Background: Patients with cancer are vulnerable to coronavirus disease 2019 (COVID-19). Given the rising number of COVID-19 cases and relaxation of stringent COVID-19 protocols, assessment of the level of protective immunity to COVID-19 in patients with cancer has assumed importance. Objectives: Our primary objective was to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in patients with cancer. Materials and Methods: We conducted a cross-sectional study on 100 patients with solid tumors attending our Oncology Department at the Believers Church Medical College, Kerala, India, between December 2020 and June 2021. Seroprevalence was assessed using the VITROS® Anti-SARS-CoV-2 IgG test (Ortho-Clinical Diagnostics, Rochester, NY, USA). Additionally, we assessed the factors associated with seropositivity and collected data regarding the general experience of patients with cancer during the pandemic. Results: The median age of the participants was 62 years (IQR, 53 - 69.8); 52 (52%) were males. The seroprevalence of the SARS-CoV-2 IgG antibodies was 11% (95% CI, 4.8–17.1). Age < 50 years was the only factor that was significantly associated with a higher rate of COVID-19 antibodies (77% vs 8.9% in patients ≥ 50 years; P = 0.007), and sex, smoking, and the use of alcohol did not show any association. The majority (77/100, 77%) of the patients were worried about contracting COVID-19 infection; some even deferred cancer-directed treatment because of the fear of visiting health care settings. Conclusion: Low seroprevalence of SARS-CoV-2 IgG antibodies in unvaccinated patients with cancer is a matter of concern as it indicates that many of these patients are still vulnerable to infection. There is an urgent need to continue implementing strict safety measures in oncology centers and to encourage widespread COVID-19 vaccination to prevent the uncontrolled spread of COVID-19 among patients with cancer. (Funded by the institution, Believers Church Medical College, Kerala)

Background: During the coronavirus disease 2019 (COVID-19) pandemic, established best practices in cancer care were modified to diminish the risk of COVID-19 infection among patients and health-care workers. Objective: We aimed to study the modifications in cancer-directed therapy during the first wave of the COVID-19 pandemic. Materials and Methods: A cross-sectional study of patients with cancers of the head and neck, thoracic, urologic, and central nervous systems who visited the medical oncology department of the Tata Memorial Hospital, Mumbai, India, between April 22, 2020 and June 01, 2020, was conducted. Data were prospectively collected in an online pro forma and supplemented from the electronic medical records. Results: Of a total of 514 patients, 363 (71%) were men. The most common malignancy was lung cancer in 234 patients (46%). Cancer-directed therapy was modified in 83 patients (16%). Deviations consisted of modification of the chemotherapy regimen (48%), temporary discontinuation of chemotherapy in 37%, and interim chemotherapy to delay surgery in 5%. Changes in the chemotherapy regimen included a shift to a less intensive regimen in 45%, changing from intravenous to oral in 40%, and less frequent dosing of immunotherapy in 7%. Considering missed appointments as a deviation from planned cancer therapy, 68% of patients had a deviation in the standard planned cancer care. Conclusions: Almost two-thirds of the patients could not reach the hospital during the COVID-19 pandemic lockdown in India. Of those who could reach the hospital, one of out every six patients with cancer had a change in their cancer-directed treatment, half of which consisted of a modification in the standard chemotherapy regimens. The effects of these therapy deviations are likely to be long-lasting. (Clinical Trials Registry-India, CTRI/2020/07/026533)

Background: Patients with cancer and their caregivers have multiple needs. The majority of these concerns are not adequately addressed, which increases their psychological distress and impacts their quality of life. Objectives: Our goal was to understand the challenges faced by caregivers of patients with cancer visiting our institute. Materials and Methods: This exploratory survey was conducted between Nov 2019 and Feb 2020 on the caregivers of patients with cancer. A standardized questionnaire was validated by experts and then given to all the participants to evaluate the difficulties faced by the caregivers. The questionnaire included questions regarding the details of the socio-demographic profile, disease-related information, and financial and psychosocial issues. Results: Of the 310 caregivers evaluated for the survey, 280 completed the questionnaire. Most of the caregivers (93, 33.2%) were aged between 41 and 50 years. The educational status of one-third of the caregivers (97, 34.6%) was only primary schooling. Regarding the type of cancer-directed therapy received by the patients, 37 (13.2%) were only on palliative care for symptom management without any active oncological management. Family responsibility was considered one of the most common liabilities among 132 (47.1%) respondents. A total of 136 (48.5%) caregivers felt a loss of privacy and/or personal time because of patient care, 154 (55%) experienced sleep disturbances because of caring, 228 (87.4%) felt worried that they would not be able to manage work, and 67 (23.9%) had similar concerns regarding an inability to manage family responsibilities. Conclusions: Cancer caregivers bear the burden of care, which affects their health and well-being, but their persistent efforts despite numerous issues play a vital role in improving the patients' outcomes and quality of life. Support from healthcare professionals is key to improving the ability of caregivers to cope with the difficulties encountered by patients with cancer.

Background: Community-level surveys of potentially malignant and malignant oral lesions are helpful to accurately determine the prevalence and aid in planning population-based strategies for oral cancer prevention. Objectives: We aimed to assess the disease burden through a systematic oral cancer screening program in a defined semi-urban population in Ranipet district (Tamil Nadu, India). Materials and Methods: A multiphase community-based screening program was conducted by the Ragas Dental College and Hospital, Chennai, India, in partnership with Thirumalai Mission Trust Hospital in Ranipet district (Tamil Nadu, India) in a zone-wise manner from Aug 1, 2018 to Dec 31, 2019. Phase I consisted of screening of those who fulfilled the eligibility criteria; demographic data were collected by trained dentists, following which toluidine blue staining of suspected potentially malignant lesions was done. Subjects whose oral lesions stained positive were referred to a hospital where the staining procedure was repeated for confirmation, and then biopsy was done for all subjects by a trained dentist. The subjects were followed up, and appropriate referrals were initiated for all the subjects based on their diagnosis. Descriptive statistics were used to analyze the distribution of potentially malignant cases. Sensitivity, specificity, and predictive values were calculated for the clinical diagnosis using the histopathologic diagnosis as the gold standard. Results: A total of 1389 tobacco users (1012 [72.9%] men) and 3140 non-tobacco users were evaluated. Among them, 194 (14%) demonstrated clinical abnormalities in their oral mucosa; 157 required follow-up and were referred. Of the 157 referrals, 140 (89.2%) went for follow-up, and 84 (64%) of them required biopsies. Of the 74 eligible biopsies examined (7 dropped out and 3 biopsies were rejected due to inadequate tissue), 1 had definite malignancy (1.4%), 41 (55.4%) had potentially malignant oral disorders, and 32 (43.2%) had non-specific features. The overall sensitivity, specificity, positive predictive value, and negative predictive value for the clinical diagnosis made at the screening program were 88%, 25%, 61%, and 61%, respectively. Conclusion: Systematic visual oral screening restricted to high-risk individuals is a worthwhile initiative for the detection and control of oral cancer. Visual screening and early detection of premalignant oral disorders has the potential for early detection of potentially malignant and malignant oral lesions, and thus could play a pivotal role in disease control and improving patient outcomes. (Partial funding provided by the University Research Committee, The TN Dr. MGR Medical University, Guindy, Chennai; and the Thirumalai Charitable Trust, Ranipet, India)

Background: Xerostomia is an important complication in patients with head-and-neck cancer treated with radiotherapy. It is caused by the radiation dose to the salivary glands situated in the lateral facial and submandibular regions, which are commonly included in or are close to the target volume. Objectives: Our primary objective was to evaluate xerostomia in patients treated with three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiation therapy (IMRT). We also aimed to identify the risk factors for the development of xerostomia and the treatment-related and dosimetric parameters associated with xerostomia in patients with oral cancers receiving radiotherapy. Materials and Methods: We enrolled 100 patients with oral cancers between Sept 2015 and Apr 2018 who were planned for adjuvant radiotherapy. Patients were treated with unilateral portals in 3DCRT or IMRT. Xerostomia was assessed using the Wake Forest National Cancer Institute Community Oncology Research Program Research Base (WF NCORP RB) # 97115 Questionnaire at baseline, treatment completion, and at 1, 4, and 7 months following the completion of radiotherapy. Detailed salivary gland dosimetric parameters including the minimum (Dmin), maximum (Dmax), and mean dose (Dmean) and other dose and volume parameters (e.g., D25, D50, D75, and V10–V60) were assessed through cumulative dose volume histograms (DVH). Multivariate analysis was performed to determine the factors associated with the development of xerostomia and assess the correlation with dosimetric parameters. Results: At a median follow-up of 20 (95% confidence interval [CI], 8–32) months, the V20, V25, V30, V40, V45, V50, V60, Dmin, and Dmean received by the ipsilateral parotid gland were significantly lower in patients treated with IMRT compared to those treated with 3DCRT (P < 0.001). After the completion of radiotherapy, the mean xerostomia scores at each follow-up were significantly lower in the patients who had received IMRT, compared to 3DCRT. At 7 months of completion of treatment, the mean score of xerostomia in the 3DCRT arm was 44.4, compared to 33.8 in the IMRT arm (P = 0.023). On multivariate analysis, Dmin, V30, V40, V45, V60, history of substance abuse, advanced age, and lower body weight were found to be associated with higher chances of xerostomia. Conclusion: Compared to 3DCRT, IMRT results in lower rates of xerostomia based on dosimetric as well as subjective analysis.

Background: Patients with cancer require a wide variety of information during their illness. Identifying their need for information and providing education are vital responsibilities of nurses and physicians. Objectives: We aimed to assess the information needs of patients with cancer receiving chemotherapy. We then aimed to develop and validate an information booklet, based on the needs assessment. Materials and Methods: This study was conducted among patients with cancer visiting the day care center for chemotherapy at the Shirdi Saibaba Cancer Hospital and Research Center, Kasturba Medical College, a tertiary cancer center in Manipal, India. The information needs of the patients were assessed through a questionnaire. The chemotherapy information module developed was then given to five subject experts for validation. Results: Between Dec 2018 and Feb 2019, we enrolled 245 patients in the study. Of these, 108 (44.1%) expressed a desperate need for information, 136 (55.5%) had a preferred need for information, and 1 (0.4%) did not require any information. The information considered as the absolute need to know by over half (52.7%) the participants was regarding the disease (severity, recurrence, malignancy, and effect on the body), followed by the side-effects of chemotherapy and their management (49%) and psychological support (45.3%). Conclusion: Patients with cancer have the desire to be well informed about their disease, treatment, and side-effects. Education sessions can be planned to improve the chemotherapy-related knowledge of patients with cancer. Regular appraisal of the need for information among patients with cancer is critical, considering the changing needs of the health-care seekers. (Clinical Trials Registry-India number CTRI/2018/11/016378)

Background: Induction therapy, both neoadjuvant chemotherapy and chemoradiotherapy, has improved outcomes in localized and locally advanced esophageal cancer. However, there is a lack of clear evidence regarding the optimal systemic therapy regimen for compromised individuals including those with significant comorbidities, poor performance status, and advanced age. Objectives: Our primary objective was to assess the overall survival of patients with locally advanced esophageal cancer who received paclitaxel and carboplatin once-a-week as induction chemotherapy. The secondary endpoints were the progression-free survival, objective response rate, surgical resectability rate, and toxicity. Materials and Methods: This was a retrospective observational study conducted in the Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India, in patients with locally advanced esophageal cancer who were planned for radical intent therapy (surgery or chemoradiotherapy) and who received induction chemotherapy with once-a-week paclitaxel and carboplatin between November 2012 and December 2019. We retrospectively assessed the efficacy and toxicity of the once-a-week paclitaxel and carboplatin induction chemotherapy regimen. The study was approved by the Institutional Ethics Committee, and the requirement for written informed consent was waived. Results: We included 141 patients in the study. Histology was squamous in 123 patients (87%). The disease was considered resectable in 44 (32.5%), borderline resectable in 65 (48.1%), and unresectable in 26 (19.2%) patients. Indications for the once-a-week induction chemotherapy regimen included age ≥70 years (89, 63%), renal dysfunction (40, 28%), comorbidities (17, 12%), poor performance status (27, 19%), and other (25, 17%). Median number of chemotherapy cycles was 6 (IQR, 5–9). Chemotherapy consisted of intravenous paclitaxel 80 mg/m² and carboplatin area under the curve (AUC) 2 once-a-week for 6–8 weeks. The objective response rate was 61%. Radical intent therapy was delivered to 81 patients (57%); surgical resection rate was 35%. The R0 resection rate was 95% and the pathological complete response rate was 10.8%. The median progression-free and overall survival were 15 (95% CI, 11–26) months and 20 (95% CI, 12–29) months, respectively. Thirty patients (21%) developed grade 3/4 toxicities (predominantly hematological) and 8 patients (6%) developed febrile neutropenia. Conclusion: Once-a-week paclitaxel and carboplatin is an active induction chemotherapy regimen with low toxicities. It can be delivered relatively easily in compromised patients; comparison of this regimen with standard induction regimen is warranted.

Background: The Eastern Cooperative Oncology Group (ECOG) performance status (PS) is a standard assessment in older patients with cancer, but the correlation of the individual components of the geriatric assessment (GA) with the ECOG PS is less well studied, especially in Indian patients. Objective: To study the correlation of the ECOG PS with the individual components of the GA and with the burden of deficits as estimated in the GA. Materials and Methods: This cross-sectional observational study was conducted in the geriatric oncology clinic of the Tata Memorial Hospital, a tertiary cancer center in Mumbai, India, with approval from the Institutional Ethics Committee. Function and falls, comorbidities, nutrition, psychological status, and cognition were evaluated as a part of the GA. The primary outcome was defined as the presence of ≥2 abnormalities on the 5 tested domains in the GA, while the independent variable was ECOG PS (0–3) which was assessed as a discrete variable. The discriminatory power of the ECOG PS in identifying ≥2 geriatric abnormalities as well as deficits in the individual geriatric domains was calculated via logistic regression receiver operating characteristics (ROC) curves using area under the ROC curve (AUC). AUCs were divided into ≥0.8, <0.8–≥0.65, and <0.65 to represent excellent, moderate, and poor discriminant ability, respectively. Results: Between May 2018 and Jan 2021, we enrolled 594 patients in the study. Their median age was 69 years (range, 60–100), and 80% patients had an ECOG PS of 1 or 2. Abnormalities in at least 2 domains were detected in 77% patients. An ECOG PS ≥1 was predictive of abnormalities in at least 2 geriatric abnormalities with an AUC = 0.69 (95% confidence interval [CI], 0.64–0.74), sensitivity of 95.4%, and specificity of 18.4%. With each 1 unit increase in the ECOG PS, the odds of having ≥2 geriatric abnormalities increased by 4.69 (95% CI, 2.53–8.68). The ECOG PS correlated moderately well with deficits in cognition (AUC = 0.66 [95% CI, 0.61–0.72]), function and falls (AUC = 0.73 [95% CI, 0.69–0.77]), and psychological domains (AUC = 0.65 [95% CI, 0.60–0.70]) and poorly correlated with nutritional status (AUC = 0.63 [95% CI, 0.58–0.68]) and comorbidities (AUC = 0.55 [95% CI, 0.49–0.61]). Conclusions: Older patients with cancer with an ECOG PS ≥1 are very likely to harbor non-oncological vulnerabilities, and should therefore undergo a GA. The ECOG PS correlates moderately well with abnormalities in function and falls, psychological assessment, and cognition, while it poorly correlates with nutritional status and comorbidities. (Clinical Trials Registry – India number: CTRI/2020/04/024675).

According to the American Joint Committee on Cancer (AJCC) eighth edition, involvement of the masticator space and infratemporal fossa (ITF) by oral cancer signifies advanced disease (T4b), which is most often deemed unresectable. The extent of ITF involvement impacts the management and outcomes. The extent of T4b disease needs to be subclassified for optimal management. T4b disease with infra-notch extension is associated with a favorable prognosis compared to supra-notch disease. Certain cases with supra-notch involvement may potentially be converted to resectable disease following neoadjuvant chemotherapy. We performed a comprehensive search of abstracts of ITF subdivisions and their impact on staging as per the AJCC eighth edition. We included studies reporting data on ITF subdivisions and their impact on clinical outcomes. The key words for Medical Subject Headings were “cross-sectional imaging,” “oral carcinoma,” “AJCC 8^th edition,” “infratemporal fossa,” “masticator space,” “survival,” and “neoadjuvant chemotherapy.” We selected 30 studies that had been published in English. We propose that the T4b category needs to be classified into compartments that have predictive and prognostic implications, including Compartment 1 comprising the low ITF (medial pterygoid and masseter), Compartment 2 comprising the anterior high ITF (retroantral fat), Compartment 3 comprising the posterior high ITF, Compartment 3a comprising the paramandibular compartment (temporalis), Compartment 3b comprising the lateral pterygoid, and Compartment 3c comprising the perineural compartment (pterygopalatine fossa and pterygomaxillary fissure). Our proposed subclassification of T4b will impact the patients' management and outcomes.

Radiotherapy-induced secondary malignancy is a well-known occurrence. During the COVID-19 pandemic, many people have undergone serial computed tomography (CT) imaging, and concerns have been raised regarding radiation-induced malignancies due to frequent scanning. Accordingly, various low and ultra-low-dose CT (LDCT) thorax protocols have been developed to reduce the dose of radiation. Major governing bodies worldwide have established guidelines regarding the indications for CT scans and chest X-rays during the pandemic. We, therefore, aimed to provide facts about the effects of radiation (both diagnostic and therapeutic). Through this article, we intend to break the myths and “mithya” (misbeliefs) regarding diagnostic radiation and its association with cancer in this COVID-19 era. For this review, we performed a search in Google using specific keywords pertaining to imaging during COVID-19 and radiation risk. We also included the names of various global governing bodies in the Google search. We included only full text articles and guidelines from authentic websites. From this review, we conclude that if we follow the recommendations of various global governing bodies and use CT scan only in cases of moderate to severe COVID-related symptoms, adhere to the principle of “as low as reasonably achievable” for radiation protection, and use LDCT scan protocols, we can significantly reduce the mean effective radiation dose delivered and the estimated cancer risk.

The emergence of molecular medicine has led to the increased development and rapid approval of small molecule inhibitors which have caused a dramatic shift in the therapeutic landscape of non-small-cell lung cancer (NSCLC). Mesenchymal epithelial transition factor (MET) exon 14 skipping is one such alteration. This mutation has been reported in 3–4% of NSCLC cases. Additionally, MET exon 14 skipping mutation occurs in 2% of patients with squamous histology NSCLC, and hence, it should be tested in the first line setting. To prepare this review, we searched for articles using the keywords “MET,” “exon 14 skipping,” “capmatinib,” “tepotinib,” and “MET TKI” in databases such as PubMed, Scopus, and Embase. There were no defined inclusion/exclusion criteria for our search strategy as this was not a meta-analysis or a systematic review. This narrative review of MET covers its biology, with a special emphasis on exon 14 skipping mutation, its clinical features, and therapeutic options.

The process of angiogenesis is a complex balance of positive and negative regulators, and vascular endothelial growth factor (VEGF) is one of the most important proangiogenic factors involved in tumor angiogenesis. One of the drugs targeting this process is regorafenib, a multi-kinase inhibitor. It inhibits VEGF receptors 1, 2, and 3; rearranged during transfection (RET); receptor tyrosine kinase (KIT); platelet-derived growth factor receptor (PDGFR) alpha and beta; fibroblast growth factor receptor (FGFR) 1 and 2; angiopoietin-1 receptor (Tie2); discoidin domain-containing receptor 2 (DDR2); Ephrin type-A receptor 2 (Eph 2A); tropomyosin receptor kinase A (TrkA); rapidly accelerated fibrosarcoma (RAF-1); v-RAF murine sarcoma viral oncogene homolog B1 (BRAF); stress-activated protein kinase-2 (SAPK2); protein tyrosine kinase 5 (PTK5); and Abelson murine leukemia virus (Abl). Regorafenib has been approved for patients with metastatic colorectal cancer (CRC), locally advanced or metastatic gastrointestinal stromal tumor (GIST), and hepatocellular carcinoma (HCC). We present a review of regorafenib which includes the history, basic chemistry, pharmacology, pharmacokinetics, clinical indications, drug interactions, and safety profile. We performed a search in PubMed and other sources using the search terms “CRC,” “GIST,” “HCC,” “osteosarcoma,” and “regorafenib” and searched for full-text articles published in the past 10 years. Out of the total 65 studies identified, we included 46 studies. We combined all the abstracts and conference proceedings to generate a comprehensive review.

Evidence-based medicine demands that the research methodology should be robust, reliable, and reproducible. Statistical power is the probability of detecting an effect that really exists in a population. It is critical to incorporate power at the designing stage of a study. A sufficiently powered study ensures reliable results and avoids wastage of resources. It is essential for a clinician to be aware of the role and interpretation of statistical power while reading the research articles. We performed a medical literature database search in PubMed, Embase, Cochrane, and Google, followed by abstract screening and then full paper study selection to gather the desired information and prepare this review on power. This review aims to provide the basic know-how about the practical aspects of statistical power for a clinician.

Although CT and MRI are crucial imaging modalities for the preoperative staging and surgical planning of head and neck tumors, the quality of reports, as well as adequate imaging methodology, are equally critical. The content and quality of the report, and proper communication of these findings to the treating physicians are the important determinants of optimal patient care. Synoptic reporting is a method of presenting specified data pieces in a predetermined format. When compared to random reporting, synoptic reporting gives standardized information in less time. It enables more comprehensive reports and ensures that no details are overlooked. By highlighting the crucial imaging results and altering overall management, it ensures improved surgical planning.