A. Krishnamurthy, Gurushankari Balakrishnan, V. Ramshankar
{"title":"Unraveling the conundrum of second primary tumors versus recurrences in head-and-neck cancers","authors":"A. Krishnamurthy, Gurushankari Balakrishnan, V. Ramshankar","doi":"10.4103/crst.crst_66_23","DOIUrl":"https://doi.org/10.4103/crst.crst_66_23","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72807634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_266_22
Vijeta Bajpai, Amit Kumar, T. Mandal, A. Batra, Rahul Sarode, Sujit Bharti, Anwita Mishra, Rashmi Sure, B. Mishra
Background: Bloodstream infections are the major cause of life-threatening complications in febrile neutropenic patients with hematolymphoid malignancies. The prevalence of these bloodstream infections is 20-30%. The bacteria that are most frequently isolated belong to Enterobacterales and Pseudomonas species. The overall infection attributable mortality rate is 21.5%. Objective: The main objective of this study was to evaluate the prevalence of bloodstream infections with multidrug-resistant (MDR) organisms in adult patients with hematolymphoid malignancies and febrile neutropenia at our newly established tertiary cancer center. Materials and Methods: This was a retrospective observational study conducted between June 2018 and April 2020 in the Departments of Microbiology and Medical Oncology at the Homi Bhabha Cancer Hospital/Mahamana Pandit Madan Mohan Malviya Cancer Center (under the aegis of the Tata Memorial Hospital, Mumbai), a tertiary oncology cancer center in Varanasi, Uttar Pradesh. We analyzed the data of all adult febrile neutropenic patients with hematolymphoid malignancies, specifically the blood culture positivity, isolated bacterial organisms, their antimicrobial resistance spectrum and the overall mortality. Results: There were 1670 adult patients with hematolymphoid malignancies who visited the outpatient and inpatient departments over a period of 2 years; of them, 307 patients had febrile neutropenia and their blood cultures were sent to the microbiology laboratory. The mean age was 41.8 ± 16.7 (range, 15-82) years, with a male predominance (186, 61%). The most common clinical diagnosis was acute lymphoid leukemia (80, 26.1%), followed by non-Hodgkin's lymphoma (76, 24.8%). Microbiologically confirmed bloodstream infections were present in 74 (24.1%) patients. Forty-seven (64.0%) patients had healthcare-associated infections, whereas 27 (36.4%) had community-acquired infections. Common organisms isolated were Escherichia coli (28, 36.4%), Klebsiella pneumoniae (12, 15.6%), Pseudomonas species (8, 10.8%), coagulase-negative Staphylococcus species (7, 9.4%), Staphylococcus aureus (5, 6.5%), Streptococcus species (4, 5.2%), Enterococcus species (3, 3.9%), Citrobacter koseri (3, 3.9%), Acinetobacter baumannii (2, 2.6%), Aeromonas species, and Shewanella putrefaciens (1, 1.3%). Of the 55 Gram-negative bloodstream infections, 21 (38.2%) were carbapenem-resistant. Of the 19 Gram-positive bloodstream infections, there were a significant proportion of resistant organisms noted as well, including methicillin-resistant Staphylococcus aureus in 15.8% (3/19; 60% [3/5] of the Staphylococcus aureus infections) and vancomycin-resistant Enterococcus (VRE) in 5.3% (1/19; 33.3% [1/3] of all enterococcal infections). Overall, the mortality rate was 32.6% (100/307). The mortality rate was greater in patients with MDR bloodstream infections (20/47, 42.5%) compared to that in patients with non-MDR bloodstream infections (3/27, 11.2%; P = 0.004). Con
{"title":"Prevalence of multidrug resistant bloodstream infections in febrile neutropenic patients with hematolymphoid malignancies: A retrospective observational study from a newly established tertiary oncology center in India","authors":"Vijeta Bajpai, Amit Kumar, T. Mandal, A. Batra, Rahul Sarode, Sujit Bharti, Anwita Mishra, Rashmi Sure, B. Mishra","doi":"10.4103/crst.crst_266_22","DOIUrl":"https://doi.org/10.4103/crst.crst_266_22","url":null,"abstract":"Background: Bloodstream infections are the major cause of life-threatening complications in febrile neutropenic patients with hematolymphoid malignancies. The prevalence of these bloodstream infections is 20-30%. The bacteria that are most frequently isolated belong to Enterobacterales and Pseudomonas species. The overall infection attributable mortality rate is 21.5%. Objective: The main objective of this study was to evaluate the prevalence of bloodstream infections with multidrug-resistant (MDR) organisms in adult patients with hematolymphoid malignancies and febrile neutropenia at our newly established tertiary cancer center. Materials and Methods: This was a retrospective observational study conducted between June 2018 and April 2020 in the Departments of Microbiology and Medical Oncology at the Homi Bhabha Cancer Hospital/Mahamana Pandit Madan Mohan Malviya Cancer Center (under the aegis of the Tata Memorial Hospital, Mumbai), a tertiary oncology cancer center in Varanasi, Uttar Pradesh. We analyzed the data of all adult febrile neutropenic patients with hematolymphoid malignancies, specifically the blood culture positivity, isolated bacterial organisms, their antimicrobial resistance spectrum and the overall mortality. Results: There were 1670 adult patients with hematolymphoid malignancies who visited the outpatient and inpatient departments over a period of 2 years; of them, 307 patients had febrile neutropenia and their blood cultures were sent to the microbiology laboratory. The mean age was 41.8 ± 16.7 (range, 15-82) years, with a male predominance (186, 61%). The most common clinical diagnosis was acute lymphoid leukemia (80, 26.1%), followed by non-Hodgkin's lymphoma (76, 24.8%). Microbiologically confirmed bloodstream infections were present in 74 (24.1%) patients. Forty-seven (64.0%) patients had healthcare-associated infections, whereas 27 (36.4%) had community-acquired infections. Common organisms isolated were Escherichia coli (28, 36.4%), Klebsiella pneumoniae (12, 15.6%), Pseudomonas species (8, 10.8%), coagulase-negative Staphylococcus species (7, 9.4%), Staphylococcus aureus (5, 6.5%), Streptococcus species (4, 5.2%), Enterococcus species (3, 3.9%), Citrobacter koseri (3, 3.9%), Acinetobacter baumannii (2, 2.6%), Aeromonas species, and Shewanella putrefaciens (1, 1.3%). Of the 55 Gram-negative bloodstream infections, 21 (38.2%) were carbapenem-resistant. Of the 19 Gram-positive bloodstream infections, there were a significant proportion of resistant organisms noted as well, including methicillin-resistant Staphylococcus aureus in 15.8% (3/19; 60% [3/5] of the Staphylococcus aureus infections) and vancomycin-resistant Enterococcus (VRE) in 5.3% (1/19; 33.3% [1/3] of all enterococcal infections). Overall, the mortality rate was 32.6% (100/307). The mortality rate was greater in patients with MDR bloodstream infections (20/47, 42.5%) compared to that in patients with non-MDR bloodstream infections (3/27, 11.2%; P = 0.004). Con","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76540236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Are Tai Chi and Qigong efficient methods to treat cancer-related fatigue and improve the QoL in patients with breast cancer? The need for a holistic approach","authors":"Anandan K Niraimathi, E. Vidhubala, V. Saraswathi","doi":"10.4103/crst.crst_74_23","DOIUrl":"https://doi.org/10.4103/crst.crst_74_23","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73411776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Export Background: In the West, the median age at diagnosis of multiple myeloma is 66 years, with only 2% of patients diagnosed below the age of 40 years. The median age at diagnosis of multiple myeloma in India is approximately a decade earlier. The clinical profiles and outcomes in young patients with multiple myeloma compared to older patients vary in different studies. Objectives: We aimed to study the clinical profiles and outcomes of young (≤50 years) patients compared to those of elderly patients with multiple myeloma, at our center. Materials and Methods: This was a retrospective observational study conducted from January 2012 to December 2019 in the Department of Medical Oncology at Vydehi Institute of Medical Sciences, Bangalore, a tertiary cancer center in South India. We included patients with newly diagnosed multiple myeloma and evaluated the patient characteristics, clinical and laboratory findings, response to treatment, and survival outcomes. Results: We enrolled 106 patients; the median age was 57 years (range, 32–74). There were 29 patients (27.4%) who were aged 50 years or below, and 5 (4.7%) were 40 years or younger. The male-to-female ratio was 1.9:1 for the overall population, but 0.6:1 in the cohort of young patients; P, 0.003. Most patients presented with International Staging System (ISS) Stage III disease, 80% (n = 20) and 90% (n = 53) in the young and elderly groups, respectively. In terms of clinical presentation in the young versus elderly cohorts, renal failure was less (5 [17.2%] vs. 19 [35.8%], respectively; P, 0.038), while anemia (22 [75.9%] versus 38 [76%], respectively; P, 0.496) and hypercalcemia (7 [24.1%] versus 9 [23%], respectively; P, 0.458) occurred to a similar extent. In the overall population, the chemotherapy regimen, bortezomib + thalidomide + dexamethasone (VTd), led to a better complete response rate compared to thalidomide + dexamethasone (Td) (15 [57.7%] versus 3 [37.5%], respectively; P, 0.022. The median survivals in the young versus elderly groups were 7.76 (95% CI, 6.24-9.06) vs 6.53 (95% CI, 5.38-7.80) years, respectively; P, 0.045. Conclusion: There are definite differences in clinical characteristics and survival outcomes of younger compared to older patients with newly diagnosed multiple myeloma. The results of our study will inform the design of larger prospective studies and help tailor the management strategies in each cohort of patients.
{"title":"Clinical profiles and outcomes of young versus elderly patients with multiple myeloma: A retrospective observational study from a tertiary cancer center in South India","authors":"Angadi Veerendra, Nitesh Anand, Sachet Saxena, Manjunath Nandennavar, Shashidhar Vishvesh Karpurmath","doi":"10.4103/crst.crst_24_23","DOIUrl":"https://doi.org/10.4103/crst.crst_24_23","url":null,"abstract":"ABSTRACT Export Background: In the West, the median age at diagnosis of multiple myeloma is 66 years, with only 2% of patients diagnosed below the age of 40 years. The median age at diagnosis of multiple myeloma in India is approximately a decade earlier. The clinical profiles and outcomes in young patients with multiple myeloma compared to older patients vary in different studies. Objectives: We aimed to study the clinical profiles and outcomes of young (≤50 years) patients compared to those of elderly patients with multiple myeloma, at our center. Materials and Methods: This was a retrospective observational study conducted from January 2012 to December 2019 in the Department of Medical Oncology at Vydehi Institute of Medical Sciences, Bangalore, a tertiary cancer center in South India. We included patients with newly diagnosed multiple myeloma and evaluated the patient characteristics, clinical and laboratory findings, response to treatment, and survival outcomes. Results: We enrolled 106 patients; the median age was 57 years (range, 32–74). There were 29 patients (27.4%) who were aged 50 years or below, and 5 (4.7%) were 40 years or younger. The male-to-female ratio was 1.9:1 for the overall population, but 0.6:1 in the cohort of young patients; P, 0.003. Most patients presented with International Staging System (ISS) Stage III disease, 80% (n = 20) and 90% (n = 53) in the young and elderly groups, respectively. In terms of clinical presentation in the young versus elderly cohorts, renal failure was less (5 [17.2%] vs. 19 [35.8%], respectively; P, 0.038), while anemia (22 [75.9%] versus 38 [76%], respectively; P, 0.496) and hypercalcemia (7 [24.1%] versus 9 [23%], respectively; P, 0.458) occurred to a similar extent. In the overall population, the chemotherapy regimen, bortezomib + thalidomide + dexamethasone (VTd), led to a better complete response rate compared to thalidomide + dexamethasone (Td) (15 [57.7%] versus 3 [37.5%], respectively; P, 0.022. The median survivals in the young versus elderly groups were 7.76 (95% CI, 6.24-9.06) vs 6.53 (95% CI, 5.38-7.80) years, respectively; P, 0.045. Conclusion: There are definite differences in clinical characteristics and survival outcomes of younger compared to older patients with newly diagnosed multiple myeloma. The results of our study will inform the design of larger prospective studies and help tailor the management strategies in each cohort of patients.","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135784766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_154_23
Balakrishnan Gurushankari, Vikram Kate
Diagnosis of cancer is emotionally and financially challenging for patients and their relatives.[1-3] Colorectal cancer (CRC), earlier considered a disease of the West, now has an increasing prevalence in many low- and middle-income countries (LMICs) due to the westernization of the diet.[4] This includes a diet comprising red meat, refined sugars, grains, and proportionally more low-residue processed foods.[5,6] When this is associated with a lack of physical exercise, obesity, and smoking, the incidence of CRC further increases. These lifestyle changes are slowly being adopted in countries such as India and other LMICs, leading to an increase in the incidence of CRC.[7] Because the incidence of CRC was previously low in these countries, organized screening programs for CRC have not yet been established LMICs as in Western countries. Hence, it is imperative to increase awareness about this disease, as early diagnosis of CRC can result in a better prognosis. Survival rates can go up to 90% if diagnosed early, however, they can drastically fall to as low as 10% when diagnosed late.[8] Studies have documented that healthy lifestyle choices can reduce the incidence of CRC by 20–40% and mortality by 50%.[9] For CRC, the focus must be on disease awareness, specifically focusing on risk factors and warning symptoms. Thomas et al.,[10] conducted a study to determine the awareness of risk factors and warning signals in a rural and semi-urban population in South India. In their questionnaire-based study, they found a low level of awareness of risk factors and warning signs of CRC and identified that a low-fiber diet (fast food), alcohol consumption, cigarette smoking, and a family history of CRC were the most frequently recognized risk factors. Symptoms such as abdominal pain, bleeding per rectum, change in bowel habits, and loss of appetite were commonly identified as warning signs.[10] Of note, some well-known factors that needed prompting, were not elaborated in the study. We request the authors to provide the details, preferably in a diagrammatic form, of the questions that needed prompting, and those that did not. The scores reported showed that people were unaware of most of the CRC risk factors and needed prompting to even identify them. The authors have described the rationale of the study quite well and the need for such regional data. There are limited studies reported from India on this subject, as highlighted by the authors.[10] The primary determinants of survival among patients with CRC include advanced stage and late presentation, and it is important that the population at risk is aware of this fact as well as the preventive measures. Noronha et al.[11] reported in their study on 151 patients that 41.8% of the patients presented with stage IV disease, and 27% presented with stage III, thus stressing that the majority presented in the late stages of CRC. Thomas et al.,[10] have also highlighted the same fact of late diagnosis of CRC and the
{"title":"Colorectal cancer: Awareness in people and policymakers is the key","authors":"Balakrishnan Gurushankari, Vikram Kate","doi":"10.4103/crst.crst_154_23","DOIUrl":"https://doi.org/10.4103/crst.crst_154_23","url":null,"abstract":"Diagnosis of cancer is emotionally and financially challenging for patients and their relatives.[1-3] Colorectal cancer (CRC), earlier considered a disease of the West, now has an increasing prevalence in many low- and middle-income countries (LMICs) due to the westernization of the diet.[4] This includes a diet comprising red meat, refined sugars, grains, and proportionally more low-residue processed foods.[5,6] When this is associated with a lack of physical exercise, obesity, and smoking, the incidence of CRC further increases. These lifestyle changes are slowly being adopted in countries such as India and other LMICs, leading to an increase in the incidence of CRC.[7] Because the incidence of CRC was previously low in these countries, organized screening programs for CRC have not yet been established LMICs as in Western countries. Hence, it is imperative to increase awareness about this disease, as early diagnosis of CRC can result in a better prognosis. Survival rates can go up to 90% if diagnosed early, however, they can drastically fall to as low as 10% when diagnosed late.[8] Studies have documented that healthy lifestyle choices can reduce the incidence of CRC by 20–40% and mortality by 50%.[9] For CRC, the focus must be on disease awareness, specifically focusing on risk factors and warning symptoms. Thomas et al.,[10] conducted a study to determine the awareness of risk factors and warning signals in a rural and semi-urban population in South India. In their questionnaire-based study, they found a low level of awareness of risk factors and warning signs of CRC and identified that a low-fiber diet (fast food), alcohol consumption, cigarette smoking, and a family history of CRC were the most frequently recognized risk factors. Symptoms such as abdominal pain, bleeding per rectum, change in bowel habits, and loss of appetite were commonly identified as warning signs.[10] Of note, some well-known factors that needed prompting, were not elaborated in the study. We request the authors to provide the details, preferably in a diagrammatic form, of the questions that needed prompting, and those that did not. The scores reported showed that people were unaware of most of the CRC risk factors and needed prompting to even identify them. The authors have described the rationale of the study quite well and the need for such regional data. There are limited studies reported from India on this subject, as highlighted by the authors.[10] The primary determinants of survival among patients with CRC include advanced stage and late presentation, and it is important that the population at risk is aware of this fact as well as the preventive measures. Noronha et al.[11] reported in their study on 151 patients that 41.8% of the patients presented with stage IV disease, and 27% presented with stage III, thus stressing that the majority presented in the late stages of CRC. Thomas et al.,[10] have also highlighted the same fact of late diagnosis of CRC and the ","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135734811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/crst.crst_183_22
R. Rai, V. Patil, Mitali Alone, S. Saha, R. Tudu, V. Noronha, Deevyashali Parekh, N. Menon, S. Ghosh-Laskar, P. Pai, K. Prabhash
{"title":"Neoadjuvant chemotherapy in locally advanced (T3-T4) external auditory canal carcinoma: A retrospective observational study","authors":"R. Rai, V. Patil, Mitali Alone, S. Saha, R. Tudu, V. Noronha, Deevyashali Parekh, N. Menon, S. Ghosh-Laskar, P. Pai, K. Prabhash","doi":"10.4103/crst.crst_183_22","DOIUrl":"https://doi.org/10.4103/crst.crst_183_22","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85292407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Authors' reply to Ravind","authors":"V. Noronha, A. Rao, A. Ramaswamy, K. Prabhash","doi":"10.4103/crst.crst_77_23","DOIUrl":"https://doi.org/10.4103/crst.crst_77_23","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72385514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Authors' reply to Unnikrishnan","authors":"S. Nathany, M. Sharma, U. Batra","doi":"10.4103/crst.crst_76_23","DOIUrl":"https://doi.org/10.4103/crst.crst_76_23","url":null,"abstract":"","PeriodicalId":9427,"journal":{"name":"Cancer Research, Statistics, and Treatment","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73082215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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