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Introduction: Healthy habits such as regular physical activity, a balanced diet and tobacco abstinence are associated with better health-related quality of life (HRQoL) in cancer survivors. However, there is limited evidence on this relationship in Latin American countries, where socioeconomic and cultural factors may influence adherence to healthy behaviours.

Objectives: To evaluate the relationship between adherence to healthy lifestyle recommendations and HRQoL in cancer survivors in Uruguay.

Materials and methods: A cross-sectional study was conducted with 241 early-stage cancer survivors treated at two hospitals in Uruguay. Adherence to healthy habits was assessed using a questionnaire based on the American Cancer Society recommendations. HRQoL was measured using the RAND-36 questionnaire. Categorical variables were analysed using the chi-square test, while continuous variables were analysed using Student's t-test or the Mann-Whitney test. The correlation between SF-36 dimensions and healthy habits was assessed using Spearman's coefficient.

Results: The median age was 66.7 years and 55.2% were women. The most common cancers were breast (31.1%), colorectal (28.2%) and prostate (26.6%). A total of 62.7% of participants adhered to three or more healthy habits. Adherent patients showed significantly higher HRQoL scores, particularly in physical function (62.68 versus 45.67, p < 0.001), energy/fatigue (64.83 versus 45.89, p < 0.001) and emotional well-being (69.43 versus 53.02, p < 0.001). Adherence to multiple healthy habits was significantly correlated with improvements in physical and mental domains, with energy/fatigue showing the strongest correlation (rs = 0.66, p < 0.001).

Conclusion: Adherence to healthy habits has a cumulative positive impact on the HRQoL of cancer survivors. This study highlights the need to design comprehensive interventions to promote healthy behaviours in this population, contributing to the global evidence on cancer care and underscoring its importance in developing countries.

Background: Palliative care research (PCR) plays a critical role in improving the quality of life for patients with serious illness, yet its global distribution and focus areas remain uneven. Understanding the trends and impact of PCR over the past decade can inform future research priorities and policy development.

Methods: We conducted a bibliometric analysis of publications indexed in the Web of Science related to PCR between 2013 and 2022. Articles were identified using a comprehensive filter based on title keywords and specialist journals, and were further classified by research domain, disease area and study type.

Results: The volume of PCR publications has grown over the past decade, increasing from 0.29% of all biomedical research outputs in 2013-14 to 0.62% in 2021-22. Countries with the highest levels of PCR output-primarily European and Anglophone nations-also ranked highly on the Economist Intelligence Unit's Quality of Death Index. Using eight different bibliometric indicators, we assessed the impact of countries' PCR outputs; while rankings varied by metric, European countries such as the Netherlands, Belgium, the United Kingdom and Ireland consistently performed strongly. Cancer emerged as the dominant disease focus, although many studies also addressed co-morbid conditions including COVID-19 in recent years. A significant proportion of PCR also examined the impact of illness on patients' families and caregivers.

Conclusion: The findings highlight cancer as a major area of focus and need within PCR. However, research outputs remain disproportionately concentrated in high-income countries, revealing a persistent gap in low- and middle-income settings.

Recommendations: To address the growing global burden of cancer and serious illness, palliative care should be integrated as a core component of national cancer control plans. This integration must be supported by a targeted research agenda that emphasises implementation and scaling of palliative care models, particularly in low- and middle-income countries. Policymakers and research funders should prioritise holistic, patient-centred approaches and ensure that impact measurement reflects meaningful outcomes for patients and families.

Mutations in the BRCA1 and BRCA2 genes significantly increase the risk of hereditary cancers, mainly of the breast and ovary, but also of other cancers such as those of the pancreas, prostate and cervix. In carriers of these mutations, multiple primary malignancies (MPM) represent a complex clinical challenge, influenced by genetic and environmental factors, as well as previous cancer treatments. The case reports a patient with a BRCA1 mutation with a family history of breast and ovarian cancer and who developed cervical cancer then recurrent triple-negative breast cancer treated with mastectomy, radiotherapy, chemotherapy and Poly (Adenosine diphosohate-ribose) polymérase inhibitors. This case underlines the interplay between different malignancies in the context of breast cancer mutations and the importance of specific and personalised treatment of patients with multiple primary malignancies.

Metastasis of renal cell carcinoma (RCC) to the head and neck region is rare. The metastases of RCC are radioresistant with surgery as the primary treatment modality. Here, we present a case of a 73-year-old male who presented with left facial swelling which on biopsy and immunohistochemistry showed metastatic RCC. The patient was re-evaluated again and the left renal primary was found out.

Background: Head and neck squamous cell carcinoma is often treated with radiotherapy, frequently combined with chemotherapy, to improve overall survival (OS). Despite advancements, locoregional control (LRC) remains a significant challenge, with 15%-50% of patients experiencing locoregional recurrence, negatively impacting OS and quality of life. Hypoxia within tumor cells is a critical factor contributing to treatment failure, necessitating higher radiation doses to achieve similar therapeutic effects as in normoxic cells. This study aims to investigate the role of dose escalation using [18F] fluoromisonidazole (FMISO) positron emission tomography/computed tomography (PET CT) to target hypoxic sub-volumes in head and neck cancer (HNC) to improve LRC.

Methods: The dose-escalated hypoxia-adjusted radiotherapy trial is an open-label, parallel, randomised, single-centre, phase II study. Patients with HNC will undergo [18F]. FMISO PET CT to identify hypoxic regions. Normoxic patients will be labeled as Arm 1 and will not be part of the primary assessment. Patients with hypoxia will be stratified into two arms (2 and 3). Arm 2 will receive standard radiotherapy of 70 Gy in 2 Gy fractions, while Arm 3 will receive an additional boost to the hypoxic sub-volumes, delivering a total of 80 Gy (Phase 2). All patients in Arms 2 and 3 will also receive concurrent chemotherapy with cisplatin. Patients will be monitored weekly for treatment tolerance, with acute adverse events recorded according to National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. The primary endpoint is LRC, defined as the time from randomisation to the first histopathologically confirmed relapse of locoregional disease. Secondary endpoints include OS, locoregional relapse-free survival, acute and late toxicity and patient-reported outcomes assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-H&N35 questionnaires.

Discussion: This study addresses a critical gap in the management of HNC by targeting hypoxic regions within tumours, potentially improving LRC and, consequently, OS. The use of [18F] FMISO PET CT for identifying hypoxic sub-volumes allows for tailored radiation dose escalation, which could overcome the radioresistance associated with hypoxia. By comparing outcomes among standard radiotherapy (Arm 2) and dose-escalated treatment (Arm 3), this trial aims to establish a more effective therapeutic strategy for HNC patients.

Trial registration: This trial is registered with the Clinical Trials Registry of India (CTRI/2024/04/065373), registered on 08^th April 2024 on ctri.nic.in and clinicaltrials.gov (NCT06087614) registered on 18th September 2023 on clinicaltrials.gov.

Introduction: Cancer care in Sri Lanka is predominantly provided through its state health system which is free at the point of delivery. We performed a budget impact analysis of novel cancer drugs with a view to enabling better prioritising of their procurement.

Methods: Median survival gain was obtained for each indication of a novel cancer drug by a review of the literature. The direct cost of drug procurement was obtained from the Ministry of Health of Sri Lanka and the cost per life year gained was computed for each indication. Two thresholds - per capita gross domestic product (GDP) per life year gained (GDP × 1 = US$3815) and three times per capita GDP per life year gained (GDP × 3 = US$11445) were considered to determine cost effectiveness. The cumulative annual cost of these treatments was subsequently determined.

Results: Data obtained on 42 novel cancer drugs spanning across 90 indications were included in the analysis. The cumulative annual treatment cost when the threshold was set at GDP × 1 was United States Dollar (US$) 6 million and it increased to US$ 13.2 million if the threshold was expanded (GDP × 3 = US$11445). Only 27 indications met the (GDP × 3 = US$11445) threshold while there were 18 drugs that did not meet the thresholds for any indication. Without a threshold, if every eligible patient were to receive treatment as currently indicated, the total cost would reach almost US$ 300 million per year.

Conclusion: Budget impact analyses and defining cost-effectiveness thresholds will lead to considerable savings and help prioritise the procurement of novel agents in the state health system in Sri Lanka.

Background: Zambia faces the double burden of rising cancer incidence and a disproportionate volume of mortality from delayed presentations. The Ministry of Health Zambia acknowledged cancer research as a key pillar of cancer control in the National Cancer Control Strategic Plan 2022-2026, but there remains a paucity of country-specific evidence to inform strategies, implementation, monitoring and evaluation of research activities. Our study aimed to map and critically analyse the existing cancer research landscape to inform national planning.

Methods: We adopted a two-stage mixed-method research. First, we conducted a systematic review, including 76 Zambian cancer studies published between 2012 and 2022, adhering to PRISMA guidance. Second, we conducted an in-person modified consensus meeting in Ndola, Zambia attended by 31 domestic and international stakeholders, to co-develop priorities and strategies based on gaps and facilitators identified through the systematic review.

Results: The year-on-year cancer research output in Zambia had risen and diversified beyond cervical cancer but prevention, palliative care and health economic studies were lacking. Delay in deciding to seek care was most studied (n = 17, 63.0%), especially in cervical cancer. Research activities were mostly retrospective (n = 47/76, 61.8%) with only one randomised controlled trial identified. Greater than 90% (n = 10/11, 90.9%) of the most prolific research funders were international, predominantly from the United States and the United Kingdom, and Zambian researchers were under-represented as first and last authors at 43% (n = 33/76) and 45% (n = 34/76), respectively. The existing national cervical cancer registry, active global collaboration and adoption of technology were facilitators to be leveraged to build research capacity through multi-level, stakeholder-specific strategies.

Conclusion: To strengthen research capacity, sustained commitment to priorities through the implementation of co-developed strategies is required at individual, organisational and institutional levels. This paradigm shift is necessary to deliver evidence-based cancer care tailored to the needs of Zambians with emphasis on value and quality.

Background: Locally advanced cervical cancer (LACC) can result in obstructive uropathy (OU). Urinary diversion (UD) is the treatment of LACC patients with OU. This study assessed the benefits of UD before or during radiotherapy by examining its effect on improving kidney function and survival in patients with LACC.

Materials and methods: The study retrospectively analysed the clinical data of 119 women with LACC treated from January 2020 to December 2021. The treatment intention (radical or palliative) was decided by a multidisciplinary team based on the disease stage, Karnofsky performance status and degree of renal derangement. Treatment and outcome details were retrieved from electronic records. This included obtaining serum creatinine levels before the UD, 7 days after, 21 days after and 1 month after the UD. Time to normalisation of serum creatinine, feasibility of delivering planned treatment and overall survival were determined. The impact of various prognostic factors on outcomes was determined using univariate or multivariate analysis. The significance level was set at 0.05.

Results: The mean age was 51.1 ± 9.9 years. Approximately a third of patients underwent UD. Percutaneous nephrostomy was the most frequently performed type of UD (92%). About 85% of patients had hydronephrosis, and 56.3% had unilateral hydronephrosis. The mean baseline serum creatinine level was 662 µmol/L for the entire cohort. There was a 53% reduction of serum creatinine from the baseline to 30 days post-UD (p = 0.001). The median equivalent dose in 2-Gy (EQD2) for the whole cohort was 86 Gy. The median survival time for the entire cohort was 20 months. In the multivariate analysis, UD resulted in a 40% decreased mortality risk (aHR 0.6, p-value = 0.03). Patients who did not receive brachytherapy had 5.9 times more risk of mortality compared to those who had brachytherapy (aHR 5.9, p-value = 0.001). EQD2 ≥72 Gy was associated with 40% less mortality risk than those who had EQD2 of <72 Gy (aHR 0.4, p-value = 0.005). Patients with a maximum tumour diameter of more than 5 cm had 2 times higher mortality risk than those with a tumour with a maximum tumour diameter of less than 5 cm (aHR 2, p-value = 0.005). Patients who were treated with concurrent chemoradiotherapy had 60% less risk of mortality compared to those treated with radiotherapy alone (aHR 0.4, p-value = 0.048).

Conclusion: UD was associated with a 53% reduction in baseline serum creatinine levels 30 days post-UD, reducing mortality risk by 40%.

Background: Lympho-epithelial carcinoma (LEC) is most commonly found in the nasopharynx, while LEC of the hypopharynx and larynx is rare, with fewer than 50 cases in the published literature. As the non-nasopharyngeal presentations are rare, the clinical course, diagnosis and treatment for this tumour are sparsely reported. Here, we report a rare case report of Epstein-Barr virus negative laryngeal LEC treated with combined modality therapy in a tertiary care centre. We also review the literature regarding currently acceptable treatment strategies.

Case presentation: We present a case of a 59-year-old male who presented with hoarseness of voice and acute onset of respiratory distress. Post emergency tracheostomy for respiratory distress, evaluation with contrast-enhanced computed tomography head and neck revealed cT3N0M0 supraglottic disease. Biopsy revealed poorly differentiated carcinoma. In view of thyroid cartilage erosion, the patient underwent two cycles of neo-adjuvant chemotherapy followed by total laryngectomy, bilateral neck dissection and primary closure. Postoperative histopathology revealed ypT1N0 LEC, with adequate margins and adequate neck dissection. The patient was then treated with adjuvant chemoradiotherapy. 6 months follow-up positron emission tomography/computed comography shows no locoregional disease.

Conclusion: The treatment for rare cases like non-nasopharyngeal LEC is yet to be standardised. However, as seen in our case report, multimodality management including surgery, chemotherapy and radiation therapy seems to be a feasible approach to managing such rare cases of non-nasopharyngeal LEC.

Introduction: Cancer Health Literacy is the individual's ability to seek, understand, evaluate and use basic information and services necessary to make appropriate decisions regarding cancer prevention, diagnosis and treatment. The aim of this study was to analyse the Health Literacy Profile of Argentine cancer patients.

Methodology: A non-experimental, descriptive, cross-sectional design was used. A non-probabilistic sampling method was applied and 500 adult cancer patients who provided their consent participated. A sociodemographic questionnaire and the Cancer Health Literacy Test were administered. Data were collected through mixed methods and analysed using R Studio.

Results: The average Cancer Health Literacy score was 22.01 points (SD = 5.68, Mdn = 24), with 73% of patients classified at an intermediate level. Multiple linear regression analysis revealed that educational level and information-seeking behaviour regarding diet and cancer were significant contributing factors to this construct, explaining 30.6% of its variability (adjusted R ² = 0.306) with a large effect size (f² = 0.44). Cancer Health Literacy was lower in patients with an incomplete secondary education or lower and higher in those who actively sought information.

Conclusion: Cancer Health Literacy was associated with educational level and nutritional information-seeking behaviour. Measuring these factors in clinical practice contributes to evidence-based care.