Financial impact of oral cancer treatment on the households in rural India.

Background: Oral cancer ranks second and accounts for over 20% of all cancers reported in India. Like management of all other cancers, oral cancers bring a heavy financial burden to their families. This study analyzes the financial burden on families during the management of oral cancer at Kasturba Hospital, Sewagram, a government-aided tertiary health care facility in central India. Methods: The hospital-based cross-sectional study was conducted in the cancer unit of a government-aided tertiary hospital of central India. A total of 100 patients with oral cancer being treated in the hospital were included in the study. Information regarding cost incurred on management of oral cancer was inquired from a close family member or a caregiver of the study subjects. Results: The out-of-pocket expenditure on treatment of oral cancer was approximately INR 100,000 (USD 1363). It has been found that 96% of families experienced catastrophic health expenditure as a result of treatment. Conclusion: Although India aims for universal health coverage, it is important to protect cancer patients from catastrophic health expenditure.

Feasibility, Tolerance, and Quality of Life for Hypofractionation Versus Conventional Fractionation for Post-mastectomy Radiotherapy in Indian Patients.

INTRODUCTION: The international standard for post-operative radiotherapy for breast cancer delivers hypofractionated radiotherapy. However, many centers in India still follow the longer conventional schedule probably because of paucity of large prospective trials in Indian patients on the same and apprehension regarding tolerance of high dose per fraction in the said population. We aimed to test the feasibility of hypofractionation in our setting and compared the toxicities and the quality of life in patients receiving conventional and hypofractionated radiotherapy. MATERIALS AND METHODS: Eighty histopathologically proven women of non-metastatic carcinoma breast who underwent modified radical mastectomy were assigned to receive 50 Gray/25 fractions/five weeks or 40 Gray/15 fractions/three weeks. Patients were assessed for the following toxicities - radiation dermatitis, radiation pneumonitis, dysphagia, skin fibrosis, lymphedema, shoulder stiffness, and brachial plexopathy, during radiation and at treatment completion and then at first, third, and sixth-month follow-up. Health-related quality of life was assessed using the European Organisation for Research and Treatment of Cancer core quality of life questionnaire (EORTC QLQ-C30) and breast cancer-specific quality of life questionnaire (QLQ-BR23) at treatment completion and then at first, third, and sixth-month follow-up. RESULTS AND CONCLUSION: We had a mean follow-up of 12.78 months. All the assessed toxicities and quality of life scores were comparable between the two arms at all time points of evaluation (p>0.05); 40 Gray in 15 fractions over three weeks is feasible and as safe as the five-week schedule with comparable quality of life. Hypofractionation can be practiced as a routine for post-mastectomy breast cancer patients as this shorter radiotherapy schedule is convenient and cheaper for the patients with no compromise on normal tissue toxicity or quality of life.

Quality of Life in Patients of Head and Neck Cancer During Covid 19.

The Indian Institute of head and neck oncology, a charitable Cancer Centre under the Indore Cancer foundation, continued to offer treatment during the Covid pandemic. 44 head and neck cancer patients who underwent surgery with adjuvant radiotherapy and 43 head and neck cancer patients who underwent only radiotherapy as the primary line of treatment from March 2020 to May 2021, were selected for the purpose of this study. Patients who underwent treatment for head and neck cancer either by radiotherapy or by surgery followed by post-operative radiotherapy were analysed to evaluate quality of life. Feedback was obtained using a QOL questionnaire. The results were analysed against numerical scores. Pain, appearance, speech, swallowing, chewing taste sensation etc. were analysed. Fear and psychological discomfort remained the overriding aspect.

Choroidal metastasis in pancreatic adenocarcinoma.

Pancreatic adenocarcinoma is the seventh largest cause of death from cancer with a death rate of 3.8%. The 5-year survival rate is only 5%. We report A case 28 year old male presented with a 3 week history of pain in upper part of abdomen and dyspepsia of similar duration. After 2 cycles of palliative chemotherapy he presented with diminution of vision in right eye and watering of eye. USG showed retinal detachment with vitreous hemorrhage in the right eye and left eye was normal. On fundoscopy choroidal metastasis was detected as an accidental finding in the right eye. Though Ca Pancreas usually presents in as locally advanced or metastatic disease choroidal metastasis are extremely rare. Despite disappearance of ocular metastasis he had a progressive disease and died of intraparenchymal hemorrhage. Reports of pancreatic cancer with metastasis to the choroid and optic nerve have been rare. There were few reports that demonstrated the significance of a choroidal lesion as the initial clinical sign of pancreatic cancer. This aggressive behavior of the lesion may be an important feature to determine the origin of the tumor. Cancer of the tail of the pancreas is often not detected in the early stages before metastasizing.

Cardiac hemodynamic profile and its correlates by Impedance plethysmography in normal individuals of Central India.

Evaluation of hemodynamic profile by impedance plethysmography (IPG) provides functional expression of cardiovascular performance with efficacy of treatment. Objective of this study was to establish normative hemodynamic parameters by IPG. In this cross-sectional study hemodynamic parameters including cardiac output (CO), Stroke volume (SV), left ventricular ejection time (LVET), impedance (Zo) Cardiac index (CI) and Stroke index (SI) of 50 normal individuals in mean age 38.9±15.2 years were evaluated. Mean CO and CI were 4.9±0.8L/min and 3.3±0.7 L/min/m2 respectively. A negative linear co-relation of CI with increasing age and body fat mass was observed. Mean LVET was 336±33ms with a significant positive linear correlation (r = 0.46) with advancing age and body fat mass while a negative linear correlation with BSA. To conclude preliminary normative data of cardiac parameters using IPG, in subjects of central India of different age groups has been presented.