol 2024; 25:e63-e72. [PMID: 38301704 DOI: 10.1016/s1470-2045(23)00568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 02/03/2024]
Abstract
This Policy Review sourced opinions from experts in cancer care across low-income and middle-income countries (LMICs) to build consensus around high-priority measures of care quality. A comprehensive list of quality indicators in medical, radiation, and surgical oncology was identified from systematic literature reviews. A modified Delphi study consisting of three 90-min workshops and two international electronic surveys integrating a global range of key clinical, policy, and research leaders was used to derive consensus on cancer quality indicators that would be both feasible to collect and were high priority for cancer care systems in LMICs. Workshop participants narrowed the list of 216 quality indicators from the literature review to 34 for inclusion in the subsequent surveys. Experts' responses to the surveys showed consensus around nine high-priority quality indicators for measuring the quality of hospital-based cancer care in LMICs. These quality indicators focus on important processes of care delivery from accurate diagnosis (eg, histologic diagnosis via biopsy and TNM staging) to adequate, timely, and appropriate treatment (eg, completion of radiotherapy and appropriate surgical intervention). The core indicators selected could be used to implement systems of feedback and quality improvement.
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Affiliation(s)
- Megan McLeod
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Julie Torode
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Kari Leung
- Guy's and St Thomas' NHS Trust, London, UK
| | - Nirmala Bhoo-Pathy
- Department of Clinical Epidemiology, Universiti Malaya Medical Centre, Kuala Lampar, Malaysia
| | - Christopher Booth
- Department of Medical Oncology, Queen's University, Kingston, ON, Canada
| | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA, USA
| | | | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Jeannette Parkes
- Division of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Merixtell Mallafré-Larrosa
- City Cancer Challenge, Geneva, Switzerland; Department of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - C S Pramesh
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Audrey Tsunoda
- Department of Gynecologic Oncology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Aasim Yusuf
- Department of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK; Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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16
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Chintapally N, Nuwayhid M, Arroju V, Muddu VK, Gao P, Reddy BY, Sunkavalli C. State of cancer care in India and opportunities for innovation. Future Oncol 2023; 19:2593-2606. [PMID: 37675499 DOI: 10.2217/fon-2023-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Cancer is one of the leading causes of morbidity and mortality in India. Despite recent medical and technological advances, the cancer burden in India remains high and continues to rise. Moreover, substantial regional disparities in cancer incidence and access to essential medical resources exist throughout the country. While innovative and effective cancer therapies hold promise for improving patient outcomes, several barriers hinder their development and utilization in India. Here we provide an overview of these barriers, including challenges related to patient awareness, inadequate infrastructure, scarcity of trained oncology professionals, and the high cost of cancer care. Furthermore, we discuss the limited availability of cancer clinical trials in the country, along with an examination of potential avenues to enhance cancer care in India. By confronting these hurdles head-on and implementing innovative, pragmatic solutions, we take an indispensable step toward a future where every cancer patient in the country can access quality care.
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Affiliation(s)
- Neha Chintapally
- Pi Health USA, Cambridge, MA, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | - Vamshi K Muddu
- Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, Telangana, India
| | - Peng Gao
- Pi Health USA, Cambridge, MA, USA
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17
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Thasweer AM, Renuka Devi P, Thirunavukkarasu V. Molecular docking and dynamic simulation studies of α4β2 and α7 nicotinic acetylcholine receptors with tobacco smoke constituents nicotine, NNK and NNN. J Biomol Struct Dyn 2023; 41:8462-8471. [PMID: 36270967 DOI: 10.1080/07391102.2022.2135022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/06/2022] [Indexed: 10/24/2022]
Abstract
Smoking constitutes a major global health problem. As it triggers various health hazards including cancers, cardiac and pulmonary illness, it is imperative to understand the mechanism of action of various smoke constituents on our cellular processes. Various in vitro studies have compiled the affinity of cigarette smoke constituents on various nicotinic acetylcholine receptors (nAChRs). But the nature of the intermolecular interactions contributing to this affinity and the key amino acids in the receptor active sites involved in this are not investigated so far. Here, we are examining the interaction of α7nAChR and α4β2nAChR on nicotine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) and N-nitrosornicotine (NNN), the physiologically significant constituents in smoke, through molecular docking and dynamics simulations study. The docking of α4β2nAChR structure with the ligands nicotine, NNK and NNN yielded docking scores of -41.45 kcal/mol, -59.28 kcal/mol and -54.60 kcal/mol, respectively, and that of α7nAChR receptor molecule with the ligands yielded docking scores of -59.54 kcal/mol, -71.06 kcal/mol and -70.86 kcal/mol, respectively. The study showed that NNK exhibited the highest affinity with the ligands which was confirmed by dynamics simulation. But higher stability of interactions as surmised from Molecular dynamics simulations was found for nicotine with α4β2nAChR and NNN with α7nAChR. The findings validate the in vitro studies comparing the affinities of these compounds. The study will be useful in formulating effective nAChR agonists to treat neurological disorders and antagonists for smoke deaddiction and improve health standards.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- A M Thasweer
- Department of Biotechnology, Anna University Regional Campus, Coimbatore, Tamil Nadu, India
| | - P Renuka Devi
- Department of Biotechnology, Anna University Regional Campus, Coimbatore, Tamil Nadu, India
| | - Velusamy Thirunavukkarasu
- Department of Biotechnology, School of Biotechnology and Genetic Engineering, Bharathiar University, Coimbatore, Tamil Nadu, India
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18
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Tholeti P, Uppangala S, Jayaram RK, Udupa KS, Kalthur G, Spears N, Woodruff T, Adiga SK. Oncofertility awareness among primary care physicians in India. F1000Res 2023; 12:153. [PMID: 37767024 PMCID: PMC10521121 DOI: 10.12688/f1000research.126232.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Primary care physicians not only coordinate referrals to oncology services but can play a crucial role in successful fertility preservation referrals in cancer-diagnosed patients. Hence, it is important to assess their knowledge and attitudes towards fertility preservation. METHODS An eighteen-item oncofertility survey was administered to primary care physicians between May 2019 to September 2020. Results: A total of forty-six responses were received and analysed. About 60% of primary care physicians did not have adequate knowledge about available fertility preservation options and only 26-32% were aware of international guidelines recommending fertility preservation in cancer patients. Conclusions: Imparting awareness and knowledge of fertility preservation and its options to primary care physicians could enable an integrated cancer care model while also facilitating successful oncofertility referrals in countries like India.
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Affiliation(s)
- Prathima Tholeti
- Centre for Fertility Preservation, Division of Clinical Embryology, Department of Reproductive Science, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576 104, India
| | - Shubhashree Uppangala
- Division of Reproductive Genetics, Department of Reproductive Science, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576 104, India
| | | | - Karthik S Udupa
- Department of Medical Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576 104, India
| | - Guruprasad Kalthur
- Division of Reproductive Biology, Department of Reproductive Science, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576 104, India
| | - Norah Spears
- Department of Biomedical Sciences, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Teresa Woodruff
- Oncofertility Consortium, Room A626B, Michigan State University, East Lansing, Michigan, 48824-1316, USA
| | - Satish K Adiga
- Centre for Fertility Preservation, Division of Clinical Embryology, Department of Reproductive Science, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576 104, India
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Vaid A, Rastogi N, Doherty TM, San Martin P, Chugh Y. Review of the unmet medical need for vaccination in adults with immunocompromising conditions: An Indian perspective. Hum Vaccin Immunother 2023; 19:2224186. [PMID: 37402477 DOI: 10.1080/21645515.2023.2224186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023] Open
Abstract
Immunocompromised (IC) populations are at increased risk of vaccine-preventable diseases (VPDs). In India, the concern of VPDs in IC populations is particularly acute due to the prevalence of crowded living situations, poor sanitation and variable access to healthcare services. We present a narrative review of IC-related disease and economic burden, risk of VPDs and vaccination guidelines, based on global and India-specific literature (2000-2022). IC conditions considered were cancer, diabetes mellitus, chronic kidney disease, respiratory disorders, disorders treated with immunosuppressive therapy, and human immune deficiency virus (HIV). The burden of IC populations in India is comparable to the global population, except for cancer and HIV, which have lower prevalence compared with the global average. Regional and socioeconomic inequalities exist in IC prevalence; VPDs add to the burden of IC conditions, especially in lower income strata. Adult vaccination programs could improve health and reduce the economic impact of VPDs in IC populations.
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Affiliation(s)
- Ashok Vaid
- Medical Oncology and Hematology, Medanta Cancer Institute, Gurugram, India
| | - Neha Rastogi
- Pediatric Hematology, Oncology and BMT, Medanta Cancer Institute, Gurugram, India
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20
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Fox L, Santaolalla A, Handford J, Sullivan R, Torode J, Vanderpuye V, Pramesh C, Mula-Hussain L, AlWaheidi S, Makaroff LE, Kaur R, Mackay C, Mukherji D, Van Hemelrijck M. Redefining Cancer Research Priorities in Low- and Middle-Income Countries in the Post-COVID-19 Global Context: A Modified Delphi Consensus Process. JCO Glob Oncol 2023; 9:e2300111. [PMID: 37561978 PMCID: PMC10857688 DOI: 10.1200/go.23.00111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/24/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE The post-COVID-19 funding landscape for cancer research globally has become increasingly challenging, particularly in resource-challenged regions (RCRs) lacking strong research ecosystems. We aimed to produce a list of priority areas for cancer research in countries with limited resources, informed by researchers and patients. METHODS Cancer experts in lower-resource health care systems (as defined by the World Bank as low- and middle-income countries; N = 151) were contacted to participate in a modified consensus-seeking Delphi survey, comprising two rounds. In round 1, participants (n = 69) rated predetermined areas of potential research priority (ARPs) for importance and suggested missing ARPs. In round 2, the same participants (n = 49) rated an integrated list of predetermined and suggested ARPs from round 1, then undertook a forced choice priority ranking exercise. Composite voting scores (T-scores) were used to rank the ARPs. Importance ratings were summarized descriptively. Findings were discussed with international patient advocacy organization representatives. RESULTS The top ARP was research into strategies adapting guidelines or treatment strategies in line with available resources (particularly systemic therapy) (T = 83). Others included cancer registries (T = 62); prevention (T = 52); end-of-life care (T = 53); and value-based and affordable care (T = 51). The top COVID-19/cancer ARP was strategies to incorporate what has been learned during the pandemic that can be maintained posteriorly (T = 36). Others included treatment schedule interruption (T = 24); cost-effective reduction of COVID-19 morbidity/mortality (T = 19); and pandemic preparedness (T = 18). CONCLUSION Areas of strategic priority favored by cancer researchers in RCRs are related to adaptive treatment guidelines; sustainable implementation of cancer registries; prevention strategies; value-based and affordable cancer care; investments in research capacity building; epidemiologic work on local risk factors for cancer; and combatting inequities of prevention and care access.
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Affiliation(s)
- Louis Fox
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Aida Santaolalla
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Jasmine Handford
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Richard Sullivan
- Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Julie Torode
- Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | - Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - C.S. Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Layth Mula-Hussain
- Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
| | - Shaymaa AlWaheidi
- Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
| | | | - Ranjit Kaur
- Advanced Breast Cancer Global Alliance, Petaling Jaya, Malaysia
| | - Clara Mackay
- World Ovarian Cancer Coalition, Toronto, ON, Canada
| | - Deborah Mukherji
- Naef K Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society and Public Health, King's College London, London, United Kingdom
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Ranganathan S, Tomar V, Chino F, Jain B, Patel TA, Dee EC, Mathew A. A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India. Support Care Cancer 2023; 31:420. [PMID: 37354234 DOI: 10.1007/s00520-023-07886-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.
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Affiliation(s)
| | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology and Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Aju Mathew
- Department of Oncology, MOSC Medical College, Ernakulam, Kerala, 682311, India
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Kerketta ZH, Kujur A, Kumari N, Sagar V, Pushpa F. A Cross-Sectional Study on the Epidemiology of Newly Diagnosed Breast Cancer Patients Attending Tertiary Care Hospitals in a Tribal Preponderant State of India: Regression Analysis. Cureus 2023; 15:e40489. [PMID: 37461757 PMCID: PMC10349914 DOI: 10.7759/cureus.40489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Breast cancer (BC) is globally prevalent and the leading cause of death due to cancer in females. Due to changes in risk factor profiles, improved cancer registration, and cancer detection, its incidence and death rates have risen over the past three decades. Both modifiable and immutable risk factors for BC make up a sizable portion of the total risk factors. Methodology: This was a hospital-based cross-sectional study carried out in the Department of Surgery, Rajendra Institute of Medical Sciences (RIMS), Ranchi. Consecutive sampling was done with a complete enumeration of all newly diagnosed cases of breast cancer >15 years old. Those who consented to participate and those who were extremely ill, deaf, or dumb were excluded from the study. RESULTS A total of 88 patients were included. Maximum patients diagnosed with breast cancer belonged to the age group of 40-50 years (37.5%), Hindu by religion (76.1%), non-tribal (80.68%), illiterate (89.8%), married (98.9%), housewives (92%), and of class IV socio-economic status (SES) (65.9%). CONCLUSION Regular training of Sahiya (the local name of Accredited Social Health Activist (ASHA) in Jharkhand), empowerment of screening clinics for cancer, and upgraded diagnostic facilities for timely referral should be stressed upon.
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Affiliation(s)
| | - Anit Kujur
- Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Neelanjali Kumari
- Preventive Medicine, Mahatma Gandhi Memorial Medical College, Jamshedpur, Jamshedpur, IND
- Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Vidya Sagar
- Preventive Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Fnu Pushpa
- Community Medicine, Rajendra Institute of Medical Sciences, Ranchi, IND
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Tavallaii A, Meybodi KT, Nejat F, Habibi Z. Current Status of Research on Targeted Therapy Against Central Nervous System Tumors in Low- and Lower-Middle-Income Countries. World Neurosurg 2023; 174:74-80. [PMID: 36918096 DOI: 10.1016/j.wneu.2023.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE In recent decades, a significant body of research has focused on targeted therapies for the treatment of central nervous system (CNS) tumors to enhance the effectiveness of management strategies. However, most of these efforts have been centered in high-income countries, which renders the generalizability of their results to low- and middle-income countries questionable. Therefore, in this review, we systematically investigated the status of research conducted on targeted therapy for CNS tumors in low- and lower-middle-income countries to elucidate the contribution of these countries in advancing neuro-oncology. METHODS A systematic search of 3 databases was performed using a predefined search strategy. After screening the articles based on our inclusion/exclusion criteria, the data were extracted to a predesigned Excel worksheet. RESULTS A review of 44 included studies showed that India, Iran, and Lebanon were the only countries with a contribution to this field. All included studies were laboratory or animal experiments, and there were no clinical studies in this field. The most investigated CNS tumor was malignant glioma, and gene-targeted therapy was the most investigated category of targeted therapies in these countries. CONCLUSIONS Low- and lower-middle-income countries comprise more than half of the world population, but they are deprived of targeted therapies against CNS tumors. Although there are basic experiments performed on this subject, they originate in a limited number of these countries. Therefore, targeted therapy is in its preliminary stage in these countries.
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Affiliation(s)
- Amin Tavallaii
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyvan Tayyebi Meybodi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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H.V. A, Maka VV, Patil P, C. A. Incidence, Patterns, and Severity of Potential Drug Interactions Among Cancer Patients on Chemotherapy in a Tertiary Care Hospital. J Pharmacol Pharmacother 2023. [DOI: 10.1177/0976500x231162712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Objective To study the incidence of potential drug−drug interactions (DDIs) and evaluate their pattern and severity in cancer inpatients. Materials and Methods A detailed clinical data and prescriptions of 150 inpatients with different malignancies were subjected to DDI screening using Micromedex software. The frequency of potential DDIs and their types, patterns, and severity were investigated. Results A total of 360 potential DDIs were present in 111 (74%) of 150 inpatients, dominated by female (67.33%) and breast cancer (30%) patients. The incidence of severe interactions was 63.88%, moderate interactions 35.83%, and mild interactions 0.27%. The potential mechanisms of DDIs were 38.33% pharmacodynamic, 48.33% pharmacokinetic, and 13.33% unspecified. The drug interactions were found to be positively correlated ( p < 0.01) with the 6–10 number of prescribed medicines. Conclusion According to this study, the number of medicines prescribed to cancer inpatients increased the chance of DDIs. As a result, the drug surveillance program could save a sizable number of patients from the potentially hazardous clinical effects of DDIs.
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Zochedh A, Chandran K, Priya M, Sultan AB, Kathiresan T. Molecular simulation of Naringin combined with experimental elucidation – Pharmaceutical activity and Molecular docking against Breast cancer. J Mol Struct 2023. [DOI: 10.1016/j.molstruc.2023.135403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Ramani VK, Jayanna K, Naik R. A commentary on cancer prevention and control in India: Priorities for realizing SDGs. Health Sci Rep 2023; 6:e1126. [PMID: 36824617 PMCID: PMC9941912 DOI: 10.1002/hsr2.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/02/2023] [Accepted: 02/12/2023] [Indexed: 02/25/2023] Open
Abstract
In India, cancers along with cardiovascular diseases contribute to significant mortality and morbidity. With less than 10 years remaining towards achieving Sustainable development Goals (SDGs), public health systems in India need to be critically assessed and strengthened, for addressing non-communicable diseases (NCDs) in general and cancers in particular. Our Commentary address the public health response to cancer prevention and control, with specific pointers based on emerging evidence. The relevant issues are stratified as: emphasis on the critical appraisal of national programs, strengthening primary health care (PHC) systems, enhancing focus on client and community centricity, exploring integrative approaches to cancer management and stepping up implementation and multidisciplinary research. Ongoing surveillance is essential to assess the current and future trends of cancer as well as the outcomes of prevention and treatment measures. For revitalizing comprehensive PHC, much depends on our epidemiological capacity and surveillance systems which impart information for local planning. It is imperative to address the cultural barriers and societal norms, which limit the acceptability and participation in screening programs. SDG 3 has ushered the wellbeing agenda at an opportune time. There is a compelling need to conduct research on an integrated approach (ayurveda complimenting allopathic medication) for the treatment of cancer. The unique challenges posed by the rise in NCD morbidity in LMIC, requires horizontal integration of the health systems with new services focused on cancer control.
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Affiliation(s)
- Vinod K. Ramani
- Preventive OncologyHealthcare Global Enterprise Ltd.BangaloreIndia
| | - Krishnamurthy Jayanna
- Department of Public Health, Faculty of Life and Allied Health SciencesM. S. Ramaiah University of Applied SciencesBangaloreIndia
| | - Radheshyam Naik
- Medical OncologyHealthcare Global Enterprise Ltd.BangaloreIndia
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Sheng B, Yao D, Du X, Chen D, Zhou L. Establishment and validation of a risk prediction model for high-grade cervical lesions. Eur J Obstet Gynecol Reprod Biol 2023; 281:1-6. [PMID: 36521399 DOI: 10.1016/j.ejogrb.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To establish and validate a risk prediction model for cervical high-grade squamous intraepithelial lesions (HSIL). METHODS This retrospective study included patients who underwent cervical biopsies at the Cervical Disease Centre of Maternal and Child Hospital of Hubei Province between January 2021 and December 2021. RESULTS A total of 1630 patients were divided into the HSIL + cervical lesion group (n = 186) and the ≤ LSIL cervical lesions group (n = 1444). LSIL, ASC-H, HSIL and SCC, high-risk HPV, HPV16, HPV18/45, multiple HPV strains, acetowhite epithelium, atypical vessels, and mosaicity were independently associated with HSIL + lesions. These factors were used to establish a risk prediction model with a demonstrated area under the curve (AUC) of 0.851 and a C-index of 0.829. Calibration curve analysis showed that the model performed well, with a mean absolute error (MAE) of 0.005. The decision curve showed that the model created by combining the risk factors was more specific and sensitive than each predictive variable. CONCLUSION The model for predicting HSIL demonstrated promising predictive capability and might help identify patients requiring biopsy and treatment.
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Affiliation(s)
- Binyue Sheng
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China
| | - Dongmei Yao
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China.
| | - Xin Du
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China
| | - Dejun Chen
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China
| | - Limin Zhou
- Department of Gynaecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Hongshan, Wuhan, Hubei 430070, PR China
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Patel D, Patel P, Ramani M, Makadia K. Exploring Perception of Terminally Ill Cancer Patients about the Quality of Life in Hospice based and Home based Palliative Care: A Mixed Method Study. Indian J Palliat Care 2023; 29:57-63. [PMID: 36846286 PMCID: PMC9945234 DOI: 10.25259/ijpc_92_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/28/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives The objectives of the study were to evaluate the perceptions and performance of terminally ill cancer patients regarding the quality of palliative care at different settings and to measure their quality of life (QOL) at the end of life. Material and Methods This comparative, parallel and mixed method study was conducted at the Community Oncology Centre, Ahmedabad, among 68 terminally ill cancer patients as per inclusion criteria; who were receiving hospice (HS)-based and home (HO)-based palliative care under 2 months permitted by the Indian Council of Medical Research. In this parallel and mixed method study, qualitative findings were supplemented by quantitative data with both components executed simultaneously. Interview data were recorded by taking extensive notes during interviews along with an audio recording. Interviews were transcribed verbatim and a thematic approach was adopted. QoL questionnaire ('FACIT© System') was used for the assessment of QOL in terms of four dimensions. Data were analysed using the appropriate statistical test on Microsoft Excel. Results The qualitative data (primary component) analysed under five themes - staff behaviour, comfort and peace, enough and consistent care, nutrition and moral support, in the present study favours a HS-based setting more than a HO-based setting. Among all four subscale scores, physical well-being and emotional well-being subscale scores were statistically significantly associated with the place of palliative care. Functional Assessment of Cancer Therapy-General (FACT-G) total score was high among patients getting HO-based palliative (mean = 67.64) care than HS-based palliative care (mean = 56.56) and the difference between total FACT-G scores was statistically significant (unpaired t-test = 2.20, P = 0.03). Conclusion Overall, with the primary component favouring HS care and higher scores obtained in HO-based patients, the present study advocates the necessity for palliative services to expand their coverage regardless of whether they are provided at HS or HO, as it has improved the QOL of cancer patients significantly.
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Affiliation(s)
- Dhriti Patel
- Department of Internal Medicine, B.J. Medical College and Civil Hospital, Gujarat, India
| | - Parimalkumar Patel
- Department of Community Medicine, B.J. Medical College and Civil Hospital, Gujarat, India
| | - Monal Ramani
- Department of Anaesthesiology, B.J. Medical College and Civil Hospital, Gujarat, India
| | - Khushbu Makadia
- Department of Department of Community Medicine, GMERS Medical College, Himmatnagar, Gujarat, India
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Reddy VA, Sarin R, Panda D, Hanitha R, Jain J, Chatterjee S, Annapurneswari S, Saipillai MZ, Gupta S, Khan E, Bhattacharya J, Bhandari TPS, Prasad SVSS, Swain M. A Multi-centric retrospective study into the epidemiological distribution of breast cancer patients in India. J Cancer Res Ther 2023; 19:S869-S876. [PMID: 38384068 DOI: 10.4103/jcrt.jcrt_1876_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/01/2022] [Indexed: 02/23/2024]
Abstract
BACKGROUND A multicentric private hospital-based retrospective study was conducted to understand the epidemiology of breast cancer in terms of demographics and clinical characteristics (staging and hormone receptor status) at the time of diagnosis. METHODS The data for 5,688 female breast cancer patients were collected from the hospital and clinical records of four study centres. All statistical analysis was performed using Microsoft Excel 2016 and R software. Survival was estimated by the Kaplan-Meier method and compared by the log-rank test. A P value of <.05 was considered statistically significant. RESULTS The mean and median age of the study population was 52.6 (± 12.4) years and 53.0 (range 51-54 across the four centers) years, respectively. About 68% of patients were in the age category of 41 65 years, 17.6% were <40 years old among whom 23.4% of patients reported a positive family history. Most of the patients (66.3%) were diagnosed at an early stage (Stage I and II). The 3-year OS probability was 100%, 97.5%, 94.1%, and 74.7% for TNM Stages I, II, III, and IV, respectively. The 3-year RFS was 95.7%, 95.5%, 84.5%, and 49% for TNM Stages I, II, III, and IV, respectively. CONCLUSION The present study highlights the epidemiological distribution of breast cancer patients. It emphasizes the importance of disease awareness among the urban and educated female population as most patients were diagnosed at earlier stages and demonstrated higher OS and RFS than reported in government registries.
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Affiliation(s)
- Vijay Anand Reddy
- Apollo Health City Jubilee Hills, Jubilee Hills, Hyderabad, Telangana, India
| | - Ramesh Sarin
- Indraprastha Apollo Hospitals, Sarita Vihar, Delhi, India
| | - Dipanjan Panda
- Indraprastha Apollo Hospitals, Sarita Vihar, Delhi, India
| | - Rnm Hanitha
- Sapien Biosciences Private Limited, AIMSR Building, Apollo Health City, Jubilee Hills, Hyderabad, Telangana, India
| | - Jugnu Jain
- Sapien Biosciences Private Limited, AIMSR Building, Apollo Health City, Jubilee Hills, Hyderabad, Telangana, India
| | - Soma Chatterjee
- Sapien Biosciences Private Limited, AIMSR Building, Apollo Health City, Jubilee Hills, Hyderabad, Telangana, India
| | - S Annapurneswari
- Apollo Cancer Center No. 320, Anna Salai, Thiru Vi Ka Kudiyiruppu, Teynampet, Chennai, Tamil Nadu, India
| | - Mohamed Zehran Saipillai
- Apollo Cancer Center No. 320, Anna Salai, Thiru Vi Ka Kudiyiruppu, Teynampet, Chennai, Tamil Nadu, India
| | - Shaikat Gupta
- Apollo Multispecialty Hospitals, Kolkata, West Bengal, India
| | - Enamuddin Khan
- Apollo Multispecialty Hospitals, Kolkata, West Bengal, India
| | | | | | - S V S S Prasad
- Apollo Health City Jubilee Hills, Jubilee Hills, Hyderabad, Telangana, India
| | - Meenakshi Swain
- Apollo Health City Jubilee Hills, Jubilee Hills, Hyderabad, Telangana, India
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Dolui M, Sarkar S, Ghosh P, Hossain M. Dietary diversity and association with non-communicable diseases (NCDs) among adult men (15-54 years): A cross-sectional study using National Family and Health Survey, India. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001775. [PMID: 37185617 PMCID: PMC10132668 DOI: 10.1371/journal.pgph.0001775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/10/2023] [Indexed: 05/17/2023]
Abstract
A healthy and diversified diet is essential for preventing several non-communicable diseases (NCDs). Given the increasing evidence of diet-related health burdens and the rising prevalence of NCDs among Indian adults, the present study aims to explore dietary diversity patterns among adult men in India and their association with non-communicable diseases (NCDs). For this purpose, the study used the fourth round of the National Family and Health Survey (NFHS-4) to analyze adult male samples (n = 1,12,122). Dietary Diversity Scores (DDS) were computed by the weighted sum of the number of different food groups consumed by an individual. The prevalence of diabetes, heart disease, and cancer among adult men is considered a non-communicable disease. Bivariate and logistic regression was carried out to examine the association between DDS and NCDs by estimating chi-squared tests (χ2-test), odds ratio (OR), and 95% confidence interval (CI). The prevalence of diabetes, heart disease, and cancer among adult men in India is 2.1 percent, 1.2 percent, and 0.3 percent, respectively. Results show a positive association between dietary diversity score and the prevalence of the non-communicable disease. High-level dietary diversity scores increase to two times the likelihood of diabetes (OR 2.15 with p<0.05) among adult men than to better-off counterparts while controlling all the covariates. However, a moderate dietary diversity score significantly decreases the likelihood of heart disease (OR 0.88 with p<0.10) and Cancer (OR 0.71 with p<0.05) for adult men compared to a lower score of dietary diversity. In addition, age, marital status, drinking and smoking habits, occupation, and wealth index are also significantly associated with the odds of non-communicable diseases among adult men.
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Affiliation(s)
- Mriganka Dolui
- Department of Geography, School of Earth Sciences, Central University of Karnataka, Karnataka, India
| | - Sanjit Sarkar
- Department of Geography, School of Earth Sciences, Central University of Karnataka, Karnataka, India
| | - Pritam Ghosh
- Department of Geography, University of Calcutta, Kolkata, West Bengal, India
- Department of Geography, Ramsaday College, Howrah, West Bengal, India
| | - Moslem Hossain
- Department of Geography, School of Earth Sciences, Central University of Karnataka, Karnataka, India
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Natuhwera G, Ellis P, Wilson Acuda S, Namukwaya E. Psychosocial and emotional morbidities after a diagnosis of cancer: Qualitative evidence from healthcare professional cancer patients. Nurs Open 2022; 10:2971-2982. [PMID: 36539936 PMCID: PMC10077364 DOI: 10.1002/nop2.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022] Open
Abstract
AIM This inquiry aimed to; (1) examine the psychosocial and emotional sequelae associated with cancer patient-hood experience in healthcare professionals (HCPs) in Uganda, (2) generate evidence to inform clinical and nursing practice about the needs of HCP patients with cancer. DESIGN This was a qualitative phenomenological study. METHODS The study was conducted among HCP cancer patients and survivors recruited from oncology and palliative care settings in Uganda. Data were collected via audio-taped, face-to-face or telephone open-ended interviews. Interviews were transcribed verbatim. Thematic analysis was used. RESULTS Eight HCP cancer patients and survivors participated in the study. Their mean age was 56 years, range 29-85 years. Three major themes emerged: (1) From a healthcare provider to a patient, (2) Socioeconomic challenges, and (3) Coping and support strategies.
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Affiliation(s)
| | - Peter Ellis
- CEO Intelligent Care Software Canterbury Christ Church University Canterbury UK
| | - Stanley Wilson Acuda
- Institute of Hospice and Palliative Care in Africa Hospice Africa Uganda Kampala Uganda
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Sharma BM, Scheringer M, Chakraborty P, Bharat GK, Steindal EH, Trasande L, Nizzetto L. Unlocking India's Potential in Managing Endocrine-Disrupting Chemicals (EDCs): Importance, Challenges, and Opportunities. EXPOSURE AND HEALTH 2022; 15:1-15. [PMID: 36530567 PMCID: PMC9744066 DOI: 10.1007/s12403-022-00519-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/08/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
Endocrine-disrupting chemicals (EDCs) are a prime concern for the environment and health globally. Research shows that in developing countries such as India both the environment and human populations are severely exposed to EDCs and consequently experience rising incidents of adverse health effects such as diabetes and cancers. In this paper, we discuss the current EDC management approach in India, critically assess its limitations, and describe opportunities for potential improvements. Foremost, current EDC management actions and interventions in India are fragmented and outdated, and far behind the modern and comprehensive approaches adopted in the European Union and other developed countries. Strong and well-planned actions are required on various fronts of science, policy, commerce, and public engagement. These actions include the adoption of a dedicated and modern regulatory framework for managing EDCs, enhancing capacity and infrastructure for EDC monitoring in the environment and human population, employing public-private partnership programs for not only managing EDCs but also in the sectors that indirectly contribute toward the mismanagement of EDCs in the country, and raising awareness on EDCs and promoting health-preserving consumption habits among the public. As India hosts a large proportion of the global human population and biodiversity, the success or failure of its actions will substantially affect the direction of global efforts to manage EDCs and set an example for other developing countries.
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Affiliation(s)
- Brij Mohan Sharma
- Faculty of Science, RECETOX, Masaryk University, Kotlarska 2, 62500 Brno, Czech Republic
| | - Martin Scheringer
- Faculty of Science, RECETOX, Masaryk University, Kotlarska 2, 62500 Brno, Czech Republic
| | - Paromita Chakraborty
- Environmental Science and Technology Laboratory, Department of Chemical Engineering, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu 603203 India
| | | | - Eirik Hovland Steindal
- Norwegian Institute for Water Research (NIVA), Økernveien 94, 0579 Oslo, Norway
- Norwegian University of Life Sciences (NMBU), Universitetstunet 3, 1432 Ås, Norway
| | - Leonardo Trasande
- Department of Pediatrics, Environmental Medicine, and Population Health, New York University Grossman School of Medicine, New York, NY USA
- NYU College of Global Public Health, New York, NY USA
| | - Luca Nizzetto
- Faculty of Science, RECETOX, Masaryk University, Kotlarska 2, 62500 Brno, Czech Republic
- Norwegian Institute for Water Research (NIVA), Økernveien 94, 0579 Oslo, Norway
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Ahmad A, Prakash R, Khan MS, Altwaijry N, Asghar MN, Raza SS, Khan R. Nanoparticle-Mediated PRDX2 Inhibition for Specific Targeting of CHK2-Null Colorectal Cancer. ACS Biomater Sci Eng 2022; 8:5210-5220. [PMID: 36446128 DOI: 10.1021/acsbiomaterials.2c01073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Synthetic lethality is a pragmatic targeted cancer therapy approach in which cancer cells harboring genetic alterations are exploited for the specific killing of cancer cells. Earlier, we have established a synthetic lethal (SL) interaction between two genes that are CHK2 and PRDX2 in colorectal cancer (CRC) cells. The SL interaction between CHK2 and PRDX2 resulted in selective targeting of CHK2-defective CRC cells. N-Carbamoyl alanine (NCA) is a PRDX2 inhibitor and is a peptide-like organic compound, which degrades after oral administration in harsh gastric pH. To overcome the limitations of NCA, a chitosan-based nanocarrier was developed for the entrapment of NCA. In this study, we targeted the SL interaction between PRDX2 and CHK2 using NCA-loaded chitosan nanoparticles (NCA-Chit NPs) to selectively inhibit the CHK2-null HCT116 cells. NCA-Chit NPs were assessed for various physicochemical characterizations such as the hydrodynamic diameter (size), zeta potential, and polydispersity index using a Zetasizer. Additionally, morphological studies for the shape and size of NPs were confirmed by transmission electron microscopy, scanning electron microscopy, and atomic force microscopy. Cellular uptake of NPs was confirmed using confocal microscopy, which exhibited that nanoparticles were able to internalize into the HCT116 cells. Blank Chit NPs were found to be cytocompatible as they did not exert any cytotoxic effects on hTERT, L929, and Caco-2 cells (intestinal epithelial cells). Importantly, NCA-Chit NPs were quite hemocompatible also. In the form of an NCA-chitosan nanoformulation, the efficacy was enhanced by about 8 times compared to free form of NCA towards selective killing of CHK2-null HCT116 cells as compared to HCT116 cells. The chitosan-based nanoformulation for NCA was developed to augment the efficacy of the NCA for enhanced cell death of colorectal cancer cells having CHK2 defects.
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Affiliation(s)
- Anas Ahmad
- Chemical Biology Unit, Institute of Nano Science and Technology, Knowledge City, Sector-81, Mohali140306, Punjab, India
| | - Ravi Prakash
- Laboratory for Stem Cell & Restorative Neurology, Department of Biotechnology, Era's Lucknow Medical College Hospital, Sarfarazganj, Lucknow226003, Uttar Pradesh, India
| | - Mohd Shahnawaz Khan
- Department of Biochemistry, College of Sciences, King Saud University, Riyadh, Riyadh Province11451, Saudi Arabia
| | - Nojood Altwaijry
- Department of Biochemistry, College of Sciences, King Saud University, Riyadh, Riyadh Province11451, Saudi Arabia
| | - Muhammad Nadeem Asghar
- Department of Medical Biology, University of Québec at Trois-Rivieres, Trois-Rivieres, QuébecG9A 5H7, Canada
| | - Syed Shadab Raza
- Laboratory for Stem Cell & Restorative Neurology, Department of Biotechnology, Era's Lucknow Medical College Hospital, Sarfarazganj, Lucknow226003, Uttar Pradesh, India
| | - Rehan Khan
- Chemical Biology Unit, Institute of Nano Science and Technology, Knowledge City, Sector-81, Mohali140306, Punjab, India
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Ghoshal A, Joad AK, Spruijt O, Nair S, Rajagopal MR, Patel F, Damani A, Deodhar J, Goswami D, Joshi G, Butola S, Singh C, Rao SR, Bhatwadekar M, Muckaden MA, Bhatnagar S. Situational analysis of the quality of palliative care services across India: a cross-sectional survey. Ecancermedicalscience 2022; 16:1486. [PMID: 36819806 PMCID: PMC9934966 DOI: 10.3332/ecancer.2022.1486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Palliative care services in India were established in the 1980s but there is no detailed up-to-date knowledge about the quality-of-service provision nationally. We aim to describe the current quality of palliative care provision in India, as measured against nationally adopted standards. Method A digital survey adapted from the Indian Association of Palliative Care Standards Audit Tool was administered to 250 palliative care centres. Results Two hundred and twenty-three (89%) palliative care centres participated - 26.4% were government-run, while the rest include non-governmental organisations, private hospitals, community-led initiatives and hospices. About 200 centres 'often' or 'always' fulfilled 16/21 desirable criteria; however, only 2/15 essential criteria were 'often' or 'always' fulfilled. Only 5.8% provide uninterrupted access to oral morphine. Significance of the results Palliative care centres in India are falling short of meeting the essential quality standards, indicating the urgent need for new initiatives to drive national change.
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Affiliation(s)
- Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Anjum Khan Joad
- Department of Anaesthesia and Palliative Care Medicine, Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur 302017, India
| | - Odette Spruijt
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Shobha Nair
- Department of Palliative Medicine, Amrita Hospital, Kochi 682041, India
| | - MR Rajagopal
- Trivandrum Institute of Palliative Sciences and Pallium India, Aisha Memorial Hospital Building, Paruthikuzhy, Thiruvananthapuram 695009, India
| | - Firuza Patel
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Dinesh Goswami
- Guwahati Pain and Palliative Care Society, Uzan Bazar, Guwahati, Assam 781001, India
| | - Geeta Joshi
- Community Oncology Center, Gujarat Cancer Society, Ahmedabad 380007, India
| | - Savita Butola
- Border Security Force Sector Hospital, Panisagar, Tripura 799260, India
| | - Charu Singh
- Department of Palliative Medicine, Amrita Hospital, Kochi 682041, India
| | | | | | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Center, Homi Bhabha National Institute, Mumbai 400012, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R.A Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India
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Hassen HY, Hussien FM, Hassen AM, Dewau R, Amsalu ET, Limenih MA, Berhe NM, Kassaw NA, Sisay BG, Manzar MD. Survival pattern of colorectal cancer in Sub-Saharan Africa: A systematic review and meta-analysis. Cancer Epidemiol 2022; 81:102276. [PMID: 36257176 DOI: 10.1016/j.canep.2022.102276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
Cancer incidence is relatively low in sub-Saharan Africa (SSA), however, prognosis is expected to be poor in comparison with high-income countries. Comprehensive evidence is limited on the survival pattern of colorectal cancer patients in the region. We conducted a systematic review and meta-analysis to investigate the pattern of colorectal cancer survival in the region and to identify variation across countries and over time. We searched international databases MEDLINE, Scopus, Embase, Web of Science, ProQuest, CINAHL, and Google Scholar to retrieve studies that estimated survival from colorectal cancer in SSA countries from inception to December 31, 2021 without language restriction. Due to between-study heterogeneity, we performed a random-effects meta-analysis to pool survival rates. To identify study-level sources of variation, we performed subgroup analysis and meta-regression. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guideline and the protocol was registered in PROSPERO database (CRD42021246935). 23 studies involving 10,031 patients were included in the review, of which, 20 were included in the meta-analysis. The meta-analysis results showed that the pooled 1-, 2-, 3-, 4-, and 5-year survival rates in SSA were 0.74 (95% CI, 0.66-0.81), 0.50 (95% CI, 0.41-0.58), 0.36 (95% CI, 0.27-0.47), 0.31 (95% CI, 0.22-0.42), and 0.28 (95% CI, 0.19-0.38) respectively. Subgroup analyses indicated that the survival rate varied according to year of study, in which those conducted in recent decades showed relatively better survival. The 5-year survival was higher in middle-income SSA countries (0.31; 95%CI: 0.17-0.49) than low-income countries (0.20; 95%CI: 0.11-0.35), however, the difference was not statistically significant. In conclusion, survival from colorectal cancer is low in sub-Saharan Africa compared to other regions. Thus, intervention strategies to improve screening, early diagnosis and treatment of colorectal cancer should be developed and implemented to improve survival in the region.
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Affiliation(s)
- Hamid Y Hassen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium.
| | - Foziya M Hussien
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anissa M Hassen
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Erkihun T Amsalu
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Miteku A Limenih
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Neamin M Berhe
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Nigussie A Kassaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Binyam G Sisay
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
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George S. Being sick to a cancer patient: pathways of delay in help seeking and diagnosis of cancer in India. JOURNAL OF SOCIAL AND ECONOMIC DEVELOPMENT 2022; 25:52-69. [PMID: 36466373 PMCID: PMC9685046 DOI: 10.1007/s40847-022-00221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 06/03/2023]
Abstract
There is evidence that cancer mortality and morbidity could be reduced when the disease is diagnosed and treated at an early stage. The paper examines the pathways of delay of cancer diagnosis in an Indian setting. It draws on a qualitative study conducted among cancer survivors and family members of cancer patients in the city of Bengaluru, South India. The results show that a substantial part of the delay occurred at the stage of initial formal help seeking wherein patient and family-led, disease-related and systemic factors together played a major role. Patient-led factors included trivialisation and normalisation of symptoms as part of general fatigue and aging; unrealistic risk perceptions that linked causality of cancer merely to heredity and behavioural risk factors; fear of being diagnosed as cancer patient; gender related reasons including family's gender performance expectation, lower agency of women to seek help and lower prioratisation of women's health in the household and access related issues including financial constraints and unavailability of specialised hospitals nearby. Disease-related factors included the presence of comorbidity, cancer's mimicking of symptoms of other diseases and absence of distinguishable symptoms at the initial stage for certain types of cancers. The practitioner-led and system-led factors such as trivialisation of symptoms by general practitioners, non cancer-specific referrals, and lack of cancer screening facilities accounted for a major part of delay after the formal help seeking. The paper argues that the mere knowledge of cancer symptoms did not always lead to early diagnosis due to the interplay of these factors. The ongoing cancer prevention and control interventions in India need to be informed of these micro level factors while developing strategies to prevent avoidable delays in cancer diagnosis.
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Affiliation(s)
- Sobin George
- Centre for the Study of Social Change and Development, Institute for Social and Economic Change, Bengaluru, India
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Ramanadhan S, Xuan Z, Choi J, Mahtani SL, Minsky S, Gupte H, Mandal G, Jagiasi D, Viswanath K. Associations between sociodemographic factors and receiving "ask and advise" services from healthcare providers in India: analysis of the national GATS-2 dataset. BMC Public Health 2022; 22:2115. [PMID: 36401241 PMCID: PMC9673333 DOI: 10.1186/s12889-022-14538-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
India is home to about 12% of the world's tobacco users, with about 1.35 million tobacco-related deaths each year. The morbidity and mortality rates are socially patterned based on gender, rural vs. urban residence, education, and other factors. Following the World Health Organization's guidance, it is critical to offer tobacco users support for cessation as a complement to policy and environmental changes. Such guidance is typically unavailable in low-resource systems, despite the potential for population-level impact. Additionally, service delivery for tobacco control tends to be patterned by sociodemographic factors. To understand current activity in this area, we assessed the percentage of daily tobacco users being asked about tobacco use and advised to quit by a healthcare provider. We also examined social patterning of receipt of services (related to by rural vs. urban residence, age, gender, education, caste, and wealth).
Methods
We analyzed cross-sectional data from India's 2016-2017 Global Adult Tobacco Survey (GATS-2), a nationally representative survey. Among 74,037 respondents, about 25% were daily users of smoked and/or smokeless tobacco. We examined rates of being asked and advised about tobacco use overall and based on rural vs. urban residence, age, gender, education, caste, and wealth. We also conducted multivariate logistic regression to assess the association of demographic and socioeconomic conditions with participants' receipt of “ask and advise” services.
Results
Nationally, among daily tobacco users, we found low rates of individuals reporting being asked about tobacco use or advised to quit by a healthcare provider (22% and 19%, respectively). Being asked and advised about tobacco use was patterned by age, gender, education, caste, and wealth in our final regression model.
Conclusions
This study offers a helpful starting point in identifying opportunities to address a critical service delivery gap in India. Given the existing burden on the public health and health systems, scale-up will require innovative, resource-appropriate solutions. The findings also point to the need to center equity in the design and scale-up of tobacco cessation supports so that marginalized and underserved groups will have equitable access to these critical services.
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Meena RK, Syed NA, Sheikh ZA, Guru FR, Mir MH, Banday SZ, MP AK, Parveen S, Dar NA, Bhat GM. Patterns of Treatment and Outcomes in Epithelial Ovarian Cancer: A Retrospective North Indian Single-Institution Experience. JCO Glob Oncol 2022; 8:e2200032. [PMID: 36332174 PMCID: PMC9668559 DOI: 10.1200/go.22.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Ovarian cancer (OC) is ranked as the third most common gynecologic cancer in various Indian cancer registries. In India, OC is seen in the younger age group, with a median age < 55 years being reported by most of the studies. The majority of patients are diagnosed in advanced stage (70%-80%), where the long-term (10-year) survival rate is poor, estimated at 15%-30%. The aim of this study was to evaluate clinical epidemiology, treatment patterns, and survival outcomes in patients with epithelial OC. METHODS This was a retrospective analysis of patients with epithelial OC who were treated at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, over a period of 9 years, from January 2010 to December 2018. RESULTS OC constituted 2.94% of all cancers registered. Epithelial OC constituted 88.4% of all OCs, with a median age 50 years. More than two third of patients belonged to rural background and the majority (76.9%) of the patients were in stage III or IV at the time of diagnosis. The main presenting symptoms were abdominal distension/bloating (46.5%) and gastrointestinal disturbances (35.2%). The most common histologic types were serous (65.9%) followed by mucinous carcinoma (15%). Median overall survival for the whole study cohort was 30 months (95% CI, 28.0 to 31.9). Median overall survival for stage I, II, III, and IV was 72, 60, 30, and 20 months, respectively. CONCLUSION Most of the patients presented in advanced stage of the disease and have poor outcome. Delay in diagnosis and improper management before registering in tertiary cancer center and lack of tertiary care facilities are the root causes of poor outcomes. The general population and primary care physicians need to be made aware of OC symptoms.
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Affiliation(s)
- Rajendra Kumar Meena
- Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
| | - Nisar Ahmad Syed
- Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India,Nisar Ahmad Syed, MD, DM, Department of Medical Oncology, Sheri Kashmir Institute of Medical Sciences (SKIMS), State Cancer Institute Building, Srinagar, UT Jammu & Kashmir, 190011, India;
| | - Zahoor Ahmad Sheikh
- Department of Surgical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
| | - Faisal Rashid Guru
- Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
| | - Mohmad Hussain Mir
- Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
| | - Saquib Zaffar Banday
- Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
| | - Arun Krishnan MP
- Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
| | - Shaheena Parveen
- Department of Gastroentrology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
| | - Nazir Ahmad Dar
- Department of Radiation Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
| | - Gull Mohammad Bhat
- Department of Medical Oncology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, Srinagar, India
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Song B, Li S, Sunny S, Gurushanth K, Mendonca P, Mukhia N, Patrick S, Peterson T, Gurudath S, Raghavan S, Tsusennaro I, Leivon ST, Kolur T, Shetty V, Bushan V, Ramesh R, Pillai V, Wilder-Smith P, Suresh A, Kuriakose MA, Birur P, Liang R. Exploring uncertainty measures in convolutional neural network for semantic segmentation of oral cancer images. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:115001. [PMID: 36329004 PMCID: PMC9630461 DOI: 10.1117/1.jbo.27.11.115001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
SIGNIFICANCE Oral cancer is one of the most prevalent cancers, especially in middle- and low-income countries such as India. Automatic segmentation of oral cancer images can improve the diagnostic workflow, which is a significant task in oral cancer image analysis. Despite the remarkable success of deep-learning networks in medical segmentation, they rarely provide uncertainty quantification for their output. AIM We aim to estimate uncertainty in a deep-learning approach to semantic segmentation of oral cancer images and to improve the accuracy and reliability of predictions. APPROACH This work introduced a UNet-based Bayesian deep-learning (BDL) model to segment potentially malignant and malignant lesion areas in the oral cavity. The model can quantify uncertainty in predictions. We also developed an efficient model that increased the inference speed, which is almost six times smaller and two times faster (inference speed) than the original UNet. The dataset in this study was collected using our customized screening platform and was annotated by oral oncology specialists. RESULTS The proposed approach achieved good segmentation performance as well as good uncertainty estimation performance. In the experiments, we observed an improvement in pixel accuracy and mean intersection over union by removing uncertain pixels. This result reflects that the model provided less accurate predictions in uncertain areas that may need more attention and further inspection. The experiments also showed that with some performance compromises, the efficient model reduced computation time and model size, which expands the potential for implementation on portable devices used in resource-limited settings. CONCLUSIONS Our study demonstrates the UNet-based BDL model not only can perform potentially malignant and malignant oral lesion segmentation, but also can provide informative pixel-level uncertainty estimation. With this extra uncertainty information, the accuracy and reliability of the model’s prediction can be improved.
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Affiliation(s)
- Bofan Song
- The University of Arizona, Wyant College of Optical Sciences, Tucson, Arizona, United States
| | - Shaobai Li
- The University of Arizona, Wyant College of Optical Sciences, Tucson, Arizona, United States
| | - Sumsum Sunny
- Mazumdar Shaw Medical Centre, Bangalore, Karnataka, India
| | | | | | - Nirza Mukhia
- KLE Society Institute of Dental Sciences, Bangalore, Karnataka, India
| | | | - Tyler Peterson
- The University of Arizona, Wyant College of Optical Sciences, Tucson, Arizona, United States
| | - Shubha Gurudath
- KLE Society Institute of Dental Sciences, Bangalore, Karnataka, India
| | | | - Imchen Tsusennaro
- Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India
| | - Shirley T. Leivon
- Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India
| | - Trupti Kolur
- Mazumdar Shaw Medical Foundation, Bangalore, Karnataka, India
| | - Vivek Shetty
- Mazumdar Shaw Medical Foundation, Bangalore, Karnataka, India
| | - Vidya Bushan
- Mazumdar Shaw Medical Foundation, Bangalore, Karnataka, India
| | - Rohan Ramesh
- Christian Institute of Health Sciences and Research, Dimapur, Nagaland, India
| | - Vijay Pillai
- Mazumdar Shaw Medical Foundation, Bangalore, Karnataka, India
| | - Petra Wilder-Smith
- University of California, Beckman Laser Institute & Medical Clinic, Irvine, California, United States
| | - Amritha Suresh
- Mazumdar Shaw Medical Centre, Bangalore, Karnataka, India
- Mazumdar Shaw Medical Foundation, Bangalore, Karnataka, India
| | | | - Praveen Birur
- KLE Society Institute of Dental Sciences, Bangalore, Karnataka, India
- Biocon Foundation, Bangalore, Karnataka, India
| | - Rongguang Liang
- The University of Arizona, Wyant College of Optical Sciences, Tucson, Arizona, United States
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Sharma A, Sharma A, Patni S, Gupta A, Ledwani N, Saini S, Patni N, Bapna A, Somani N, Sharma M, Verma S, Sharma GK, Nunia V. A single centre study from western India to evaluate the frequency of developing second and subsequent multiple primary malignancies among cancer survivors. SURGICAL AND EXPERIMENTAL PATHOLOGY 2022. [DOI: 10.1186/s42047-022-00122-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Aim
This study was designed to evaluate the frequency of developing second and subsequent primary cancers among cancer survivors.
Methods
We have retrospectively analyzed 121 multiple primary cancer patients treated at Bhagwan Mahavir Cancer Hospital and Research Centre, Jaipur, Rajasthan, India from the last 20 years. The survival analysis was performed by Kaplan-Meier methodology.
Results
The prevalence of multiple primary malignant tumors (MPMTs) was 1.51% (121/8000), with a male to female ratio of 1:1.42. In males most of the reported MPMTs were synchronous and most common first primary cancer cases were head & neck and lung whereas, in females most of the reported MPMTs were metachronous and most common first primary cancer cases were breast and gynaecological malignancies. Family history was reported in 15 cases. Maximum 33.05% patients received combined treatment of chemotherapy, radiotherapy and 91.73% (111/121) of patients with MPMTs were effectively followed up, 35 (28.92%) patients died and 5-year survival rate of the remaining 86 patients was 68.46%.
Conclusions
In the present observational study the most frequent sites of MPMTs in men were head & neck and lung whereas, in women breast and gynaecological sites were common. Therefore, careful monitoring and follow up are required for these patients.
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Joad ASK, Hota A, Agarwal P, Patel K, Patel K, Puri J, Shin S. “I want to live, but …” the desire to live and its physical, psychological, spiritual, and social factors among advanced cancer patients: evidence from the APPROACH study in India. BMC Palliat Care 2022; 21:153. [PMID: 36045352 PMCID: PMC9429624 DOI: 10.1186/s12904-022-01041-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
The limited access to palliative care resources along with the social stigma around cancer largely explains the poor quality of life (QoL) of Indian advanced cancer patients. As advanced cancer patients with poor QoL often harbour a desire for hastened death (DHD), it is imperative to understand factors affecting DHD, or the desire to live (DTL) among advanced cancer patients in India. We aim to examine the relationship between DTL and physical, psychological, spiritual, and social factors measuring patients’ QoL alongside their awareness of their late cancer stage.
Methods
We surveyed 200 patients from a tertiary cancer hospital in India to collect their DTL, awareness of cancer stage, demographic characteristics, and standardized measures for patients’ QoL. We used a linear probability regression model to quantify the association between these factors and patients’ DTL among the final sample of 192 patients with no missing information for the variables of interest.
Results
Among the various domains affecting cancer patients’ QoL, we found that the pain severity score (ranging from 0 to 10) and psychological distress score (ranging from 0 to 42) are negatively associated with the DTL. One point increase in each score reduced the DTL by 2.2% (p < 0.05) and 0.7% (p < 0.05), respectively. Our results also showed that patients whose perceived socio-economic status (SES) is poor have a 16% (p < 0.05) lower probability of DTL, compared to those with higher SES (lower middle class, upper middle class, and wealthy). Controlling for caste, religion, gender, age, marital status and years of education, we found psychological distress is statistically higher among patients belonging to this bottom SES.
Conclusions
We found that pain severity, psychological distress and perceived low SES are negatively associated with the desire to live in advanced cancer patients. Future research should focus on developing interventions to improve physical pain and psychological distress, particularly for patients who are socially and economically disadvantaged.
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Chandran K, Shane DI, Zochedh A, Sultan AB, Kathiresan T. Docking simulation and ADMET prediction based investigation on the phytochemical constituents of Noni ( Morinda citrifolia) fruit as a potential anticancer drug. In Silico Pharmacol 2022; 10:14. [PMID: 36034317 PMCID: PMC9411403 DOI: 10.1007/s40203-022-00130-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/05/2022] [Indexed: 02/02/2023] Open
Abstract
Morinda citrifolia is a traditional plant used in Asian and African countries for its wide nutraceutical and therapeutic effects for the treatment of various ailments. The fruit of M. citrifolia has various biological properties such as anti-bacterial, anti-oxidant, anti-cancer. Using the molecular docking based investigation; we explored around twenty three bioactive phytochemicals in M. citrifolia fruit against human cancer. MAPK6 (mitogen-activated protein kinase 6) was selected as target protein and these twenty three phytochemicals along with a known MAPK6 inhibitor were docked against the target protein. The docking scores of the bioactive phytochemicals against MAPK6 protein range between - 4.5 kcal/mol to - 7.9 kcal/mol and the docking score of the standard drug (CID: 447077) was - 7.3 kcal/mol. Based on the binding affinity five phytochemicals asperuloside (- 6.7 kcal/mol), asperulosidic acid (- 7.2 kcal/mol), deacetylasperulosidic acid (- 7.0 kcal/mol), eugenol (- 6.8 kcal/mol) and rutin (- 7.9 kcal/mol) were chosen for further evaluation. These five compounds were further investigated through RC plot analysis, density function theory and ADMET properties. Stable linkage of protein-ligand interaction was observed through RC plot, density function theory showed the structural stability and reactivity of bioactive compounds through the energy gap between HOMO and LUMO and the ADMET (adsorption, distribution, metabolism, excretion and toxicity) studies showed the safety profile of the bioactive compounds. These in silico results support the utilization of M. citrifolia fruit in the traditional medication and the initiation for the development of new drug against human cancer through in vivo and in vitro evaluation. Supplementary Information The online version contains supplementary material available at 10.1007/s40203-022-00130-4.
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Affiliation(s)
- Kaliraj Chandran
- Department of Biotechnology, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu India
| | - Drose Ignatious Shane
- Department of Biotechnology, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu India
| | - Azar Zochedh
- Department of Biotechnology, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu India
| | - Asath Bahadur Sultan
- Department of Physics, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu India
| | - Thandavarayan Kathiresan
- Department of Biotechnology, Kalasalingam Academy of Research and Education, Krishnankoil, Tamilnadu India
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Hassan M, Butt ZA. Cancer research in Pakistan: Opportunities, challenges and the way forward. J Cancer Policy 2022; 34:100358. [PMID: 36007874 DOI: 10.1016/j.jcpo.2022.100358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/19/2022] [Indexed: 11/15/2022]
Abstract
Chronic disease disparities, in low and middle income countries (LMICs), need to be addressed through research to improve health equity. Most LMICs including Pakistan have a huge burden of non communicable disease (NCDs) like cancer and a high number of deaths due to cancer. National Cancer Control Programmes are recommended for countries with high cancer burden like Pakistan to ensure systematic implementation of evidence based strategies for cancer control however there is limited capacity for evidence generation through research. We describe the existing status for cancer registries and research in Pakistan and suggest a syndemic framework to prioritize contextually relevant research which can advance cancer health equity for Pakistani population.
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Affiliation(s)
- Mariam Hassan
- Clinical Research Office, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan.
| | - Zahid Ahmad Butt
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Mungle T, Das N, Pal S, Gogoi MP, Das P, Ghara N, Ghosh D, Arora RS, Bhakta N, Saha V, Krishnan S. Comparative treatment costs of risk-stratified therapy for childhood acute lymphoblastic leukemia in India. Cancer Med 2022; 12:3499-3508. [PMID: 36812120 PMCID: PMC9939102 DOI: 10.1002/cam4.5140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To evaluate the treatment cost and cost effectiveness of a risk-stratified therapy to treat pediatric acute lymphoblastic leukemia (ALL) in India. METHODS The cost of total treatment duration was calculated for a retrospective cohort of ALL children treated at a tertiary care facility. Children were risk stratified into standard (SR), intermediate (IR) and high (HR) for B-cell precursor ALL, and T-ALL. Cost of therapy was obtained from the hospital electronic billing systems and details of outpatient (OP) and inpatient (IP) from electronic medical records. Cost effectiveness was calculated in disability-adjusted life years. RESULTS One hundred and forty five patients, SR (50), IR (36), HR (39), and T-ALL (20) were analyzed. Median cost of the entire treatment for SR, IR, HR, and T-ALL was found to be $3900, $5500, $7400, and $8700, respectively, with chemotherapy contributing to 25%-35% of total cost. Out-patient costs were significantly lower for SR (p < 0.0001). OP costs were higher than in-patient costs for SR and IR, while in-patient costs were higher in T-ALL. Costs for non-therapy admissions were significantly higher in HR and T-ALL (p < 0.0001), representing over 50% of costs of in-patient therapy. HR and T-ALL also had longer durations of non-therapy admissions. Based on WHO-CHOICE guidelines, the risk-stratified approach was very cost effective for all categories of patients. CONCLUSIONS Risk-stratified approach to treat childhood ALL is very cost-effective for all categories in our setting. The cost for SR and IR patients is significantly reduced through decreased IP admissions for both, chemotherapy and non-chemotherapy reasons.
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Affiliation(s)
- Tushar Mungle
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Nandana Das
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Saikat Pal
- Tata Consultancy ServicesTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Manash Pratim Gogoi
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Parag Das
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Niharendu Ghara
- Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia
| | - Debjani Ghosh
- Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia
| | | | - Nickhill Bhakta
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Vaskar Saha
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia,Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia,Division of Cancer Sciences, Faculty of Biology, Medicine and HealthSchool of Medical Sciences, University of ManchesterManchesterUK
| | - Shekhar Krishnan
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia,Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia,Division of Cancer Sciences, Faculty of Biology, Medicine and HealthSchool of Medical Sciences, University of ManchesterManchesterUK
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Jiwnani S, Penumadu P, Ashok A, Pramesh CS. Lung Cancer Management in Low and Middle-Income Countries. Thorac Surg Clin 2022; 32:383-395. [PMID: 35961746 DOI: 10.1016/j.thorsurg.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lung cancer is an increasing problem in the developing world due to rising trends in smoking, high incidence of air pollution, lack of awareness and screening, delayed presentation, and diagnosis at the advanced stage. Even after diagnosis, there are disparities in access to health care facilities and inequitable distribution of resources and treatment options. In addition, the shortage of trained personnel and infrastructure adds to the challenges faced by patients with lung cancer in these regions. A multi-pronged effort targeting tobacco cessation, health promotion and awareness, capacity building, and value-based care are the need of the hour.
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Affiliation(s)
- Sabita Jiwnani
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, India.
| | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Medical Education and Research, JIPMER, 5343, 3rd Floor, SSB, Gorimedu, Pondicherry 605006, India
| | - Apurva Ashok
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Tata Memorial Hospital, 3rd Floor, Dr. E. Borges Road, Parel, Mumbai 400012, India
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Tata Memorial Hospital, Main Building, Ground Floor, Dr. E. Borges Road, Parel, Mumbai 400012, India
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Marbaniang I, Joshi S, Sangle S, Khaire S, Thakur R, Chavan A, Gupte N, Kulkarni V, Deshpande P, Nimkar S, Mave V. Smokeless tobacco use and oral potentially malignant disorders among people living with HIV (PLHIV) in Pune, India: Implications for oral cancer screening in PLHIV. PLoS One 2022; 17:e0270876. [PMID: 35788753 PMCID: PMC9255739 DOI: 10.1371/journal.pone.0270876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 06/17/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION In India, smokeless tobacco (SLT) is a predominant form of tobacco used among people living with HIV (PLHIV). Despite SLT being a risk factor for oral potentially malignant disorders (OPMDs), no prior studies have quantified the association of OPMDs with SLT use among PLHIV. This limits the planning of preventive and control strategies for oral cancer among PLHIV, who are at higher risk for the disease. METHODS We enrolled 601 PLHIV and 633 HIV-uninfected individuals in an oral cancer screening study at BJ Government Medical College, Pune, India. Oral cavity images were collected using an m-Health application and reviewed by three clinicians. Participants with two clinician positive diagnoses were deemed to have suspected OPMDs. Prevalence ratios (PRs) were used to quantify the association between suspected OPMDs and SLT use among PLHIV. PRs for current SLT users, across HIV status and use duration were also estimated. Corrected PRs were obtained by modifying the maximum likelihood estimation. Models were adjusted for age, smoking, alcohol use and CD4 counts. RESULTS Of those enrolled, 61% were men, median age was 36 years (IQR: 28-44), and 33% currently use SLT. Proportion of current SLT users was similar across PLHIV and HIV-uninfected groups but use duration for current SLT use was higher among PLHIV(p<0.05). Among PLHIV, current SLT users had a 5-times (95% CI:3.1-7.0) higher prevalence of suspected OPMDs, compared to non-users. Relative to HIV uninfected individuals with the same SLT use duration, significant associations with suspected OPMDs were seen for PLHIV with<10 use years (PR: 3.5, 95% CI: 1.5-8.1) but not for PLHIV with≥10 use years (PR: 1.3, 95% CI: 0.9-1.8). CONCLUSION PLHIV that are current SLT users are at high risk of OPMDs and potentially oral cancer. The development of strategies for screening, early detection, and management of OPMDs must be considered for this group.
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Affiliation(s)
- Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Department of Epidemiology, McGill University, Montreal, Québec, Canada
- * E-mail:
| | - Samir Joshi
- Department of Otorhinolaryngology and Head & Neck Surgery, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Shashikala Sangle
- Department of Medicine, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Samir Khaire
- Department of Dentistry, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Rahul Thakur
- Department of Otorhinolaryngology and Head & Neck Surgery, Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Vandana Kulkarni
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Prasad Deshpande
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College – Johns Hopkins University Clinical Research Site, Pune, India
- Center for Clinical Global Health Education, Johns Hopkins University, Baltimore, Maryland, United States of America
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Sengar M, Fundytus A, Hopman W, Pramesh CS, Radhakrishnan V, Ganesan P, Mathew A, Lombe D, Jalink M, Gyawali B, Trapani D, Roitberg F, De Vries EGE, Moja L, Ilbawi A, Sullivan R, Booth CM. Cancer Medicines: What Is Essential and Affordable in India? JCO Glob Oncol 2022; 8:e2200060. [PMID: 35853192 PMCID: PMC9812506 DOI: 10.1200/go.22.00060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE The WHO essential medicines list (EML) guides selection of drugs for national formularies. Here, we evaluate which medicines are considered highest priority by Indian oncologists and the extent to which they are available in routine practice. METHODS This is a secondary analysis of an electronic survey developed by the WHO EML Cancer Medicine Working Group. The survey was distributed globally using a hierarchical snowball method to physicians who prescribe systemic anticancer therapy. The survey captured the 10 medicines oncologists considered highest priority for population health and their availability in routine practice. RESULTS The global study cohort included 948 respondents from 82 countries; 98 were from India and 67 were from other low- and middle-income countries. Compared with other low- and middle-income countries, the Indian cohort was more likely to be medical oncologist (70% v 31%, P < .001) and work exclusively in the private health system (52% v 17%, P < .001). 14/20 most commonly selected medicines were conventional cytotoxic drugs. Universal access to these medicines was reported by a minority of oncologists; risks of significant out-of-pocket expenditures for each medicine were reported by 19%-58% of oncologists. Risk of catastrophic expenditure was reported by 58%-67% of oncologists for rituximab and trastuzumab. Risks of financial toxicity were substantially higher within the private health system compared with the public system. CONCLUSION Most high-priority cancer medicines identified by Indian oncologists are generic chemotherapy agents that provide substantial improvements in survival and are already included in WHO EML. Access to these treatments remains limited by major financial burdens experienced by patients. This is particularly acute within the private health system. Strategies are urgently needed to ensure that high-quality cancer care is affordable and accessible to all patients in India.
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Affiliation(s)
- Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Adam Fundytus
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Oncology, Queen's University, Kingston, Canada
| | - Wilma Hopman
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Aju Mathew
- Malankara Orthodox Syrian Church Medical College, Kolenchery, India
| | | | - Matthew Jalink
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Oncology, Queen's University, Kingston, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Dario Trapani
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, Milan, Italy
| | - Felipe Roitberg
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Elisabeth G E De Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lorenzo Moja
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - André Ilbawi
- Department of Health Products Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada.,Department of Oncology, Queen's University, Kingston, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Canada
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Zochedh A, Priya M, Shunmuganarayanan A, Thandavarayan K, Sultan AB. Investigation on structural, spectroscopic, DFT, biological activity and molecular docking simulation of essential oil Gamma-Terpinene. J Mol Struct 2022. [DOI: 10.1016/j.molstruc.2022.133651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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49
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Venkataramanan R, Pradhan A, Kumar A, Purushotham A, Alajlani M, Arvanitis TN. Digital Inequalities in Cancer Care Delivery in India: An Overview of the Current Landscape and Recommendations for Large-Scale Adoption. Front Digit Health 2022; 4:916342. [PMID: 35832659 PMCID: PMC9272889 DOI: 10.3389/fdgth.2022.916342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction COVID-19 pandemic has caused major disruptions to delivery of various cancer care services as efforts were put to control the outbreak of the pandemic. Although the pandemic has highlighted the inadequacies of the system but has also led to emergence of a new cancer care delivery model which relies heavily on digital mediums. Digital health is not only restricted to virtual dissemination of information and consultation but has provided additional benefits ranging from support to cancer screening, early and more accurate diagnosis to increasing access to specialized care. This paper evaluates the challenges in the adoption of digital technologies to deliver cancer care services and provides recommendation for large-scale adoption in the Indian healthcare context. Methods We performed a search of PubMed and Google Scholar for numerous terms related to adoption of digital health technologies for cancer care during pandemic. We also analyze various socio-ecological challenges—from individual to community, provider and systematic level—for digital adoption of cancer care service which have existed prior to pandemic and lead to digital inequalities. Results Despite encouraging benefits accruing from the adoption of digital health key challenges remain for large scale adoption. With respect to user the socio-economic characteristics such as age, literacy and socio-cultural norms are the major barriers. The key challenges faced by providers include regulatory issues, data security and the inconvenience associated with transition to a new system. Policy Summary For equitable digital healthcare, the need is to have a participatory approach of all stakeholders and urgently addressing the digital divide adequately. Sharing of health data of public and private hospitals, within the framework of the Indian regulations and Data Protection Act, is critical to the development of digital health in India and it can go a long way in better forecasting and managing cancer burden.
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Affiliation(s)
- Ramachandran Venkataramanan
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
- Research Division, Karkinos Healthcare, Mumbai, India
- *Correspondence: Ramachandran Venkataramanan
| | - Akash Pradhan
- Research Division, Karkinos Healthcare, Mumbai, India
- Akash Pradhan
| | | | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Mohannad Alajlani
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
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Kulothungan V, Sathishkumar K, Leburu S, Ramamoorthy T, Stephen S, Basavarajappa D, Tomy N, Mohan R, Menon GR, Mathur P. Burden of cancers in India - estimates of cancer crude incidence, YLLs, YLDs and DALYs for 2021 and 2025 based on National Cancer Registry Program. BMC Cancer 2022; 22:527. [PMID: 35546232 PMCID: PMC9092762 DOI: 10.1186/s12885-022-09578-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 04/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Cancer is the major cause of morbidity and mortality worldwide. The cancer burden varies within the regions of India posing great challenges in its prevention and control. The national burden assessment remains as a task which relies on statistical models in many developing countries, including India, due to cancer not being a notifiable disease. This study quantifies the cancer burden in India for 2016, adjusted mortality to incidence (AMI) ratio and projections for 2021 and 2025 from the National Cancer Registry Program (NCRP) and other publicly available data sources. Methods Primary data on cancer incidence and mortality between 2012 and 2016 from 28 Population Based Cancer Registries (PBCRs), all-cause mortality from Sample Registration Systems (SRS) 2012–16, lifetables and disability weight from World Health Organization (WHO), the population from Census of India and cancer prevalence using the WHO-DisMod-II tool were used for this study. The AMI ratio was estimated using the Markov Chain Monte Carlo method from longitudinal NCRP-PBCR data (2001–16). The burden was quantified at national and sub-national levels as crude incidence, mortality, Years of Life Lost (YLLs), Years Lived with Disability (YLDs) and Disability Adjusted Life Years (DALYs). The projections for the years 2021 and 2025 were done by the negative binomial regression model using STATA. Results The projected cancer burden in India for 2021 was 26.7 million DALYsAMI and expected to increase to 29.8 million in 2025. The highest burden was in the north (2408 DALYsAMI per 100,000) and northeastern (2177 DALYsAMI per 100,000) regions of the country and higher among males. More than 40% of the total cancer burden was contributed by the seven leading cancer sites — lung (10.6%), breast (10.5%), oesophagus (5.8%), mouth (5.7%), stomach (5.2%), liver (4.6%), and cervix uteri (4.3%). Conclusions This study demonstrates the use of reliable data sources and DisMod-II tools that adhere to the international standard for assessment of national and sub-national cancer burden. A wide heterogeneity in leading cancer sites was observed within India by age and sex. The results also highlight the need to focus on non-leading sites of cancer by age and sex. These findings can guide policymakers to plan focused approaches towards monitoring efforts on cancer prevention and control. The study simplifies the methodology used for arriving at the burden estimates and thus, encourages researchers across the world to take up similar assessments with the available data. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09578-1.
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Affiliation(s)
- Vaitheeswaran Kulothungan
- Indian Council Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Krishnan Sathishkumar
- Indian Council Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Sravya Leburu
- Indian Council Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Thilagavathi Ramamoorthy
- Indian Council Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Santhappan Stephen
- Indian Council Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | | | - Nifty Tomy
- Indian Council Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Rohith Mohan
- Indian Council Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Geetha R Menon
- Indian Council Medical Research (ICMR) - National Institute of Medical Statistics (NIMS), New Delhi, India
| | - Prashant Mathur
- Indian Council Medical Research (ICMR) - National Centre for Disease Informatics and Research (NCDIR), Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India.
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