Oncofertility and Pregnancy in Adolescent and Young Adult Cancers: Physicians' Knowledge and Preferences in India.

PURPOSE: The treatment outcomes of adolescent and young adult (AYA) cancers have improved with advanced oncology care. Hence, fertility preservation (FP) and post-therapy pregnancies (PTPs) become vital issues. MATERIALS AND METHODS: An online survey link with 17 questions regarding oncofertility and PTPs was circulated among oncologists to assess the knowledge, understand the oncofertility care patterns, and seek suggestions to improve oncofertility services. RESULTS: The median age of 179 respondents, predominantly medical oncologists (68.7%), was 37 years (IQR, 10; range, 29-74), working in academic centers (39%) having a median experience of 4 years (IQR, 4; range, 1-42); 23 (12.8%) had dedicated AYA cancer units. Although a quarter (19%-24%) of respondents discussed fertility issues in >90% of AYA patients with cancer, only a tenth (8%-11%) refer >90% for FP, with significantly higher (P < .05) discussions and referrals in males and by more experienced oncologists (P < .05). Forty-six (25.6%) were not well versed with international guidelines for FP. Most (122, 68.1%) oncologists knew about the referral path for semen cryopreservation; however, only 46% were knowledgeable about additional complex procedures. One hundred and ten (61.5%) oncologists never or rarely altered the systemic treatment for FP. Prominent barriers to FP were ignorance, lack of collaboration, and fear of delaying cancer treatment. Lead thrust areas identified to improve FP practices are education, and enhanced and affordable access to FP facilities. Seventy-four (41.3%) respondents knew about international guidelines for PTPs; however, only half (20%) of them often monitored fertility outcomes in survivors. Oncologists have conflicting opinions and uncertainties regarding pregnancy safety, assisted reproductive techniques, breastfeeding, and pregnancy outcomes among survivors. CONCLUSION: Oncologists are uncertain about the guidelines, FP practices, referral pathways, and PTPs. Multipronged approaches to improve awareness and provision for affordable oncofertility facilities are needed to enhance AYA cancer outcomes in India, which will be applicable to other low- and middle-income countries too.

The Impact of COVID-19 Pandemic on Cancer Care in a Tertiary Care Facility.

Background Coronavirus disease 2019 (COVID-19) pandemic had an overwhelming impact on health care worldwide. Cancer patients represent a subgroup that is vulnerable and is under high risk. It is, therefore, necessary to analyze factors that predict outcomes in these patients so that they can be triaged accordingly to mitigate the effects of COVID-19 on cancer management. To date, the impact of COVID-19 on cancer patients remain largely unknown. Methods Data of 291 cancer patients undergoing active treatment from March 23 to August 15, 2020 were retrospectively reviewed; the incidence, demographic and clinical characteristics, treatment, and outcomes of cancer patients infected by COVID-19 were included in the analysis. Discussion During the index period (March 23-August 15, 2020), 4,494 confirmed cases of COVID-19 were admitted at our institute. In the department of medical oncology out of 578 patients presented to outpatient department, 291 patients were admitted for active treatment. Considering the cancer patients, infection rate was 7.9% (23/291) and mortality 13% (3/23). Median age was 40 years and the majority of patients were male (60%). The most common cancer type was acute lymphoblastic leukemia presented at various stages of treatment. Twenty patients (86.9%) were discharged after full clinical recovery and negative real-time polymerase chain reaction on a nasopharyngeal swab. Anticancer treatment was modified according to the type of cancer under intensive surveillance. Conclusion Although mortality rate in COVID-19 cancer patients is elevated, our results support the feasibility and safety of continuing anticancer treatment during pandemic by endorsing consistent preventive measures, but however should be modified based on the type and prognosis of cancer.

Practical Consensus Recommendations for Optimizing Risk versus Benefit of Chemotherapy in Patients with HR Positive Her2 Negative Early Breast Cancer in India.

Breast cancer is a public health challenge globally as well as in India. Improving outcome and cure requires appropriate biomarker testing to assign risk and plan treatment. Because it is documented that significant ethnic and geographical variations in biological and genetic features exist worldwide, such biomarkers need to be validated and approved by authorities in the region where these are intended to be used. The use of western guidelines, appropriate for the Caucasian population, can lead to inappropriate overtreatment or undertreatment in Asia and India. A virtual meeting of domain experts discussed the published literature, real-world practical experience, and results of opinion poll involving 185 oncologists treating breast cancer across 58 cities of India. They arrived at a practical consensus recommendation statement to guide community oncologists in the management of hormone positive (HR-positive) Her2-negative early breast cancer (EBC). India has a majority (about 50%) of breast cancer patients who are diagnosed in the premenopausal stage (less than 50 years of age). The only currently available predictive test for HR-positive Her2-negative EBC that has been validated in Indian patients is CanAssist Breast. If this test gives a score indicative of low risk (< 15.5), adjuvant chemotherapy will not increase the chance of metastasis-free survival and should not be given. This is applicable even during the ongoing COVID-19 pandemic.

A Bidirectional Observational Study of Concomitant Chemo-Radiotherapy in Adenocarcinoma Stomach.

BACKGROUND: Although many cancers have seen a significant improvement in survival and reduction in morbidity in the past few decades, the same cannot be said about adenocarcinoma stomach. Upfront surgery in non metastatic stomach cancers definitely improves survival. It is well established that any form of adjuvant therapy adds to the improvement in survival, controversy remains if adjuvant chemoradiotherapy is the standard or not. METHODOLOGY: This study is a single arm bidirectional observational study of the stomach cancer patients undergoing adjuvant concurrent chemoradiotherapy with 5 FU (5 Fluorouracil) with an aim to estimate the disease free survival (DFS) and to analyze toxicity patterns. A total of 73 patients with stomach cancer undergoing gastric resection with a curative intent were evaluated. RESULTS: With a median follow up of 16 months, the estimated disease free survival is 31.6 months. Of the 73 patients, recurrences were observed in 33 patients and the most common site was liver metastasis. Except for 2 patients, out of which one expired because of 5 FU induced myocardial infarction and another expired because of neutropenic sepsis during the first cycle of chemotherapy, most of the patients tolerated the regimen well. CONCLUSION: 5 FU based adjuvant CT-RT can be safely given in the Indian population with acceptable survival rates.

Epidemiology of cancer in young in central India: An analysis of rural cancer hospital data.

BACKGROUND: Cancers in teenage and young adults (TYAs), though an increasing cause of mortality in our country, have been scarcely studied. The lack of studies of TYAs can significantly affect the outcomes of the youth in the prime of their lives. AIMS: The aim of this study was to study the type of cancers in the TYA at a rural cancer center in central India. DESIGN AND METHODS: A prospective study in the department of medical oncology, from the period of January 2013 till March 2016, was done. Data regarding socioepidemiological factors were collected for new cancer patients between the age group of 15-30 years in semi-structured questionnaire and from the hospital records. Cancers were classified according to the Birch classification. The cases were analyzed according to the epidemiological profile, classification of cancer, and age-wise distribution using descriptive analysis. RESULTS: In this study, out of 5221 cancer patients, TYAs accounted for 327 (6.26%) with 189 males and 138 females (M: F- 1.37:1). The maximum cases were seen in 25-30 years' age group. Carcinoma was the most common malignancy (54.74%) with an increase from 19.56% in the 15-19 years' age group to 64.82% in the 25-30-year-old patients. CONCLUSION: The present study gives a glimpse of the TYA cancers in the central India. More than half of the young cancer patients suffer from carcinomas with about half of these being head and neck cancers.