Comparison of stressful life events among family caregivers of cancer, mental retardation and schizophrenia patients leading to stress, anxiety and depression and its effect on quality of life

Background: Mental retardation (MR), schizophrenia and cancer are chronic disorders, requiring long term treatment along with family support. Principal caregiver is usually nonprofessional family person who play a pivotal role in supporting the patient medically, emotionally and financially which in turn affects their own health and quality of life. To identify stressful life events, level of anxiety, stress, depression and Quality of life in these family caregivers (FC), this study was planned.Methods: After gaining consent, the FC were assessed on Presumptive Stressful Life Events Scale (PSLE), Depression Anxiety Stress Scale (DASS) and WHO Quality of Life -Bref Scale (WHOQOL-Bref). Data so gained was analyzed by SPSS-21 and results were drawn.Results: 66 FC of cancer patients, 39 FC of MR patients and 53 FC of Schizophrenia patients were assessed. All three groups were found to be matched socio-demographically. On PSLE Mean of total stressful life events for cancer FC was 7±1.5, for MR 6.02±1.5 and for schizophrenia FC was 5.75±1.70 and this difference was statistically significant. Mean of total undesirable life events was 5.31±1.3, 4.33±1.34 and 3.86±1.46 respectively and this difference was also statistically significant. Similarly difference in mean stress score of total life events and for undesirable events was also statistically significant. On DASS scale no statistically significant difference was found within the groups. Quality of life was significantly low depicting high impact on physical health and social life of these care givers.Conclusions: Family Caregivers of cancer, mental retardation and schizophrenia groups are highly affected and there is urgent need to address these issues for early diagnosis and treatment

Survival of Trial-Like and Non–Trial-Like Patients With Immunotherapy in Advanced Hepatocellular Carcinoma in Real World: A Collaborative Multicenter Indian Study (IMHEP)

PURPOSEImmune checkpoint inhibitors (ICIs) is the initial line of management in advanced hepatocellular carcinoma (HCC), but survivals in the real world are not known.MATERIALS AND METHODSA retrospective study of patients with advanced HCC receiving ICIs (as first-line therapy or as later lines of therapy) across 11 Indian institutions was conducted. Patients were divided into either cohort 1 (trial-like receiving ICI as first-line therapy), with a Child Pugh score (CTP) of ≤6, an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0/1, and no VP4 (main portal vein thrombosis [MPVT]) or cohort 2 (trial unlike) who did not satisfy at least one of the above criteria. The primary end point was 12-month overall survival (OS).RESULTSBetween January 2017 and January 2022, 133 patient data were analyzed. The presence of MPVT was seen in 33 patients (25%). The ICIs used were atezolizumab-bevacizumab, nivolumab, and pembrolizumab in 89 (66%), 44 (33%), and one (1%) patients, respectively. With a median follow-up of 13.8 months, the 12-month OS for the entire cohort was 33.4% (95% CI, 23.6 to 43.2). Patients in cohort 1 (n = 31) had a significantly improved OS compared with patients in cohort 2 (n = 102; 12-month OS, 57.9% [95% CI, 38.5 to 77.3] v 24% [95% CI, 13.4 to 34.6]; P = .005). Patients with CTP A as compared with CTP B (9.7 v 4.3 months; P < .001) and an ECOG PS of 0/1 as compared with a PS of ≥2 (8.7 v 7.2 months; P = .04) and without MPVT (9.4 v 4.0; P < .001) had superior survivals.CONCLUSIONPatients with advanced HCC in the real world, trial-like have survivals in consonance with trial data, whereas patients with features excluding them from trials, such as main portal vein thrombosis, poor ECOG PS, and child Pugh B status, have markedly inferior survivals, despite good tolerance to immunotherapy