PSYCHOLOGICAL AND MENTAL HEALTH BURDEN ON HEALTH CARE PROVIDERS IN A CANCER CENTRE DURING COVID-19 PANDEMIC OUTBREAK IN INDIA

Background: The outbreak of novel coronavirus (COVID-19) is severely affecting the public health and posing a challenge to health care providers, especially working as front-line medical staff. This study was aimed to understand the psychological impact and mental burden of the present outbreak on Indian health care providers who are working at cancer care centre. Subjects and methods: A self-reporting online questionnaire was given to the multidisciplinary staff (n=344) and their mental health was assessed using various scales via GAD-7 scale for anxiety, PHQ-9 scale for depression, ISI for insomnia, K-10 for distress, and STAI for stress along with five self-made Pandemic specific questions. Results: Response rate was 91% (n=344) among 190 (55%) were male and 154 (45%) were female. The frontline and secondline workers were 178 (52%) and 166 (48%), respectively. Symptoms of anxiety, depression, insomnia and distress was observed in 62 (18%), 75 (22%), 42 (12%), and 60 (17%) of the participants, respectively. They were predominantly influenced by variables such as gender (female), education (≥graduation), co-morbidities, and level of work (frontline). Followed by other less dominant variables such as contact with patients (frequent), and working in hospital (<3 years), respectively. Conclusion: A mild to moderate level of psychological burden was observed in the health care providers. Overall, there is a need to address the mental health issues by providing, timely training, counselling, rotation in shifts, lowering workload and intensify the awareness programmes of the staff during this COVID-19 pandemic for better outcomes and promoting resilience in the staff

Free-flap reconstitutions of head and neck defects after oncologic ablation

Background: Head and neck cancers are the sixth most common cancers worldwide. The primary treatment modality for most head and neck cancers is surgery with reconstruction of resultant defects. Reconstruction of these defects is a unique challenge as it has to not only restore integrity but also function and often cosmesis. The objective of this study was to assess the utility of free flaps in the reconstruction of these defects, done in a tertiary care centre in a three-tier city in India. Methodology: We analyzed the computerized medical records of the last 3 years in this retrospective study carried out in the department of head and neck oncology at the cancer centre. The study included cases that had undergone surgery for head and neck cancer and underwent free flap reconstruction. Results: Out of the 1061 cases requiring reconstruction after an oncologic ablation, 201 cases underwent free flap reconstruction. For defects requiring Facio cutaneous reconstruction, the radial forearm was the preferred donor free flap site, while the fibula was the preferred donor site for mandibular reconstructions survival rate was 94.5%, with factors like age and comorbidities like diabetes and hypertension or habits like cigarette smoking or tobacco chewing not affecting survival rates. Twenty cases of minor flap complications were observed. Conclusions: Free flap reconstructions for head and neck defects after oncologic ablation have been a boon with good survival rates and immense flexibility of use, giving good cosmetic and functional outcomes. Our study shows that a significant number of free flap reconstructions can be done in a tertiary care centre in a three-tier city in India with an internationally comparable survival rate

Free-flap reconstitutions of head and neck defects after oncologic ablation

Background: Head and neck cancers are the sixth most common cancers worldwide. The primary treatment modality for most head and neck cancers is surgery with reconstruction of resultant defects. Reconstruction of these defects is a unique challenge as it has to not only restore integrity but also function and often cosmesis. The objective of this study was to assess the utility of free flaps in the reconstruction of these defects, done in a tertiary care centre in a three-tier city in India. Methodology: We analyzed the computerized medical records of the last 3 years in this retrospective study carried out in the department of head and neck oncology at the cancer centre. The study included cases that had undergone surgery for head and neck cancer and underwent free flap reconstruction. Results: Out of the 1061 cases requiring reconstruction after an oncologic ablation, 201 cases underwent free flap reconstruction. For defects requiring Facio cutaneous reconstruction, the radial forearm was the preferred donor free flap site, while the fibula was the preferred donor site for mandibular reconstructions survival rate was 94.5%, with factors like age and comorbidities like diabetes and hypertension or habits like cigarette smoking or tobacco chewing not affecting survival rates. Twenty cases of minor flap complications were observed. Conclusions: Free flap reconstructions for head and neck defects after oncologic ablation have been a boon with good survival rates and immense flexibility of use, giving good cosmetic and functional outcomes. Our study shows that a significant number of free flap reconstructions can be done in a tertiary care centre in a three-tier city in India with an internationally comparable survival rate

Cervical Chondrosarcoma: A critical review with an illustration of a rare technically challenging case

Chondrosarcoma of the cervical spine is an extremely rare tumour. The indolent course and neglected behaviour of the patient often give enough time for tumour expansion. The surgical management of these types of tumours is challenging. En bloc resection is a proven ideal treatment but it is not always feasible in this region because of the proximity to vital neurovascular structures which explains the recurrence and poor prognosis of this tumour. The role of radiation and chemotherapy in these tumours is limited. We are highlighting unique huge cervical chondrosarcoma which is not mentioned in literature and its management along with a review of 34 cases, published so far

Randomized, double-blind, placebo-controlled phase II study of AMG 386 combined with weekly paclitaxel in patients with recurrent ovarian cancer

PurposeTo estimate the efficacy and toxicity of AMG 386, an investigational peptide-Fc fusion protein that neutralizes the interaction between the Tie2 receptor and angiopoietin-1/2, plus weekly paclitaxel in patients with recurrent ovarian cancer.Patients and methodsPatients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer were randomly assigned 1:1:1 to receive paclitaxel (80 mg/m(2) once weekly [QW], 3 weeks on/1 week off) plus intravenous AMG 386 10 mg/kg QW (arm A), AMG 386 3 mg/kg QW (arm B), or placebo QW (arm C). The primary end point was progression-free survival (PFS). Secondary end points included overall survival, objective response, CA-125 response, safety, and pharmacokinetics.ResultsOne hundred sixty-one patients were randomly assigned. Median PFS was 7.2 months (95% CI, 5.3 to 8.1 months) in arm A, 5.7 months (95% CI, 4.6 to 8.0 months) in arm B, and 4.6 months (95% CI, 1.9 to 6.7 months) in arm C. The hazard ratio for arms A and B combined versus arm C was 0.76 (95% CI, 0.52 to 1.12; P = .165). Further analyses suggested an exploratory dose-response effect for PFS across arms (Tarone's test, P = .037). Objective response rates for arms A, B, and C were 37%, 19%, and 27%, respectively. The incidence of grade ≥ 3 adverse events (AEs) in arms A, B, and C was 65%, 55%, and 64%, respectively. Frequent AEs included hypertension (8%, 6%, and 5% in arms A, B, and C, respectively), peripheral edema (71%, 51%, and 22% in arms A, B, and C, respectively), and hypokalemia (21%, 15%, and 5% in arms A, B, and C, respectively). AMG 386 exhibited linear pharmacokinetic properties at the tested doses.ConclusionAMG 386 combined with weekly paclitaxel was tolerable, with a manageable and distinct toxicity profile. The data suggest evidence of antitumor activity and a dose-response effect, warranting further studies in ovarian cancer.Beth Y. Karlan, Amit M. Oza, Gary E. Richardson, Diane M. Provencher, Vincent L. Hansen, Martin Buck, Setsuko K. Chambers, Prafull Ghatage, Charles H. Pippitt Jr, John V. Brown III, Allan Covens, Raj V. Nagarkar, Margaret Davy, Charles A. Leath III, Hoa Nguyen, Daniel E. Stepan, David M. Weinreich, Marjan Tassoudji, Yu-Nien Sun and Ignace B. Vergot