Context: Studies related to need, problems, and quality of life in advanced cancer patients receiving palliative care are scarce in India. Aim: The aim of the study 'was to assess the quality of life, problems, and needs in advanced cancer patients receiving palliative care. Settings and Design: This was a cross-sectional survey in the palliative care outpatient department of a tertiary care hospital. Materials and Methods: Survey was conducted using structured questionnaires with tools of problems and need in palliative care and the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL. Statistical Analysis Used: Survey results were presented for various palliative care needs and domains as per magnitude of palliative care received. Comparison of the scores for males and females was done using Mann–Whitney U-test. Results: More than 50% patients had difficulty in daily living and majority of patients (77%) had difficulty in doing heavy work. 82% patients presented with fatigue, 47% patients had issues regarding others being overconcerned, 71% were afraid of physical suffering, 77% faced difficulties in usual activities, and 80% felt the need for being informed about the possibility of treatment and side effects. Needs were more in female patients including a statistically significant difference in sleep quality (P < 0.05). Conclusions: Palliative care needs and quality of life in Indian patients with advanced cancer are of concern and need further attention for optimal care. Quality of life, problems, and needs in such patients need to be assessed, and provisions should be made for delivery of adequate services.

Background: Limb salvage surgery (LSS) is the current surgical standard for malignant bone tumors. The advancements in imaging, surgical techniques, chemotherapy, and biomedical engineering have made LSS oncologically safe and with improved functional outcome. In this retrospective study, we report our experience with LSS and perioperative chemotherapy for osteosarcoma in a tertiary cancer center in India. Materials and Methods: A total of 41 LSS were performed from January 2009 to January 2015. Perioperative chemotherapy was administered to all patients after histopathological confirmation of osteosarcoma. The functional outcome of the patients was evaluated using the musculoskeletal tumor society (MSTS) scoring system at regular intervals. Statistical analysis involved the use of descriptive and inferential statistics for data analysis. Kaplan–Meier method was used for calculating the recurrence free and overall survival (OS) and log-rank test for comparing survival functions. Spearman and Karl Pearson's methods were used for correlation analysis. Results: The mean age was 19.3 years (range, 8–49 years). Twenty-five (61%) patients were males. Thirty-six (88%) patients had conventional high-grade osteosarcoma. Five-year relapse-free survival and OS were 56.1% ± 7.8% (95% confidence interval [CI], 53.7–58.5) and 58.5% ± 7.7% (95% CI, 56.1–60.9), respectively. The mean MSTS scores at 1 year for tumors of the upper tibia and distal femur were 64 and 75.9, respectively. Patients with high rate of chemotherapy-induced tumor necrosis (>99%) had significantly better median OS (85.70 ± 8.22 months) compared to those with less (<99%) tumor necrosis (58.15 ± 11.77 months), P = 0.030. Conclusion: The oncological and functional outcomes in osteosarcoma patients in the present study are comparable to those from the world literature. Chemotherapy-induced tumor necrosis is a favorable prognostic factor for patients treated for osteosarcoma with curative intent.

Objectives: The main objective was to study the oncological outcomes of patients undergoing unplanned (uP) excision for soft-tissue sarcomas (STS) at a tertiary cancer institute. Materials and Methods: This was a retrospective analysis of patients of STS from June 2009 to December 2015. Patients who had undergone uP surgery outside followed by definitive surgery were compared to those undergoing surgery at our center. The oncological outcomes, including overall survival (OS) and disease-free survival (DFS), were analyzed using Kaplan–Meier method. Results: A total of 51 patients were included: 22 (43.13%) in the P group and 29 in the uP group. At a median follow-up of 44 months, the estimated 5-year OS was higher in the uP group (92.4% vs. 60.6%, P = 0.032) compared to the planned group. However, there was no difference in DFS. Conclusions: Although survival of patients undergoing uP excision outside was better, this could be related to more favorable histology, grade, and smaller tumor size at presentation.

Background: Management of ovarian cancer has evolved over time with innovations in surgical management as well as in systemic therapy. In the real world, treatment is often adapted to distinct settings based on the socioeconomic factors, physician and patient preference, availability of resources, need for referral, and controversies in the standard treatment. These deviations from conventional treatment can lead to suboptimal results and a better comprehension of this variability can help us to plan corrective measures for improvement in community practice. Methods: The survey instrument consisted of four sections dealing with baseline details of participants, early-stage ovarian cancer practice patterns, surgical practice patterns, and adjuvant/neoadjuvant chemotherapy (NACT) in advanced-stage ovarian cancer. It was an anonymous survey sent as an email and the responses were electronically captured. No incentive was provided. Descriptive statistics were performed using the SPSS software version 20 and R studio. Results: Seventy-five of 258 participants responded. Majority of participants (n = 67, 89.3%) were in favor of doing a fertility-preserving surgery in early-stage ovarian cancer with 86.7% opting for open surgery (n = 65) and only 13.3% (n = 10) using minimally invasive methods. The proportions of early-stage ovarian cancer patients receiving chemotherapy were >90% in 14.7% (n = 11), 75%–90% in 24% (n = 18), 50%–75% in 18.7% (n = 14), 10%–50% in 32% (n = 24), and <10% in 10.7% (n = 8). In the advanced stage, few centers had high rates of microscopically margin negative (R0) resection with primary cytoreduction. About 90.7% of participants (n = 68) avoided doing multiorgan resection for achieving an R0 resection. Sixty percent (n = 45) of the 75 participants offered NACT to all Stage III–IV patients. Conclusion: Ovarian cancer management in the South Asian Association for Regional Cooperation countries is largely congruent with international guidelines. Differences in the administration of intensive chemotherapy schedules and targeted therapy are observed.

Esophageal cancer is an aggressive disease with high mortality and morbidity. Many of the patients present in advanced stages. In such a situation, systemic therapies are the mainstay of therapy both for palliation of symptoms and for meaningful improvement in survival. Preservation of quality of life is an important aspect of management of advanced and metastatic esophageal cancers. In this review article, we summarize the literature available on various systemic treatment options and the benefit in terms of response rates, improvement in survival and quality of life.Available literature on the subject was searched through an online search of the databases for articles in the English language. We describe the various classes of drugs available as evaluated in clinical trials, their response rates, and various drug combination regimens to achieve maximum benefit at the cost of minimum toxicity. Also detailed in the article are the relevant points regarding each chemotherapeutic agent/regimen and the associated response rates, progression free and overall survival. Palliative systemic therapy produces meaningful outcomes and must be considered in every patient with advanced esophageal cancer. This article will help the reader choose amongst the various treatment options and tailor the treatment according to the clinical situation.

Introduction: Artificial intelligence (AI) is the fascinating result of the convergence of various technologies, algorithms and approaches. Its role in early detection and diagnosis will be a boon to society in the next few years and should be seen as 'Augmented Intelligence.' Issues like ethical considerations and collaborations need to be sorted out to ensure apt implementation in healthcare. This article reviews the current status of AI in developing nations like India and highlights some insights that could provide new directions and opportunities for AI in healthcare, especially in the field of radiology. Implications for Patient Care: (1) AI will aid in nation-wide research and cooperation that will provide an impetus for the development of imaging science and decentralization of medical services. (2) AI may help to bridge the gap for need of specialized medical personnel in the peripheral areas in developing countries like India. (3) Government initiatives, ethical considerations and joint public private sector collaborations will ensure smooth transition and implementation of AI in healthcare especially in radiology. Summary Statement: This manuscript highlights the existing gap between the developed and developing nations regarding implementation and acceptance of AI in healthcare and at the same time brings out insights in regard to the government initiatives to ease the progress of AI in healthcare in developing countries like India.

The discovery of Philadelphia (Ph) chromosome in 1959 was a landmark moment in the history of targeted therapies for cancer. The BCR-ABL fusion gene formed as a result of this translocation is the key pathogenetic event of chronic myeloid leukemia (CML) and Ph-positive acute lymphoblastic leukemia (ALL). Currently, there are five tyrosine kinase inhibitors (TKIs) available in the clinic to target the BCR-ABL kinase. The last one to be added to the list is ponatinib. Ponatinib is highly effective even in the presence of mutations such as T315I that render all other TKIs ineffective. The initial enthusiasm following the impressive results from the Ponatinib Ph-positive ALL and CML Evaluation (PACE) trial was dampened by the emergence of arterial occlusive events. With a dose-adapted strategy, the drug seems to be ready for a comeback. We review the drug ponatinib, including the history, chemistry, mechanism of action, pharmacokinetics, clinical trial data, ongoing clinical trials, and adverse events.

Background: Outcomes based on liquid biopsy in poor performance, older, biopsy-ineligible advanced non-small cell lung cancer (NSCLC) patients are unknown. Aim: The aim of the study was to evaluate the outcomes of patients treated on the basis of liquid biopsy to determine the epidermal growth factor receptor (EGFR) status. Objectives: The objective was to evaluate the progression-free survival (PFS) and overall survival (OS) of patients treated based on EGFR mutation status, determined on a liquid biopsy. Materials and Methods: This was a retrospective audit of prospectively maintained database of patients who underwent liquid biopsy EGFR mutation testing between July 2017 and January 2019 and received treatment based on that report. The primary end point was PFS defined as duration between the date of sample collection and disease progression or death, whereas OS was calculated as the interval between the date of sample collection and death. Kaplan–Meier survival was used for the above two end points. Results: Out of 28 patients, 11 (39%) were EGFR mutation positive, and 17 (61%) were EGFR mutation negative. The median age was 62 years, with 15 out of the 28 being females (54%). Nine (82%) and 13 (76%) patients had performance status (PS) 2 or 3 in the EGFR mutation-positive and EGFR mutation-negative cohorts, respectively. In the EGFR mutation-positive cohort, 4 (36%) were exon 19, 6 (54%) were exon 21, and 1 (9%) was T790M positive. After receiving tyrosine kinase inhibitors or physician's choice of chemotherapy in EGFR mutation-positive and negative cohorts, the response rates were 63% and 12%, respectively. The median follow-up was 14 months (range: 10–17 months). The median PFS was 8 months versus 2 months (P = 0.002), whereas the median OS was 17 months versus 5 months (P = 0.004) in the EGFR mutation-positive and EGFR mutation-negative cohorts, respectively. Conclusion: In patients with advanced NSCLC in whom a tissue biopsy is not feasible, especially in older, poor PS patients, treatment based on the results of liquid biopsy gives comparable outcomes to those of a tissue-based biopsy.

Introduction: Checkpoint inhibitors (CPIs) are rapidly becoming the standard of care in solid tumors for multiple indications. Steroids due to their immunosuppressive nature might decrease the efficacy of these agents. To test this hypothesis, we performed an audit of our patients who had received CPI and concomitant steroids. Patients and Methods: This was a retrospective audit of a prospectively maintained database at Tata Memorial Hospital, Mumbai, between August 2015 and November 2018. Patients who received CPI for palliative indication were included. Overall survival (OS) was calculated from the date of the start of immunotherapy to the date of death. Data regarding the use of steroids and cumulative number of days of use were noted. Time-to-event analysis was done using Kaplan–Meier estimator, and hazard ratio (HR) was calculated using Cox proportional model. Results: A total of 155 patients were identified to have received CPI during the study period, of which 38 (24.5%) patients received steroids with prednisolone equivalent of ≥10 mg/day. The median age of the patients receiving steroids was 58.7 years (range, 22–85), and 31 (81.6%) patients were male. The median duration of steroid use was 7 (range, 2–30) days. The median OS for patients who received steroids was 3.9 months (95% confidence interval [CI], 1.8–11.4) versus 5.47 months (95% CI, 1.3–9.6) in patients who did not receive steroids (P = 0.23). The median progression-free survival for patients who received steroids for <10 days was 1.4 months (95% CI, 0.9–1.9) versus 3.8 months (95% CI, 0–8.6) for patients who received steroids for 10 or more days (P = 0.009). Using duration of steroid use as a continuous variable, HR for death was 1.0 (95% CI, 0.90–1.04, P = 0.991). There was a statistically significant better OS in patients who did not receive antibiotics (median OS, 11.4 months [95% CI, 8.5–14.3] vs. 2.8 months [95% CI, 1.5–4.1], P = 0.047). Conclusions: There was no statistical difference in OS in patients on immunotherapy with or without the use of steroids supporting the notion that steroids can be judiciously used along with CPI.

Introduction: Geriatric oncology (GO) is a medicine discipline that deals with the diagnosis, treatment, and management of older patients with cancer. Objectives: The objective of this study was to describe the knowledge and awareness regarding the management of geriatric cancer patients through an online survey of oncologists in India. Materials and Methods: A detailed descriptive survey was sent to several practicing oncologists using emails and social media. Results: Between March 2019 and June 2019, 100 answers were collected. Even though 99% of the respondents were treating geriatric patients in their daily clinical practice, 44% lacked awareness for any guideline for geriatric care. Majority of the respondents (70%) claimed not to apply any special management practices using specific tools for every geriatric patient. Overall, there was agreement that the discipline of GO afforded certain potential advantages. Lack of time, training, resources, awareness, and staff were cited as the most common reasons preventing the routine implementation of geriatric assessment in clinical practice. Conclusions: From this nationwide survey, we conclude that there is a perception of the need for training in GO as there is no defined care structure for older patients with cancer.