Objectives: Laparoscopic pelvic lymph node dissection (LPLND) is an integral part of surgical staging and treatment of gynecologic malignancies. Although the laparoscopic approach has reduced postoperative morbidity compared to open surgery, lymphatic complications such as lymphorrhea, lymphocele, and lower limb lymphedema continue to occur. This study aimed to determine the incidence, pattern, and clinical outcome of lymphatic complications following LPLND in gynecological malignancies. Material and Methods: A prospective observational study was conducted, including 68 patients with carcinoma of the endometrium or cervix who underwent LPLND between January 2023 and April 2024 in a tertiary care oncology center. Results: Of 68 patients, 41 (60.3%) had carcinoma of the cervix and 27 (39.7%) had carcinoma of the endometrium. Lymphatic complications occurred in 7 patients (10.3%). Among them, 5 (7.3%) developed lower limb lymphedema, 4 (5.8%) developed lymphocele (with one symptomatic case requiring aspiration), and 1 (1.4%) experienced transient lymphorrhea. Six out of seven (85.7%) affected patients had received radiotherapy. The mean number of lymph nodes retrieved in the complication group was 11. The average time to presentation of lymphocele was 5 months. Conclusion: Lymphatic complications following LPLND are infrequent and mostly subclinical, and radiotherapy increases susceptibility. Regular postoperative imaging follow-up enables early detection and conservative management. Laparoscopic PLND remains a safe and effective approach with minimal lymphatic morbidity.
Objectives: Immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 axis have changed the management of metastatic renal cell carcinoma (mRCC). Most pivotal trials come from high-income settings and include highly selected patients. Prospective real-world data from low- and middle- income countries (LMICs), especially from public hospitals in India, are scarce. Material and Methods: This was a single-center, prospective, observational study of adults with histologically confirmed mRCC treated with PD-1/ PD-L1-based regimens at a government cancer center. Eligible patients were ≥18 years, had measurable metastatic disease, and Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0–3. Treatment with nivolumab or pembrolizumab, with or without vascular endothelial growth factor receptor (VEGFR) tyrosine kinase inhibitors (TKIs), and line of therapy were chosen by the treating oncologist. Radiological response was assessed every 3 months using Response Evaluation Criteria in Solid Tumors (RECIST) 1.1; toxicities were graded using Common Terminology Criteria for Adverse Events (CTCAE) v5.0, with a focus on immune-related adverse events (irAEs). The primary endpoint was objective response rate (ORR) at 3 months; secondary endpoints included toxicity profile and descriptive 12-month outcomes. Results: Thirty-one patients were enrolled. Most had clear-cell histology and intermediate- or poor-risk disease by IMDC criteria. ECOG PS was 0–1 in 19 patients (61%), 2 in 8 (26%), and 3 in 4 (13%). Nineteen patients (61.3%) received PD-1-based therapy as first line, 10 (32.3%) as second line, and 2 (6.5%) as third line. Nivolumab was used in 27 patients (87.1%), mostly as monotherapy; 4 patients (12.9%) received pembrolizumab, including 3 in combination with TKIs (cabozantinib, lenvatinib, or axitinib). At 3 months, 2 patients achieved complete response (CR) and 14 partial responses (PR), yielding an ORR of 51.6%. Only 1 patient had definite progressive disease (PD) at first assessment; the remainder had stable disease or were not fully evaluable. The most common were asthenia (19.4%) and fatigue (12.9%). Immune-related adverse events (AEs) included subclinical hypothyroidism (12.9%), colitis (12.9%), and pneumonitis (9.7%). Treatment discontinuation due to toxicity occurred in 2 patients (severe colitis and pneumonitis). No treatment-related deaths were recorded. Conclusion: In this prospective real-world cohort from an Indian government cancer center—enriched for intermediate- and poor-risk disease and ECOG PS ≥2—PD-1/PD-L1-based therapy produced ORR comparable to pivotal trials, with a manageable toxicity profile. These findings support the feasibility of ICIs in the public-sector LMIC setting and highlight the need for larger multicenter registries to refine patient selection, toxicity management, and access strategies.
Pharmacological therapy is central to symptom control in palliative medicine; however, polypharmacy, altered physiology, and multi-system disease place patients at high risk of drug toxicity and accidental overdose. Adverse drug effects are frequently under-recognized and may be misinterpreted as disease progression, leading to morbidity and compromised quality of life. This narrative review aims to synthesize existing evidence on toxicity and overdose associated with commonly used palliative medications, with particular emphasis on opioids, paracetamol, tricyclic antidepressants, and psychotropic drugs. The review also explores mechanisms of toxicity, clinical manifestations, management strategies, and ethical considerations relevant to palliative practice. A narrative review was conducted using PubMed, Scopus, Embase, Google Scholar, and the Cochrane Library for English-language publications from 2000 to 2024. Clinical studies, reviews, guidelines, and pharmacological literature addressing drug toxicity, overdose, and management in palliative populations were included. Data were synthesized thematically with a focus on clinical relevance rather than quantitative comparison. Opioid toxicity is commonly presented with sedation, delirium, respiratory depression, and neurotoxicity, particularly in the presence of renal impairment or drug interactions. Paracetamol toxicity, often due to repeated supratherapeutic dosing, may progress to acute liver failure, especially in malnourished or cachectic patients. Tricyclic antidepressants are associated with life-threatening cardiotoxicity, including QRS prolongation and malignant arrhythmias. Several drugs frequently used in palliative care—such as methadone, antipsychotics, antidepressants, and antiemetics— contribute to QT prolongation and risk of torsades de pointes. Management relies on early recognition, supportive care, rational description, and judicious use of antidotes. Drug toxicity in palliative medicine is not predictable. Clinicians must balance symptom relief with patient safety while respecting goals of care and ethical principles. A structured, patient-centered approach to prescribing and toxicity management is essential to preserve comfort, dignity, and quality of life at the end of life.
Objectives: Leukemia is the most common form of cancer affecting children worldwide, with acute lymphoblastic leukemia (ALL) representing the most prevalent subtype. Fatigue is one of the most frequently reported and distressing symptoms experienced by children undergoing cancer treatment. Despite its high prevalence, fatigue is often under-recognized and inadequately managed in clinical practice. Non-pharmacological interventions such as progressive muscle relaxation technique (PMRT) and guided imagery (GI) have emerged as promising approaches to manage cancer-related fatigue. The objective of this study was to evaluate the effectiveness of the PMRT and GI in reducing fatigue levels among children diagnosed with ALL. Material and Methods: A quantitative evaluative research design was adopted for the study. The sample consisted of 28 children aged 10–18 years undergoing treatment for ALL. Participants were divided into two groups: the PMRT group and the GI group, with 14 participants in each group. Fatigue levels were assessed using the Childhood Fatigue Scale (CFS) before and after the intervention. Both interventions were administered for 30 minutes daily for six consecutive days. Data were analyzed using descriptive and inferential statistics, including the Wilcoxon Signed-Rank Test. Results: The results indicated that both PMRT and GI significantly reduced fatigue levels among children with ALL ( p < 0.001). However, the reduction appears greater in the GI group descriptively. Conclusion: Both PMRT and GI were effective in reducing fatigue among children with ALL. These techniques are simple, cost-effective, and noninvasive, making them suitable supportive care interventions that can be integrated into routine pediatric oncology nursing practice.
Cancer remains a leading cause of mortality worldwide, with a significant proportion of patients presenting in advanced or terminal stages where the focus of care shifts from curative intent to palliative and supportive measures. Home-based care has emerged as a preferred approach for many terminal cancer patients, offering comfort, familiarity, and the potential for improved quality of life. However, home care practices remain heterogeneous, often unstructured, and heavily dependent on caregiver capacity. This narrative review examines current evidence on home care practices for terminal cancer patients, with particular emphasis on symptom management, psychological and emotional support, caregiver involvement, and logistical coordination of care. Available literature highlights the central role of effective pain and symptom control, the need for integrated psychosocial support, and the significant burden borne by informal caregivers. Challenges such as limited access to trained personnel, inadequate caregiver training, and fragmented care delivery models continue to hinder optimal implementation. The review underscores the importance of developing structured, multidisciplinary home care models supported by telemedicine, caregiver training programs, and expanded palliative care services. Strengthening these components may improve quality of life and ensure more compassionate, patient-centered care during the end-of-life phase.
