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   Table of Contents - Current issue
Coverpage
Oct-Dec 2020
Volume 3 | Issue 4
Page Nos. 671-892

Online since Friday, December 25, 2020

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MUSINGS  

The other side of cancer Highly accessed article p. 671
Sunila Mohandas Nagvekar
DOI:10.4103/crst.crst_295_20  
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N95 traverse and travails Highly accessed article p. 674
Ajith Cherian
DOI:10.4103/crst.crst_303_20  
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Hygiene and cancer: A perspective Highly accessed article p. 676
TS Shylasree, Abhay K Kattepur
DOI:10.4103/CRST.CRST_198_20  
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ORIGINAL ARTICLES Top

Incidence and pattern of distribution of cancer in India: A secondary data analysis from six population-.based cancer registries Highly accessed article p. 678
Rohan Shetty, Rohan Thomas Mathew, Manavalan Vijayakumar
DOI:10.4103/crst.crst_290_20  
Background: The incidence of cancer is on the rise in India as well as around the globe. Earlier oral, breast, and cervical cancers constituted a major burden of cancer in India. However, the recent world statistics suggest that the proportion of lung, colorectal, breast, and prostate cancers is increasing. The Indian National Cancer Registry reports provide robust data regarding the cancer incidence in India. Objectives: We aimed to analyze the Indian National Cancer Registry report of 2020 to determine whether there has been a change in the trend of cancer incidence. Materials and Methods: Six population-based cancer registries (PBCR) with the highest number of patients were selected from each zone of the country. From these, a total of 1,87,891 patients were included in the study to ensure a pan-India representation. The relative proportion of oral, breast, cervical, lung, ovarian, endometrial, and prostate cancers was determined from these PBCRs. The mean of these values for each of these cancer types from the six PBCRs was considered the mean proportion of these cancer types across the country. Results: According to data from the PBCRs, lung and oral cancers were found to be the leading cancer types among men, and breast and cervix uteri cancers among women. The mean relative proportions showed that oral, breast, and cervical cancers still constitute the major bulk of this disease in India. Moreover, it was observed that the incidence of lung cancer has significantly increased. Likewise, the incidence of the cancers of the prostate, ovary and endometrium is also on the rise. The highest age-adjusted incidence rates (AAR) for men were noted in the Aizawl district of Mizoram and the highest AAR for women was in Papumpare district of Arunachal Pradesh. Conclusion: There continues to be a disproportionately high incidence of cancers in northeast India. Policymakers and healthcare professionals should focus on the emerging cancers along with oral, breast, and cervical cancers, which still constitute the major cancer burden in our country.
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Impact of the coronavirus disease 2019 pandemic on cancer care delivery: A single-center retrospective study Highly accessed article p. 683
Avinash Pandey, Mala Rani, Neelam Chandra, Mridula Pandey, Ravindra Singh, Kanchan Monalisa, Umesh Yadav, Shivkant Singh
DOI:10.4103/CRST.CRST_282_20  
Background: The coronavirus disease 2019 (COVID-19) pandemic and the resultant nationwide lockdown have adversely affected all the aspects of human life, including the access to health-care facilities. However, there is currently a lack of information on the impact of this pandemic on the delivery of routine cancer care. Objectives: In this study, we aimed to evaluate the changes in the number of patients in the day care chemotherapy (DCC) unit and outpatient department (OPD) because of the nationwide COVID-19 lockdown. Materials and Methods: This retrospective audit was conducted at the Department of Medical Oncology of the Indira Gandhi Institute of Medical Sciences in Patna, India. The demographic details and data related to the diagnosis and type and frequency of chemotherapy delivered in the DCC between February 1, 2020, and July 31, 2020, were retrieved. Patient numbers were recorded. Descriptive statistics, odds ratio, Chi-squared test, and Student's t-test were used to assess the changes in the pattern of DCC and OPD patient numbers because of the imposition of a nationwide lockdown on March 24, 2020. The Pearson correlation coefficient was used to assess the correlation between the number of COVID-19 cases and the number of patients visiting the DCC and OPD. Results: A total of 3192 DCCs and 8209 OPD visits were recorded in 126 working days. The median age of the patients was 47 years (interquartile range [34–58]). Cancers of the breast (17%) and gall bladder (15%) were the most common cancers receiving chemotherapy. There was a significant decrease in the number of DCCs delivered after the imposition of the COVID-19 lockdown (mean, 21.97 [±9.7]) compared to pre-lockdown period (mean, 33.30 [±11.4]), (t = 4.11, P = 0.001). Similarly, there was a significant decrease in the number of OPD visits after the imposition of the lockdown (mean, 47.13 [±18.8]) compared to the pre-lockdown period (mean, 89.91 [±30.0]), (t = 7.09, P = 0.001). The odds of receiving weekly chemotherapy over non-weekly regimes significantly decreased after the imposition of the lockdown with an odds ratio of 0.52 (95% confidence interval, 0.36–0.75) and Chi-square value of 12.57(P = 0.001). The daily number of COVID-19 cases reported in the state and the number of patients visiting the OPD was found to be moderately positively correlated (Pearson correlation coefficient, r = 0.35, P = 0.001). Conclusions: There was a significant decrease in the number of patients visiting the OPD and the number of chemotherapy cycles immediately after the imposition of lockdown. The number increased later despite a rise in the number of COVID-19 cases.
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The spectrum of cytologic patterns in cervical smears of a high-risk group: Retrospective analysis of a cancer detection camp experience p. 692
Sabna Dev Sahadevan Kanthimathy, Nimi G Kizhakkebhagam, Sithara Aravind, Neethu Ambali Parambil, Bindu Therayangalath, Sangeetha Keloth Nayanar
DOI:10.4103/CRST.CRST_213_20  
Background: Cervical cancer is a major public health concern, especially among women in developing countries like India. The human papillomavirus (HPV) is a widely recognized etiological factor for cervical carcinogenesis. There is an increased risk of the development of cervical cancer among certain groups of women, particularly the sex workers due to high HPV exposure. Objectives: This study was conducted to analyze the spectrum of epithelial cell abnormalities and the cytomorphology in the cervical smears of the high-risk groups of women in the North Malabar region of Kerala, India. Materials and Methods: This retrospective study was conducted at the Malabar Cancer Center, in Thalassery, India, between December 2011 and December 2015. Women who attended the Early Cancer Detection Camps organized for high-risk groups were included in the study. Pap smears were collected from all the women to study the spectrum of changes in their cervical smears to determine a possible correlation between high-risk behaviors and the occurrence of precancerous lesions. Descriptive statistics were used to describe the qualitative variables and Chi-square test was used to determine the association between the abnormalities and demographic variables. A P < 0.05 was considered statistically significant. Results: Out of 289 women enrolled in the study, 277 had satisfactory smears. The median age of the women was 40 years (range, 20–69 years), with majority (44%) in the age group of 30–39 years. Epithelial abnormalities were reported in 53 (19.1%) women. Nonspecific inflammation was observed in 56.6% of the women who were negative for intraepithelial lesion/malignancy (NILM), Candidiasis was seen in 13 (4.7%) women and bacterial vaginosis in 8 (2.9%). Younger women had a significantly higher number of epithelial abnormalities than older (P = 0.01). The highest prevalence of intraepithelial lesions was observed in women in the childbearing age group. Conclusions: The high frequency of epithelial abnormalities emphasizes the need for cervical cancer awareness and prevention campaigns. Periodic cervical smear examination for these vulnerable groups could be a feasible option for the early detection of cervical cancer. The Pap smear test is a rapid, noninvasive, simple, low-cost, and effective diagnostic method for the early detection of cervical cancer in high-risk groups.
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Loss to follow-up after initial screening for cervical cancer: A qualitative exploration of barriers in Southern India p. 700
E Vidhubala, Hemant Deepak Shewade, K Niraimathi, Amol R Dongre, Ramaswamy Gomathi, S Ramkumar, Mahadevan B Sankar
DOI:10.4103/CRST.CRST_221_20  
Background: In India, opportunistic screening is routinely conducted for cervical cancer, but systematic, community-based screening is relatively new. Hence, the uptake and follow-up for community-based screening remain poor. Objectives: In this study, we aimed to explore the barriers to community-based screening and suggest possible solutions for mitigating the loss to follow-up among screen-positive women from the perspectives of both, the community women (CWs) and service providers (SPs). Materials and Methods: This descriptive, qualitative study conducted at a non-governmental organization in Tirunelveli district of Tamil Nadu between December 2017 and January 2018 included 11 CWs who completed various stages of screening and five SPs involved in community-based screening. The participants were purposively identified and interviewed face to face using a semi-structured questionnaire. Interviews were conducted in Tamil, following which the transcripts were validated by the participants, translated to English, and analyzed. The reporting was based on the Consolidated Criteria for Reporting Qualitative Research guidelines. Results: Unawareness and poor understanding of the screening process, fear associated with the procedures and the disease, no financial and family support, and sociocultural beliefs were identified as the barriers to follow-up. Persistent follow-up through phone calls and home visits along with increasing the awareness about the screening process and its benefits, establishing a rapport with the community, and using local community-based organizations to track the CWs are suggested as possible measures to mitigate the loss to follow-up. Conclusion: Sociocultural, economic, and psychological factors are the main barriers to follow-up after initial screening in cervical cancer screening programs. Conducting population-based systematic screening and awareness programs and keeping the local public healthcare professionals on the frontline along with incentivizing the healthcare professionals and screen-positive women are recommended to improve the adherence to follow-up.
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Prevalence of iron and Vitamin B12 deficiencies and inflammatory anemia in treatment-naive patients with cancer: A cross-sectional study p. 708
Avinash Pandey, Raj Aryan, Murari Krishna, Shivkant Singh, Piyush Pankaj
DOI:10.4103/CRST.CRST_248_20  
Background: Anemia in patients with cancer has been associated with poor outcomes. There are scarce data on the prevalence of iron and Vitamin B12 deficiencies and inflammatory anemia among treatment-naive patients in the Indian setting. Objectives: In this study, we aimed to evaluate the prevalence of anemia and iron and Vitamin B12 deficiencies along with inflammation in treatment-naive patients. Materials and Methods: This single-center cross-sectional study was conducted at the Indira Gandhi Institute of Medical Sciences (Patna, India) from July 2019 to December 2019. All patients registered in the Medical Oncology Department were offered testing for iron profile and serum Vitamin B12 and serum ferritin levels. Anemia was defined as hemoglobin level<11 g/dL. Transferrin saturation<20%, serum ferritin >300 mg/L, and Vitamin B12 level<200 pg/ml were the “cutoffs” used to define iron deficiency, inflammation, and Vitamin B12 deficiency, respectively. Data were analyzed using descriptive statistics in the SPSS version 17.0. Pearson's Chi-squared test and odds ratio were used to measure the strength of association of anemia with the variables. Results: We included 311 patients in the study, of which 167 (54%) were men. The median age of the cohort was 52 ± 15.9 years (range, 18–84). The prevalence of anemia was found to be 61% ± 2.7 (95% confidence interval, 55–66%). The mean hemoglobin level of the cohort was 9.86 ± 2.08 g/dl (range, 3–16). Of 311 patients, 21 (7%) had severe anemia (hemoglobin<6.9 g/dl). Iron deficiency, inflammation, and Vitamin B12 deficiency were noted in 135/189 (71%), 61/189 (32%), and 89/189 (47%) anemic patients, respectively. Over 70% of the patients with gastrointestinal, gynecological, and lung cancers had an underlying iron deficiency. Conclusions: Two-thirds of our Indian patients with cancer are iron deficient, whereas half and one-third of them have Vitamin B12 deficiency and inflammation, respectively.
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First symptom and time to diagnosis in pediatric patients with solid tumors: A cross-sectional study from a regional cancer institute in South India p. 716
Saksham Singh, Arun Kumar, Nuthan Kumar, Prakruthi S Kaushik, Veena Akkineni, L Appaji
DOI:10.4103/CRST.CRST_214_20  
Background: Timely diagnosis and early treatment are essential components of oncology that translate to better outcomes. Objectives: The primary aim of this study was to determine the time to diagnosis and its associated factors in pediatric patients with solid tumors registered at our tertiary health-care facility in South India. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department of Pediatric Oncology of the Kidwai Memorial Institute of Oncology (Karnataka, India) from January 2019 to December 2019. Children aged<15 years with newly diagnosed solid tumors were included in the study after obtaining written informed consent from their parents/guardians. The demographic details of the patients were noted, and the relevant time intervals were calculated based on the history and previous medical records. Prediagnostic time intervals were categorized as parent time (TP), time to referral (TR), time to definitive diagnosis (TDD), and total time to diagnosis (TD). The data were analyzed using the Wilcoxon signed-rank test and the independent samples median test. Results: We enrolled 75 pediatric patients in the study, with an equal distribution of male and female patients. The median TD, TR, TP, and TDD were 76, 43, 7, and 16 days, respectively. The factors associated with a delay in the diagnosis included the maternal educational status, the state of residence, site of lesion, disease stage, and tumor type. The median TD was the shortest in patients with hepatoblastoma and longest in patients with retinoblastoma. Conclusions: Educating the mothers, raising awareness among the primary care physicians about the symptoms at presentation of childhood cancers, strengthening the screening system, decentralization of cancer care, and increasing the number of pediatric oncology care centers are the need of the hour.
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Financial toxicities in patients receiving systemic therapy for brain tumors: A cross-sectional study p. 724
Devanshi Kalra, Nandini Menon, Gunjesh Kumar Singh, Ochin Dale, Supriya Adak, Sudeep Das, Sujay Srinivas, Dilip Harindran Vallathol, Vijay M Patil
DOI:10.4103/CRST.CRST_265_20  
Background: Apart from disease management and the toxicities of systemic therapy, financial burden is an additional liability in patients with brain tumors receiving systemic therapy. However, currently, there is a paucity of data on the financial toxicities incurred by these patients. Objectives: In this study, we aimed to assess the perceived financial toxicity and the quality of life (QOL) of patients with brain tumors receiving systemic therapy and to evaluate the factors affecting it. Materials and Methods: This single-center, cross-sectional study was conducted in the Department of Medical Oncology at the Tata Memorial Hospital in Mumbai, India, between January 2019 and March 2019. The financial toxicity scores (FTSs) were captured at a single visit from the patients with primary brain tumors with or without recurrence who visited the Neuro Medical Oncology Outpatient Department. The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy and Functional Assessment of Cancer Therapy-Brain (FACT-Br) questionnaires were used to collect data on the FTS and QOL, respectively. Pearson correlation coefficient was used to determine the correlation between FTS and the various domains of QOL. Multiple linear regression was used to determine the factors that influence FTS, and P < 0.05 was considered statistically significant. Results: A total of 147 patients were included in the study; the median age of the cohort was 38 years (range, 16–67). Of them, 102 (67.5%) were men and 48 (32.5%) were women. The median monthly income was ₹7000 ($92.75). The median FTS was 13 (interquartile range [IQR], 6–21). The associated risk factors for financial toxicity were age (beta = 0.242,P = 0.001), category under which the patient availed treatment – private (regular cost) or general (discounted cost) (beta = 0.398, P < 0.001), and disease status (beta = −0.151,P = 0.043). The median FACT-General score, FACT-Br Trial Outcome Index score, and FACT-Br Total score were 77.2 (IQR, 64-91.7), 92.89 (IQR, 73.16–107), and 131.5 (IQR, 107.33–150.9), respectively, and were significantly associated with FTS ( P < 0.001). Conclusions: Financial distress was found to be severe in patients with brain tumors receiving systemic therapy. The age, payment category under which the patients availed treatment, and the disease status were found to be contributory factors. These, along with the QOL, were significantly associated with FTS.
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Demography and pattern of care of patients with head-and-neck carcinoma: Experience from a tertiary care center in North India p. 730
Somnath Roy, Tanmoy Kumar Mandal, Sudeep Das, Sujay Srinivas, Anshul Agarwal, Anuj Gupta, Arpita Singh, Anil Singh, Samasivaiah Kuraparthy, Akhil Kapoor, Ranti Ghosh, BK Mishra
DOI:10.4103/crst.crst_286_20  
Background: Head-and-neck cancer (HNC) is one of the most common cancers in India and requires a multidisciplinary approach for disease management. Objectives: We aimed to report the demographic profile and pattern of care of patients with HNC and their treatment compliance at our center. Materials and Methods: This single-center, retrospective study was conducted in the Department of Medical Oncology of Homi Bhabha Cancer Hospital, Tata Memorial Center, Varanasi, India, from May 2018 to April 2020. Patients with HNCs of any sub-site, stage, and histology were included in the study. The patients underwent routine clinical and imaging evaluation, baseline investigations, and tissue biopsy. After diagnosis and staging, the cases were discussed by a multidisciplinary team for treatment planning. The number of patients presenting at our center within the specified time period, the intent of care, and the treatment received were recorded, and treatment compliance was assessed. Continuous and noncontinuous variables were described using median and proportions, respectively, and P < 0.05 was considered statistically significant. Results: A total of 1229 patients were included in the analysis, of which 87% were male and 90% belonged to Uttar Pradesh, a state in northern India. The predominant (91%) histological type was squamous cell carcinoma. Majority (81%) of the patients presented with disease in a locally advanced stage, and oral cavity was the most common sub-site (71%), followed by the oropharynx (9.7%) and the hypopharynx and larynx (10%). The treatment intent was curative in 62%, palliative in 31%, and supportive in 6% of the patients. Of patients receiving curative treatment, 12% received two to three cycles of neoadjuvant chemotherapy followed by surgery, 25% underwent upfront surgery followed by adjuvant chemo-radiation or radiation, 7% underwent surgery alone, and 11% received radical chemo-radiation. Among patients receiving treatment with palliative intent, 13% received oral metronomic chemotherapy and 13% received some form of intravenous chemotherapy. About 78% of the patients complied with their cancer-directed therapies, with male patients showing significantly better compliance than the female ones. Conclusion: This study reports the demographic profile and pattern of care of patients with HNCs from a newly developed tertiary care center in North India, and highlights the emergent need for a more dedicated cancer center in this region.
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Incidence and severity of self-reported chemotherapy side-effects in patients with hematolymphoid malignancies: A cross-sectional study p. 736
Akashdeep Batra, C Vasantha Kalyani, Kusum K Rohilla
DOI:10.4103/CRST.CRST_87_20  
Background: Chemotherapy is an indispensable part of the treatment regimen for most cancer types. However, it is difficult to predict the chemotherapy-related side effects in patients with cancer. Objectives: In this study, we aimed to assess the incidence and severity of self-reported chemotherapy-related side effects in patients with cancer. Materials and Methods: This cross-sectional study, with a univariate descriptive design was conducted on patients with blood cancers, including leukemia, lymphoma, and myeloma. Patients who were admitted to the hemato-oncology department of our tertiary care center in northern India to receive the second cycle of chemotherapy were interviewed. Patients were interviewed regarding the symptoms they experienced after the first cycle of chemotherapy using the chemotherapy symptom assessment scale. The incidence of the chemotherapy side-effects experienced by the patients after the first cycle of chemotherapy was assessed, and the most severe and common symptoms that led to botheration in the patients receiving chemotherapy were identified. Results: A total of 100 patients were enrolled in the study. Majority of the patients were men and aged between 41 and 50 years, with a diagnosis of lymphoma and an Eastern Cooperative Oncology group performance status of 1. The five most common severe symptoms reported by the patients after receiving the first cycle of chemotherapy were nausea, vomiting, constipation, pain, and shortness of breath. The three symptoms that led to maximum botheration in the patients after the first cycle of chemotherapy were nausea, vomiting, and diarrhea. The five symptoms that caused the least botheration in the patients were constipation, pain, change in temperature, problems with the skin, and problems with the mouth. Conclusion: The most common symptom experienced by the patients is nausea (93%), which is also the most commonly experienced severe symptom (80%). Identifying these symptoms and their severity can help in planning symptom management more comprehensively. Moreover, planned health education for patients with cancer can help us provide better evidence-based quality care to those receiving chemotherapy.
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ORIGINAL ARTICLE - REAL WORLD DATA Top

Biomarker testing in non-small cell lung carcinoma – More is better: A case series p. 742
Ullas Batra, Mansi Sharma, Shrinidhi Nathany, Satyajeet Soni, Abhishek Bansal, Parveen Jain, Anurag Mehta
DOI:10.4103/crst.crst_285_20  
Background: Biomarker-driven lung adenocarcinomas involving alterations in oncogenic drivers such as EGFR, ALK, ROS1, and NTRK have witnessed a dramatic shift in the therapeutic and prognostic landscape owing to the development of molecular targeted therapies. The recent approval of the selective RET inhibitor, selpercatinib, has led to an ardent interest in RET-rearranged non-small cell lung carcinoma (NSCLC). However, sequential single-gene testing cannot detect RET rearrangements accurately or characterize the fusion partners. Objectives: We aimed to determine the incidence and types of RET alterations in our patients with NSCLC, and to describe the demographic and clinical profile of our patients with RET-driven NSCLC. In addition, our aim was to highlight the advantages of broader panel-based testing by the next generation sequencing (NGS) over single-gene assays. Materials and Methods: This is a retrospective, case series of patients with advanced NSCLC who underwent testing by NGS between December 2018 and August 2020 at our center, with a focus on the cases who were found to have the RET gene rearrangement. The demographic, clinicopathological profiles, and treatment details were retrieved from the medical record archives. Statistical analysis was performed using the Statistical Package for the Social Sciences software version 23 for Windows. Results: A total of 169 patients were enrolled in the study. RET rearrangement was detected in 2.9% (n = 5) of the patients in our cohort. Four cases had the KIF5B-RET fusion, and one case had the CCDC6-RET fusion. The median age of the patients was 55 years (range, 45–82), with a slight female preponderance (men: 2 and women: 3). The RET fusions were detected using an NGS-based assay. Four out of the five patients were administered pemetrexed-carboplatin-based chemotherapy and are alive and on regular follow-up. One patient did not receive any treatment and has succumbed to the disease. One patient has been administered selpercatinib after failing many lines of chemotherapy. Conclusions: The emergence of newer molecular targets necessitates the use of an broader panel-based NGS testing to detect oncogene addiction in NSCLC. This case series highlights the importance of NGS-based testing in the light of the recent approval of selpercatinib for RET-rearranged NSCLC.
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ORIGINAL ARTICLE - HEALTH SYSTEMS AND QUALITY IMPROVEMENT Top

Implementation of the electronic medical record system in the radiation oncology department of a government health-care facility: A single-center experience p. 748
RA Sunil, Lokesh Vishwanath, T Naveen, Siddanna Pallad, Sanjeet Kumar Mandal, Tanveer Pasha, Ashalatha , Sathiya Raj, S Sathyan, KM Ganesh
DOI:10.4103/CRST.CRST_251_20  
Background: The availability of electronic medical records (EMRs) in the health-care system has greatly helped to improve the quality of care provided to the patients. Installing an EMR system requires consideration of various factors such as the institutional structure, human resources, clinical workflow in the hospital, monetary issues, and coordination between the departments. Objectives: In this article, we have outlined the steps undertaken to integrate the EMR system into regular clinical practice in the department of radiation oncology. Materials and Methods: The EMR system was implemented in the department of radiation oncology of the Kidwai Memorial Institute of Oncology, a government health-care facility. The process of integration began in June 2019 and was completed in September 2019. We chose the MOSAIQ EMR software by Elekta systems for our center. The process involved creating a core team, establishing the workflow, customizing the software according to our hospital's clinical practices, installing computers, data storage and backup, entering the old patients' data and reports into the system, and training the staff. Results: The EMR system was made available for daily clinical practice from September 25, 2019. Since then, we observed a drastic reduction in the waiting time for the patient files to be made available at the outpatient department, as information could be accessed through EMR instantaneously. Furthermore, the patients' clinical data were available without any delay in the treatment planning system rooms, when planning radiation therapy (RT). Finally, in the radiation treatment rooms, EMRs allowed the RT technologists to obtain information regarding the number of fractions planned for a patient without any confusion as opposed to the earlier handwritten RT charts. Conclusion: The immediate advantage of the EMR system is the instantaneous availability of patient data in the hospital. However, the successful implementation and optimal use of this system require commitment from the health-care staff.
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POETRY IN ONCOLOGY Top

Spare the warriors! Highly accessed article p. 755
Mansi Khanderia
DOI:10.4103/crst.crst_288_20  
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A warrior's family p. 757
Archi Rungta
DOI:10.4103/crst.crst_291_20  
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PATIENT/CAREGIVER CORNER Top

My travels from travails to hope p. 758
Sabyasachi SenGupta
DOI:10.4103/CRST.CRST_252_20  
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REVIEW ARTICLE Top

Integrating cardiopulmonary exercise testing and 6-min walk test for predicting postoperative cardiopulmonary complications in patients undergoing lung cancer surgery: A narrative review p. 760
Chidiebere Emmanuel Okechukwu
DOI:10.4103/CRST.CRST_245_20  
Cardiopulmonary exercise testing (CPET) is an effective method for the assessment of cardiopulmonary and neuromuscular reaction to physical stress. It offers an independent assessment of cardiopulmonary fitness and functional capacity in patients undergoing lung cancer surgery. The 6-min walk test (6MWT) can be used for the assessment of functional capacity when CPET is unavailable. Through this review, we aim to emphasize the importance of utilizing both CPET and 6MWT in the assessment of cardiorespiratory fitness/functional capacity in patients with lung cancer undergoing major thoracic oncological resections. We searched the PubMed electronic database using the MeSH system for articles reporting the use of CPET and 6MWT in cardiopulmonary fitness/functional capacity evaluation during cancer treatment. The full-text articles were assessed, and significant evidence was extracted. Only the articles written in the English language were selected. Using a combination of CPET and 6MWT for the assessment of cardiopulmonary fitness/functional capacity in patients with lung cancer undergoing complex oncological resections, could give a definite prediction of the possibility of postoperative cardiopulmonary complications in these patients.
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DRUG REVIEW Top

Ibrutinib: A narrative drug review Highly accessed article p. 767
Pritesh Naresh Munot, Sumeet Mirgh, Nikita Mehra, Bhausaheb P Bagal
DOI:10.4103/CRST.CRST_234_20  
Ibrutinib is an oral, irreversible covalent inhibitor of the Bruton tyrosine kinase, that plays a major role in B-cell differentiation, proliferation, migration, survival, and apoptosis. It has been found to be active against a number of B-cell malignancies. Ibrutinib has shifted the treatment strategy for malignancies away from cytotoxic chemotherapies toward a more targeted approach. It has already been approved for a number of B-cell malignancies such as mantle cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, Waldenstrom macroglobulinemia, splenic marginal zone lymphoma, and chronic graft-versus-host disease in allogeneic stem cell transplant recipients, and still continues to be evaluated for a number of other B-cell malignancies in various settings. We comprehensively searched the PubMed database to identify and compile the current scenarios in which ibrutinib is indicated for use in oncological practice.
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RESIDENT CORNER Top

The grand finale p. 785
Satvik Khaddar
DOI:10.4103/CRST.CRST_259_20  
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A pathologist on COVID duty: Stepping out of my comfort zone p. 787
Pragya Singh, Gunjesh Kumar Singh
DOI:10.4103/CRST.CRST_280_20  
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EDITORIALS Top

Patterns of cancer incidence in India – What next? p. 790
Bhawna Sirohi, Aju Mathew
DOI:10.4103/crst.crst_358_20  
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Decline in the number of patients with cancer during the COVID-19 pandemic: A matter of concern or just a statistic? p. 793
Joydeep Ghosh, Sandip Ganguly
DOI:10.4103/crst.crst_332_20  
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Cervical cancer screening in India: Need of the hour p. 796
Kranti Suresh Vora, Shahin Saiyed
DOI:10.4103/crst.crst_321_20  
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How noteworthy is a delay in the diagnosis of childhood cancers? p. 798
Gitika Pant, Nishant Verma
DOI:10.4103/crst.crst_330_20  
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MOLECULAR TUMOR BOARD Top

Resistance mechanisms to epidermal growth factor receptor inhibitors in non-small cell lung cancer Highly accessed article p. 801
Suresh Kumar Bondili, Ravindra Nandhana, Vanita Noronha, Amit Joshi, Vijay Patil, Nandini Menon, Anuradha Chougule, Omshree Shetty, Rajiv Kumar, Pratik Chandrani, Abhishek Mahajan, Sunil Chopade, Kumar Prabhash
DOI:10.4103/crst.crst_357_20  
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MUSINGS: GERIATRIC ONCOLOGY Top

Ethnocultural inequity in the geriatric assessment p. 808
Vanita Noronha, Anant Ramaswamy, Shripad Banavali, Shreya Gattani, Kumar Prabhash
DOI:10.4103/crst.crst_353_20  
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IMAGE CHALLENGE Top

Skin rash: Disease or drug? p. 814
Shikhar Kumar, Vanita Noronha, Vijay M Patil, Amit Joshi, Nandini Menon, Kumar Prabhash
DOI:10.4103/crst.crst_347_20  
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STATISTICAL RESOURCE Top

Basics of statistics – 4: Sample size calculation (ii): A narrative review p. 817
HS Darling
DOI:10.4103/CRST.CRST_279_20  
Sample size calculation is one of the most crucial aspects of planning clinical trials. Through this series, we aim to delve into the basic concepts of sample size calculation and the various methodologies used for it. For the purpose of this review, a thorough study and selection of the available literature from various sources including PubMed and Medline was conducted. The search terms used were “sample size,” “calculation,” and “oncology,” and 1370 articles were screened. The relevant material has been presented in a simplified format along with appropriate examples mimicking real-world clinical situations. This review article provides a brief overview of the sample size calculation methods used when designing clinical studies. Extensive details about the methods have been avoided to keep the write-up short, crisp, and directed toward the focus. The intricacies of complex topics will be dealt with in the subsequent issues.
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LETTERS TO EDITOR Top

Surge in pelvic and para.aortic nodal involvement in newly diagnosed cervical cancer patients during coronavirus disease 2019: A chance or imminent reality? p. 829
Vinodh Kumar Selvaraj, Deleep Kumar Gudipudi
DOI:10.4103/CRST.CRST_281_20  
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Low-dose radiotherapy for COVID-19 pneumonia: A possible low-cost treatment option for immunomodulation p. 830
Namrata Das, Kannan Periasamy
DOI:10.4103/CRST.CRST_299_20  
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Daratumumab and its efficacy in refractory myeloma with anemia p. 832
Suresh Kumar Bondili, Ravindra Nandhana, Anant Gokarn, Avinash Bonda, Manju Sengar, Bhausaheb Bagal
DOI:10.4103/crst.crst_283_20  
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Adrenal metastasis in an older patient with seminoma p. 836
Archisman Basu, Meheli Chatterjee, Deepak Dabkara, Bivas Biswas, Sandip Ganguly, Joydeep Ghosh, Priya Ghosh
DOI:10.4103/CRST.CRST_250_20  
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Lung cancer with occipital condyle syndrome in a non-smoker female patient: A case report p. 838
Milind Baldi, Sahil Mehta, Nalini Gupta, Navneet Singh
DOI:10.4103/CRST.CRST_271_20  
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Breaking the bad news of breast cancer: Picturing the Indian scenario p. 839
Monika Thakur, Roopali Sharma, Anand Mishra
DOI:10.4103/crst.crst_309_20  
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Role of exercise in mitigating breast cancer-related cognitive impairment in women p. 841
Chidiebere Emmanuel Okechukwu
DOI:10.4103/crst.crst_314_20  
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Caught in the middle: Cancer and COVID-19 risk for patients undergoing radiation therapy during the pandemic p. 844
Sheela Hanasoge, William A Stokes
DOI:10.4103/CRST.CRST_317_20  
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Can a pandemic put a spanner in the radiotherapy workflow process? p. 846
Kirthi Koushik Agrahara Srinivas, Ram Charith Alva, Janaki Gururajachar Manur
DOI:10.4103/crst.crst_305_20  
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Authors' reply to Hanasoge et al. and Srinivas et al p. 847
Richa Chauhan, Vinita Trivedi
DOI:10.4103/CRST.CRST_322_20  
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Are we radiation avid for head-and-neck cancer during the COVID-19 pandemic? p. 849
Janaki Gururajachar Manur, Kirthi Koushik Agrahara Srinivas, Ram Charith Alva
DOI:10.4103/CRST.CRST_307_20  
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Authors' reply to Hanasoge et al. and Manur et al. p. 850
Shwetabh Sinha, Sarbani Ghosh Laskar
DOI:10.4103/CRST.CRST_327_20  
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Measuring quality of life in Indian children with cancer: Addressing an unmet need p. 851
Shuvadeep Ganguly, Sameer Bakhshi
DOI:10.4103/CRST.CRST_311_20  
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Authors' reply to Ganguly et al. p. 853
Chindhu Shunmugasundaram, Vidhubala Elangovan, Venkatraman Radhakrishnan
DOI:10.4103/crst.crst_323_20  
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Systemic chemotherapy and cognitive dysfunction in primary brain tumors – To incriminate or exculpate? p. 854
KP Divya, Ajith Cherian, TM Anoop
DOI:10.4103/crst.crst_301_20  
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Authors' reply to Divya et al. p. 856
Supriya Adak, Gunjesh Kumar Singh, Nandini Menon, Vijay Patil
DOI:10.4103/crst.crst_355_20  
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Exploring the efficacy of topical tranexamic acid in headand-neck cancer surgery p. 857
Ishita Gupta, Sohin A Chaudhari, Mandar Sureshchandra Deshpande
DOI:10.4103/crst.crst_329_20  
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Authors' reply to Gupta et al. p. 858
S Anand, Vikrant Singh, Pankaj Kumar Sahu
DOI:10.4103/crst.crst_344_20  
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Should we add chemotherapy to radiation therapy in older adults with locally advanced head-and-neck squamous cell carcinoma? p. 859
Manikandan Dhanushkodi, Venktesh Vaidhyalingam, Arvind Krishnamurthy
DOI:10.4103/CRST.CRST_324_20  
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Chemoradiotherapy in older patients with squamous cell carcinoma of the head-and-neck: Is it for cure or to improve quality of life? p. 860
Jomon Raphael Chalissery
DOI:10.4103/crst.crst_343_20  
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Authors' reply to Dhanushkodi et al. and Chalissery p. 862
Gunjesh Kumar Singh, Vanita Noronha, Vijay M Patil, Nandini Menon, Amit Joshi, Kumar Prabhash
DOI:10.4103/crst.crst_356_20  
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Expanding opportunities in precision oncology p. 863
T Raja
DOI:10.4103/crst.crst_340_20  
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Liquid biopsy of bodily fluids: A rich resource of genomic information p. 864
Moushumi Suryavanshi
DOI:10.4103/crst.crst_339_20  
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Authors' reply to Raja and Suryavanshi p. 866
Anuradha Chougule, Vanita Noronha, Kumar Prabhash
DOI:10.4103/crst.crst_354_20  
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Sense and nonsense of endometrial stromal sarcoma p. 867
Smita Kayal
DOI:10.4103/CRST.CRST_328_20  
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Prognostic role of inflammatory markers: Hype or reality? p. 869
Richa Vaish, Rohit O Mundhada, Neha Mittal
DOI:10.4103/crst.crst_334_20  
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Authors' reply to Vaish et al. p. 870
Arvind Krishnamurthy, Sri Kamakshi Kothandaraman, Shobana Sekhar
DOI:10.4103/crst.crst_341_20  
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The healing nature of music Highly accessed article p. 871
Eki Shola Abrams
DOI:10.4103/crst.crst_294_20  
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Resonating the octaves p. 872
Santosh Menon
DOI:10.4103/crst.crst_302_20  
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Rock 'n roll doctor p. 873
Manoj Gandhi
DOI:10.4103/CRST.CRST_318_20  
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Addressing the oro-dental needs of patients with cancer amid the coronavirus disease 2019 pandemic: Are we equipped? p. 875
Neeraj Gugnani, Shalini Gugnani
DOI:10.4103/crst.crst_304_20  
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Bringing public health to dentistry amid the COVID-19 pandemic p. 876
Rashmi Mehra, Karn Mehra, Shivam Kapoor
DOI:10.4103/CRST.CRST_297_20  
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Dental practice during the COVID.19 pandemic: Challenges and the way forward p. 878
Byalakere Rudraiah Chandrashekar, S Suma, A Bhagyalakshmi
DOI:10.4103/CRST.CRST_312_20  
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Authors' reply to Mehra et al., Gugnani et al., and Chandrashekar et al. p. 879
Kanchan P Dholam, Madhura R Sharma, Sandeep V Gurav, Gurkaranpreet Singh, Nimisha Manjrekar
DOI:10.4103/CRST.CRST_319_20  
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The COVID-19 pandemic: An opportunity to reflect on our scientific approach Highly accessed article p. 881
Soham Dinabandu Bhaduri
DOI:10.4103/crst.crst_310_20  
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Beauty of radiotherapy is not just skin deep! p. 882
Ram Charith Alva, Janaki Gururajachar Manur, Kirthi Koushik Agrahara Srinivas
DOI:10.4103/crst.crst_306_20  
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Authors' reply to Alva et al. p. 883
Isha Jaiswal, Kaustav Talapatra, Pritanjali Singh
DOI:10.4103/crst.crst_338_20  
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Challenges in cancer associated thrombosis (CAT) p. 884
Anuprita Daddi
DOI:10.4103/CRST.CRST_316_20  
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Authors' reply to Daddi p. 885
Pritesh Naresh Munot, Vanita Noronha, Vijay Patil, Amit Joshi, Nandini Menon, Kumar Prabhash
DOI:10.4103/CRST.CRST_352_20  
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Schwannoma of the head-and-neck: Is it always about surgery? p. 886
Richa Vaish
DOI:10.4103/crst.crst_331_20  
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Authors' reply to Vaish p. 888
Akheel Mohammad, Ashmi Wadhwania
DOI:10.4103/CRST.CRST_337_20  
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The paradigm shift in cervical adenocarcinoma p. 889
Swarnalata Gowrishankar
DOI:10.4103/CRST.CRST_333_20  
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Authors' reply to Gowrishankar p. 890
Kriti Chauhan, Komal Kathuria
DOI:10.4103/crst.crst_345_20  
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ERRATUM Top

Erratum: Basics of Statistics 3: Sample size calculation – (i) p. 892
.
DOI:10.4103/2590-3233.305019  
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