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Ray CS, Gupta PC. Oral cancer in India. Oral Dis 2024. [PMID: 38950053 DOI: 10.1111/odi.14974] [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: 01/04/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To describe the epidemiological status of oral cancer (OC) in India along with updates on risk factors, advances and gaps in preventive measures, treatment, costs of care and monitoring. METHODS Two national estimates of incidence and mortality were cited, one for 2016 by the Global Burden of Disease India Study and one based on projections for 2020 by GLOBOCAN. The National Cancer Registry Project provided local and regional incidence and trends using data from 2012-2016. Scientific literature, reports of the NCRP, the IARC and government press releases were also consulted. RESULTS Tobacco and areca nut habits are the major risk factors for OC in India. In the 1980s, intervention studies on oral screening, awareness generation and habit cessation in rural areas reduced tobacco use and oral leukoplakia. Lately, adoption of the tobacco control law and mass media communications have resulted in decreased tobacco use. However, the increasing popularity of highly carcinogenic tobacco products containing areca nut, with evasion of their bans, is increasing OC incidence. CONCLUSION Despite advances in care, there is growing incidence of OC, persisting poor awareness about the need to quit tobacco/areca nut/alcohol use and go for screening. Major efforts are needed to implement preventive activities.
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Affiliation(s)
- Cecily S Ray
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
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2
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Singh A, Sullivan R, Bavaskar M, Shetty R, Joshi P, Nair S, Gupta S, Chaturvedi P, Badwe R. A prospective health economic evaluation to determine the productivity loss due to premature mortality from oral cancer in India. Head Neck 2024; 46:1263-1269. [PMID: 38622958 DOI: 10.1002/hed.27776] [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: 12/08/2023] [Revised: 03/05/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION India contributes two-thirds of the global mortality due to oral cancer and has a younger population at risk. The societal costs of this premature mortality are barely discussed. METHODS Using the human capital approach, we aimed to estimate the productivity lost due to premature mortality, valued using individual socioeconomic data, related to oral cancer in India. A bottom-up approach was used to prospectively collect data of 100 consecutive patients with oral cancer treated between 2019 and 2020, with a follow-up of 36 months. RESULTS The disease-specific survival for early and advanced stage was 85% and 70%, with a median age of 47 years. With 671 years lost prematurely, the loss of productivity was $41 900/early and $96 044/advanced stage. Based on population level rates, the total cost of premature mortality was $5.6 billion, representing 0.18% of GDP. CONCLUSION India needs to implement tailored strategies to reduce the economic burden from premature mortality.
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Affiliation(s)
- Arjun Singh
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Manasi Bavaskar
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rathan Shetty
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Poonam Joshi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudeep Gupta
- Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajendra Badwe
- Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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3
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Mankan AK, Shankar A, Limaye S, Ajaikumar BS, Nachane P, Singh N, Dawkhar S, Batra U, Bhosekar A, Ganguly S, Gawli P, Debnath K, Padalalu V, Reddy P, Sundaramoorthy S, Naveen KK, Bondarde S, Kumar P, Davis S, Ramkissoon SH, Chacko RT, Vidal L, Chico I, Hegedus A, Gupta S, Saini KS. Cancer Trials Ecosystem in India-Ready for Prime Time? JCO Glob Oncol 2024; 10:e2300405. [PMID: 38870438 DOI: 10.1200/go.23.00405] [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: 10/27/2023] [Accepted: 04/12/2024] [Indexed: 06/15/2024] Open
Abstract
Executing global clinical trials for cancer is a long, expensive, and complex undertaking. While selecting countries global studies, sponsors must consider several aspects including patient pool, quality of trained investigators, competing trials, availability of infrastructure, and financial investment versus returns. With a large, often treatment-naïve, and diverse patient pool, relatively low cost, good quality health care facilities in urban areas, and a robust and well-trained workforce, India offers several advantages for conducting oncology clinical trials. However, there remains challenges, including a shifting regulatory environment in recent decades. With the implementation of the New Drugs and Clinical Trial Rules in 2019, India's regulatory atmosphere seems to have stabilized. In this article, we present a review of the evolving clinical trial landscape in India, highlight the current regulatory scenario, and discuss the advantages and challenges of selecting India as a potential location for conducting global oncology clinical trials.
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Affiliation(s)
| | - Abhishek Shankar
- Department of Radiation Oncology, Dr BR Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, Delhi, India
| | | | | | | | - Navneet Singh
- PostGraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Ullas Batra
- Rajiv Gandhi Cancer Centre, New Delhi, India
| | | | | | | | | | | | | | | | | | | | | | - Sanish Davis
- Indian Society for Clinical Research, Mumbai, India
| | | | | | | | | | | | - Sudeep Gupta
- Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Kamal S Saini
- Fortrea Inc, Durham, NC
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Gissi DB, Suàrez-Fernandez C, Rossi R, Vitali F, Marzi Manfroni A, Gabusi A, Morandi L, Balbi T, Montebugnoli L, Foschini MP, Tarsitano A. Direct healthcare costs of oral cancer: A retrospective study from a tertiary care center. J Craniomaxillofac Surg 2024; 52:630-635. [PMID: 38582671 DOI: 10.1016/j.jcms.2024.03.002] [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: 10/20/2023] [Revised: 12/19/2023] [Accepted: 03/05/2024] [Indexed: 04/08/2024] Open
Abstract
The aim of this study was to retrospectively evaluate the direct costs of OSCC treatment and postsurgical surveillance in a tertiary hospital in northeast Italy. Sixty-three consecutive patients surgically treated for primitive OSCC at S. Orsola Hospital in Bologna (Italy) between January 2018 and January 2020 were analyzed. Billing records of the Emilia Romagna healthcare system and institutional costs were used to derive specific costs for the following clinical categories: operating theatre costs, intensive and ordinary hospitalization, radiotherapy, chemotherapy, postsurgical complications, visits, and examinations during the follow-up period. The study population comprised 17 OSCC patients classified at stage I, 14 at stage II, eight at stage III, and 24 at stage IV. The estimated mean total direct cost for OSCC treatment and postsurgical surveillance was €26 338.48 per patient (stage I: €10 733, stage II: €19 642.9, stage III: €30 361.4, stage IV: €39 957.2). An advanced diagnosis (stages III and IV), complex surgical procedure, and loco-regional recurrences resulted in variables that were significantly associated with a higher cost of OSCC treatment and postsurgical surveillance. Redirection of funds used for OSCC treatment to screening measures may be an effective strategy to improve overall health outcomes and optimize national health resources.
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Affiliation(s)
- Davide Bartolomeo Gissi
- Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy.
| | - Carlota Suàrez-Fernandez
- Department of Surgery and Medical-Surgical Specialities, School of Medicine and Health Sciences, University of Oviedo, Oviedo, Spain
| | - Roberto Rossi
- Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy
| | - Francesco Vitali
- Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery at Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Alice Marzi Manfroni
- Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery at Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Andrea Gabusi
- Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy
| | - Luca Morandi
- Functional and Molecular Neuroimaging Unit, Bellaria Hospital, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Tiziana Balbi
- Unit of Anatomic Pathology, S. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Lucio Montebugnoli
- Department of Biomedical and Neuromotor Sciences, Section of Oral Sciences, University of Bologna, Bologna, Italy
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology at Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Achille Tarsitano
- Oral and Maxillofacial Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, Section of Maxillofacial Surgery at Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
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5
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Nikte V, Patil S, Chaudhari H, Patil C, Pawar R, Patil P, More H, Katolkar U. Financial toxicity and its implication on quality of life in patients attending the palliative care department in a regional cancer centre: An observational study. J Cancer Policy 2024; 39:100460. [PMID: 38061493 DOI: 10.1016/j.jcpo.2023.100460] [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: 06/05/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023]
Abstract
In India the cancer burden for 2021 was 26.7 million disability-adjusted life years (DALYs), and this is expected to increase to 29.8 million in 2025 (Kulothungan et al., 2022). According to the World Health Organisation (WHO), cancer is a leading cause of death worldwide, accounting for one in six deaths. As per WHO, palliative care is a strategy that assists both adults and children along with their families in dealing with life-threatening illnesses. Currently, only 14% of those in need of pain and palliative (P&P) care receive it globally (WHO, 2020). Financial toxicity (FT) is the term used to describe the negative effects that an excessive financial burden resulting from cancer have on patients, their families, and society (Desai and Gyawali, 2020). Addressing this gap will require significant adjustments to both demand- and supply-side policies to ensure accessible and equitable cancer care in India (Caduff et al., 2019). Measuring FT along with health-related quality of life (HRQoL) represents a clinically relevant and patient-centred approach (de Souza et al., 2017). AIM AND OBJECTIVE To estimate FT and its association with quality of life (QoL). MATERIALS AND METHODS This was an observational descriptive study conducted among cancer patients recommended for P&P care. Scores were estimated from September 2022 to February 2023 using official tools: the Functional Assessment for Chronic illness Treatment Compressive Score for Financial Toxicity (FACIT-COST) and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of life Questionnaires for Cancer (QLQ30). RESULTS From 150 patients (70 males and 80 females, mean age 54.96 ± 13.5 years), 92.6% suffered from FT. Eleven patients (7.3%) were under FT grade 0, 41 (27.3%) were FT grade 1, 98 (65.3%) were FT grade 2, and no patients were under FT grade 3. At criterial alpha 0.05 (95%CI), FT and the global score for HRQoL showed an association. Among inpatient department (IPD) expenses, medication bills contributed the greatest expense at 33%, and among outpatient department (OPD) expenses treatment expenses contributed 50% of the total. Breast cancer (30 cases, 20%) and oral cancer (26 cases, 17.3%) were the most frequent cancers. CONCLUSION FT measured using the COST tool showed an association with HRQoL. POLICY SUMMARY This paper refers to the insurance policies available for cancer patients irrespective of P&P care treatment.
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Affiliation(s)
- Vaishnavi Nikte
- Department of Pharmacy Practice, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, 425405 Dhule, Maharashtra, India.
| | - Savita Patil
- Department of Pharmacy Practice, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, 425405 Dhule, Maharashtra, India.
| | - Hemakshi Chaudhari
- Department of Pharmacy Practice, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, 425405 Dhule, Maharashtra, India.
| | - Chaitanya Patil
- Pain and Palliative Care, Kolhapur Cancer Centre, R S 238 Opp. Mayur Petrol Pump Gokul Shirgaon, 416234 Kolhapur, Maharashtra, India.
| | - Reshma Pawar
- Clinical Research Department, Kolhapur Cancer Centre, R S 238 Opp. Mayur Petrol Pump Gokul Shirgaon, 416234 Kolhapur, Maharashtra, India.
| | - Prasad Patil
- Clinical Research Department, Kolhapur Cancer Centre, R S 238 Opp. Mayur Petrol Pump Gokul Shirgaon, 416234 Kolhapur, Maharashtra, India.
| | - Harshvardhan More
- Counselling Department, Kolhapur Cancer Centre, R S 238 Opp. Mayur Petrol Pump Gokul Shirgaon, 416234 Kolhapur, Maharashtra, India.
| | - Ujjwal Katolkar
- Pharmacology Department, R. C. Patel Institute of Pharmaceutical Education and Research, Shirpur, 425405 Dhule, Maharashtra, India.
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Singh M, Thankappan K, Balasubramanian D, Pillai V, Shetty V, Rangappa V, Chandrasekhar NH, Kekatpure V, Kuriakose MA, Krishnamurthy A, Mitra A, Pattatheyil A, Jain P, Iyer S, Iyer NG, Subramaniam N. Contrasting clinical outcomes and socio-economic impact of young versus elderly-onset oral squamous cell carcinoma, a novel health economic analysis. Cancer Med 2024; 13:e6747. [PMID: 38225902 PMCID: PMC10905235 DOI: 10.1002/cam4.6747] [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: 07/09/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVES The incidence of young-onset oral squamous cell carcinoma (OSCC) is growing, even among non-smokers/drinkers. The effects of adverse histopathological features on long-term oncologic outcomes between the young and old are controversial and confounded by significant heterogeneity. Few studies have evaluated the socio-economic impact of premature mortality from OSCC. Our study seeks to quantify these differences and their economic impact on society. MATERIALS AND METHODS Four hundred and seventy-eight young (<45 years) and 1660 old patients (≥45 years) with OSCC were studied. Logistic regression determined predictors of recurrence and death. Survival analysis was calculated via the Kaplan-Meier method. A separate health economic analysis was conducted for India and Singapore. Years of Potential Productive Life Lost (YPPLL) were estimated with the Human Capital Approach, and premature mortality cost was derived using population-level data. RESULTS Adverse histopathological features were seen more frequently in young OSCC: PNI (42.9% vs. 35%, p = 0.002), LVI (22.4% vs. 17.3%, p = 0.013) and ENE (36% vs. 24.5%, p < 0.001). Although 5-year OS/DSS were similar, the young cohort had received more intensive adjuvant therapy (CCRT 26.9% vs. 16.6%, p < 0.001). Among Singaporean males, the premature mortality cost per death was US $396,528, and per YPPLL was US $45,486. This was US $397,402 and US $38,458 for females. Among Indian males, the premature mortality cost per death was US $30,641, and per YPPLL was US $595. This was US $ 21,038 and US $305 for females. CONCLUSION Young-onset OSCC is an aggressive disease, mitigated by the ability to receive intensive adjuvant treatment. From our loss of productivity analysis, the socio-economic costs from premature mortality are substantial. Early cancer screening and educational outreach campaigns should be tailored to this cohort. Alongside, more funding should be diverted to genetic research, developing novel biomarkers and improving the efficacy of adjuvant treatment in OSCC.
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Affiliation(s)
- Manraj Singh
- Department of Head and Neck SurgerySingapore General Hospital and National Cancer CentreSingaporeSingapore
| | | | - Deepak Balasubramanian
- Department of Head and Neck Surgical OncologyAmrita Institute of Medical SciencesKochiIndia
| | - Vijay Pillai
- Department of Head and Neck Surgical OncologyMazumdar Shaw Medical Centre, Narayana HealthBangaloreIndia
| | - Vivek Shetty
- Department of Head and Neck Surgical OncologyMazumdar Shaw Medical Centre, Narayana HealthBangaloreIndia
| | - Vidyabhushan Rangappa
- Department of Head and Neck Surgical OncologyMazumdar Shaw Medical Centre, Narayana HealthBangaloreIndia
| | - Naveen Hedne Chandrasekhar
- Department of Head and Neck Surgical OncologyMazumdar Shaw Medical Centre, Narayana HealthBangaloreIndia
- Present address:
Department of Head and Neck Surgical OncologyApollo Proton Cancer CentreChennaiIndia
| | - Vikram Kekatpure
- Department of Head and Neck Surgical OncologyMazumdar Shaw Medical Centre, Narayana HealthBangaloreIndia
- Present address:
Department of Head and Neck Surgical OncologyCytecare HospitalBangaloreIndia
| | - Moni Abraham Kuriakose
- Department of Head and Neck Surgical OncologyMazumdar Shaw Medical Centre, Narayana HealthBangaloreIndia
| | | | - Arun Mitra
- Department of Surgical OncologyCancer Institute (WIA)ChennaiIndia
| | - Arun Pattatheyil
- Department of Head and Neck Surgical OncologyTata Medical CentreKolkataIndia
| | - Prateek Jain
- Department of Head and Neck Surgical OncologyTata Medical CentreKolkataIndia
| | - Subramania Iyer
- Department of Head and Neck Surgical OncologyAmrita Institute of Medical SciencesKochiIndia
| | - N. Gopalakrishna Iyer
- Department of Head and Neck SurgerySingapore General Hospital and National Cancer CentreSingaporeSingapore
| | - Narayana Subramaniam
- Department of Head and Neck Surgical OncologyMazumdar Shaw Medical Centre, Narayana HealthBangaloreIndia
- Present address:
Department of Head and Neck Surgical OncologySri Shankara Cancer Hospital and Research CentreBangaloreIndia
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7
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Noronha V, Dhanawat A, Patil VM, Menon N, Singh AK, Chaturvedi P, Pai P, Chaukar D, Laskar SG, Prabhash K. Long-term outcomes of neo-adjuvant chemotherapy on borderline resectable oral cavity cancers: Real-world data of 3266 patients and implications for clinical practice. Oral Oncol 2024; 148:106633. [PMID: 37988838 DOI: 10.1016/j.oraloncology.2023.106633] [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: 07/11/2023] [Revised: 10/08/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Neo-adjuvant chemotherapy (NACT) followed by response assessment is the standard treatment algorithm for locally advanced oral cavity squamous cell carcinomas (OCSCC) in the Indian subcontinent. The 3-drug NACT regimen (Docetaxel-Cisplatin-5-FU) has shown improvement in overall survival over 2-drug regimen (Docetaxel-Cisplatin) in a phase-3 randomised study. We have analysed the 10-year outcomes with this treatment algorithm. METHODS This was an institutional review board approved retrospective analysis of a prospectively collected dataset of borderline resectable OCSCC patients who underwent NACT. Patients who became resectable after NACT underwent surgery followed by appropriate adjuvant therapy. Patients who were unresectable received definitive chemoradiation (CTRT), palliative chemotherapy, radiotherapy or best supportive care based on general condition. RESULTS A total of 3266 patients were included. The most common subsite was buccal mucosa and the most frequent indication was peri-tumoral edema upto zygoma. More than 2-drugs NACT was offered to 32.9% patients. Overall, 32.5% patients had a response to NACT. A total of 1358 patients were offered curative treatment, of which 929 (32%) underwent surgery and the rest underwent definitive chemo-radiation (14.8%). Patients who received more than 2-drugs NACT versus those who received 2-drugs had a 10-years OS of 21% vs 5.1% (p < 0.001). Patients who underwent surgery versus those who did not had a 10-year OS of 21.8% vs 4.1% (p < 0.001). Patients who achieved pCR had a 5-year OS of 45.3% vs 13.3% for those who did not (p < 0.001). CONCLUSION NACT leads to long term survival benefit in patients of borderline resectable oral cavity cancer.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Aditya Dhanawat
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Vijay Maruti Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Ajay Kumar Singh
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Prathamesh Pai
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Devendra Chaukar
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai 400012, India.
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Katna R, Naik G, Girkar F, Deshpande A, Chalke S, Bhosale B, Kalyani N. Clinical outcomes for microvascular reconstruction in oral cancers: experience from a single surgical centre. Ann R Coll Surg Engl 2023; 105:247-251. [PMID: 35175143 PMCID: PMC9974342 DOI: 10.1308/rcsann.2021.0295] [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] [Accepted: 10/09/2021] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION Reconstruction of a surgical defect is an important part of the management of oral cancers. Microvascular free flap construction provides better functional and cosmetic outcomes. METHODS Between 2014 and 2020, some 524 patients underwent microvascular reconstruction. Comorbidity variables were scored using the Charlson Comorbidity Index (CCI). Complications were recorded using Clavien-Dindo criteria. RESULTS Eighty-three (15.84%), 339 (64.69%) and 102 (19.47%) patients underwent free radial forearm flap, free anterolateral thigh flap and free fibula osteocutaneous flap (FFOCF), respectively. Clavien-Dindo complications of grade III and above were seen in 39 (7.44%) patients. Total flap loss was seen in 18 patients and of these, 16 were salvaged using alternative free flaps or pedicled flaps. On univariate analysis, overall and major complication rates were higher in FFOCF (p=0.171). Major complications significantly more common in patients with a CCI score >4 (p=0.001). Patients aged >65 years had higher rates of complications (p=0.03). CONCLUSION Microvascular free tissue transfer is a reliable, safe and gold standard modality in surgical reconstruction and can be replicated in non-institutional settings.
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Affiliation(s)
| | - G Naik
- Vedant Hospital, Thane, India
| | | | | | | | | | - N Kalyani
- Jaslok Hospital and Research Centre, Mumbai, India
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9
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Shruti T, Khanna D, Khan A, Dandpat A, Tiwari M, Singh AG, Mishra A, Shetty A, Birur P, Chaturvedi P. Status and Determinants of Early Detection of Oral Premalignant and Malignant Lesions in India. Cancer Control 2023; 30:10732748231159556. [PMID: 36809192 PMCID: PMC9947682 DOI: 10.1177/10732748231159556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
It has been over four decades since the launch of the National Cancer Control Programme in India, yet the cancer screening rates for oral cancer remain unremarkable. Moreover, India is bracing a large burden of oral cancer with poor survival rates. An effective public health programme implementation relies on a multitude of factors related to cost-effective evidence-based interventions, the healthcare delivery system, public health human resource management, community behaviour, partnership with stakeholders, identifying opportunities and political commitment. In this context, we discuss the various challenges in the early detection of oral premalignant and malignant lesions and potential solutions.
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Affiliation(s)
- Tulika Shruti
- Departmentof Preventive Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha
Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Divya Khanna
- Departmentof Preventive Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha
Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India,Divya Khanna, MD, Department of Preventive
Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi
Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Banaras Hindu University,
Campus, Sundar Bagiya Colony, Sundarpur, Varanasi 221005, India.
| | - Aqusa Khan
- Departmentof Preventive Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha
Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Abhishek Dandpat
- Departmentof Preventive Oncology,
Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi Bhabha
Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Manish Tiwari
- Department of Head and Neck
Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi
Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | - Arjun G. Singh
- Department of Head and Neck
Oncology, Tata Memorial Centre, Mumbai, India
| | - Aseem Mishra
- Department of Head and Neck
Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre (MPMMCC) and Homi
Bhabha Cancer Hospital (HBCH), Tata Memorial Centres, Varanasi, India
| | | | - Praveen Birur
- Department of Oral Medicine and
Radiology, Consultant Biocon Foundation and Integrated Head and Neck Programme,
Mazumdar Shaw Medical Foundation, KLES Institute of Dental
Sciences, Bengaluru, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Homi Bhabha National
Institute, Anushakti Nagar, India,Centre for Cancer Epidemiology, Tata Memorial Centre, Mumbai, India
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Gole AA, Ashwinirani SR, Kadashetti V, Suragimath G, Muneshwar S, Godse P. Prevalence of Oral Cancer in Western Population of Maharashtra for 3 Years: A Prospective Study. J Midlife Health 2023; 14:3-7. [PMID: 37680369 PMCID: PMC10482017 DOI: 10.4103/jmh.jmh_44_23] [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: 03/13/2023] [Accepted: 04/27/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction In developing countries, oral cancer (OC) is estimated to be the third most common malignancy after cancer of the cervix and stomach. The aim of this study was to report the prevalence of OC for 3 years and its association with age, gender, type, and duration of habits along with the site of OC. Materials and Methods This study was conducted in the Department of Oral Medicine and Radiology from January 2019 to December 2021. All the patients were examined after recording their demographic data using a mouth mirror and probe. The diagnosis of OC was arrived based on the clinical features of the lesions. The type and duration of habits and site were recorded in clinical pro forma. The Statistical Package for the Social Sciences (SPSS) software version 21.0 was used for the statistical analysis, the Chi-square test was applied, and the significance level was set at P < 0.05. Results The prevalence of OC was 0.22% in our study. Of 317 cases, the majority of the patients were males (n = 204), and females (n = 113) accounted for a male: female ratio of 2:1. The most common age affected was 51-70 years with a history of tobacco chewing, followed by patients with multiple habits (smokers, tobacco chewers, and alcoholic). The buccal mucosa was the most common site followed by malignancies of multiple sites. Conclusion Regular camps regarding tobacco cessation and counseling should be taken care of by dentists. Male patients aged above 40 years are routinely recommended for dental visits.
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Affiliation(s)
- Abhishek Anilrao Gole
- Department of Oral Medicine and Radiology, Krishna Viswa Vidyapeeth, Deemed to be Univeristy, School of Dental Scienecs, Karad, Maharasthra, India
| | - S. R. Ashwinirani
- Department of Oral Medicine and Radiology, Krishna Viswa Vidyapeeth, Deemed to be Univeristy, School of Dental Scienecs, Karad, Maharasthra, India
| | - Vidya Kadashetti
- Department of Oral and Maxillofcaial Pathology, Krishna Viswa Vidyapeeth, Deemed to be Univeristy, School of Dental Scienecs, Karad, Maharasthra, India
| | - Girish Suragimath
- Department of Peridontology, Krishna Viswa Vidyapeeth, Deemed to be Univeristy, School of Dental Scienecs, Karad, Maharasthra, India
| | - Shrutika Muneshwar
- Department of Oral Medicine and Radiology, Krishna Viswa Vidyapeeth, Deemed to be Univeristy, School of Dental Scienecs, Karad, Maharasthra, India
| | - Priti Godse
- Department of Oral Medicine and Radiology, Krishna Viswa Vidyapeeth, Deemed to be Univeristy, School of Dental Scienecs, Karad, Maharasthra, India
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Mobile Health (mHealth) Technology in Early Detection and Diagnosis of Oral Cancer-A Scoping Review of the Current Scenario and Feasibility. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4383303. [PMID: 36312594 PMCID: PMC9605853 DOI: 10.1155/2022/4383303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/30/2022] [Indexed: 11/25/2022]
Abstract
Objective Oral cancer is one of the most common types of cancer with dreadful consequences. But it can be detected early without much expensive equipment. Screening and early detection of oral cancer using Mobile health (mHealth) technology are reported due to the availability of the extensive network of mobile phones across populations. Therefore, we aimed to explore the existing literature regarding mHealth feasibility in the early detection of oral cancer. Materials and Method. An extensive search was conducted to explore the literature on the feasibility of mobile health for early oral cancer. Clinical studies reporting kappa agreement between on-site dentists and offsite health care workers/dentists in the early detection of oral cancer were included in this review. Studies describing the development of a diagnostic device, app development, and qualitative interviews among practitioners trained in using mobile health were also included in this review for a broader perspective on mHealth. Results While most of the studies described various diagnostic accuracies using mHealth for oral cancer early detection, few studies reported the development of mobile applications, novel device designs for mHealth applications, and the feasibility of a few mHealth programs for early oral cancer detection. Community health workers equipped with a mobile phone-based app could identify “abnormal” oral lesions. Overall, many studies reported high sensitivity, specificity, and Kappa value of agreement. Effectiveness, advantages, and barriers in oral cancer screening using mHealth are also described. Conclusion The overall results show that remote diagnosis for early detection of oral cancer using mHealth was found useful in remote settings.
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Maitre P, Krishnatry R, Chopra S, Gondhowiardjo S, Likonda BM, Hussain QM, Zubizarreta EH, Agarwal JP. Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2100376. [PMID: 35839434 PMCID: PMC9812473 DOI: 10.1200/go.21.00376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Low- and middle-income countries (LMICs) have a large burden of cancer with differential population needs and outcomes compared to high-income countries. Access to radiotherapy, especially modern technology, is a major challenge. Modern radiotherapy has been demonstrated with better utility in overall cancer outcomes. We deliberate various challenges and opportunities unique to LMICs' set up for access to modern radiotherapy technology in the light of discussions and deliberations made during the recently concluded annual meeting of Tata Memorial Centre, India. We take examples available from various LMICs in this direction in our manuscript.
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Affiliation(s)
- Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India,Rahul Krishnatry, MD, Department of Radiation Oncology, Tata Memorial Hospital, Ernst Borges Rd, Parel, Mumbai 400012, India; e-mail:
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Soehartati Gondhowiardjo
- Department of Radiation Oncology, Faculty of Medicine of Indonesia,Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Beda Mnamala Likonda
- Bugando Medical Centre, Catholic University of Health Sciences, Nyamagana, Mwanza, Tanzania
| | | | - Eduardo H. Zubizarreta
- Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
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Pramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, de Andrade VP, Hunter DJ, Gopal S, Gospodarowicz M, Gunasekera S, Ilbawi A, Kapambwe S, Kingham P, Kutluk T, Lamichhane N, Mutebi M, Orem J, Parham G, Ranganathan P, Sengar M, Sullivan R, Swaminathan S, Tannock IF, Tomar V, Vanderpuye V, Varghese C, Weiderpass E. Priorities for cancer research in low- and middle-income countries: a global perspective. Nat Med 2022; 28:649-657. [PMID: 35440716 PMCID: PMC9108683 DOI: 10.1038/s41591-022-01738-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 01/22/2023]
Abstract
Cancer research currently is heavily skewed toward high-income countries (HICs), with little research conducted in, and relevant to, the problems of low- and middle-income countries (LMICs). This regional discordance in cancer knowledge generation and application needs to be rebalanced. Several gaps in the research enterprise of LMICs need to be addressed to promote regionally relevant research, and radical rethinking is needed to address the burning issues in cancer care in these regions. We identified five top priorities in cancer research in LMICs based on current and projected needs: reducing the burden of patients with advanced disease; improving access and affordability, and outcomes of cancer treatment; value-based care and health economics; quality improvement and implementation research; and leveraging technology to improve cancer control. LMICs have an excellent opportunity to address important questions in cancer research that could impact cancer control globally. Success will require collaboration and commitment from governments, policy makers, funding agencies, health care organizations and leaders, researchers and the public.
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Affiliation(s)
- C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Rajendra A Badwe
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Satish Gopal
- Centre for Global Health, National Cancer Institute, Rockville, MD, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Peter Kingham
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tezer Kutluk
- Faculty of Medicine and Cancer Institute, Hacettepe University, Ankara, Turkey
| | | | | | | | | | | | - Manju Sengar
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Ian F Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine and Korle Bu Teaching Hospital, Accra, Ghana
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