Introduction: Patients with lung cancer in Nepal often present at an advanced stage. The purpose of this study was to determine the access, diagnostic and treatment intervals in patients with lung cancer and to identify factors that may be causing the delays leading to advanced presentation. Methods: This was a descriptive, cross-sectional study conducted in the Department of Clinical Oncology, Bir Hospital from July 2023 to April 2024 after obtaining ethical approval from the Institutional Review Board. Patients with newly diagnosed lung cancer were interviewed and data was collected. Data were presented in the forms of percentages and mean/median. Univariate and multivariate logistic regression analysis was done to assess the association between various factors and different delays. Results: Of the 100 patients included, 56% were men and the mean age was 64.5 +/- 10.8 years. 64% of the patients had stage IV disease. The median access, diagnostic and treatment interval were 44.5 days, 45.5 days and 26 days, respectively. Access, diagnostic and treatment delays were seen in 72%, 63% and 42% of the patients, respectively. Receiving empirical anti-tubercular treatment and visiting informal healthcare providers as their first healthcare contact was associated with diagnostic delay whereas smoking was associated with treatment delay. Conclusion: There is a significant delay in the care-seeking pathway of lung cancer in Nepal. Implementing corrective measures to address these could help improve the outcomes for these patients.

Background: Asian patients with adenocarcinoma of lung have higher incidence of epidermal growth factor receptor mutations which predict increased response and survival in patients to oral tyrosine kinase inhibitors. This study was conducted to study the frequency of epidermal growth factor receptor mutation in patients in Nepal and compare the outcome in epidermal growth factor receptor mutated versus non-mutated patients receiving standard therapy. Methods: This is an observational study conducted among newly diagnosed patients with stage IV adenocarcinoma of lung in Bir Hospital from April 2017 to June 2018. Demographic and clinical data collection along with epidermal growth factor receptor mutation testing was done. Patients with epidermal growth factor receptor mutations received Gefitinib while non-mutated patients received systemic chemotherapy. Response evaluation, progression free survival at 1 year, objective response rate and quality of life were compared. Follow up period was for 1 year. Results: Eighty three (33%, n=253) patients were diagnosed with adenocarcinoma of the lung with mean age at diagnosis being 59.4 years. epidermal growth factor receptor mutations were found in 29% patients. Complete response was achieved in 9.1% vs 3.0 % (p=0.46), objective response rate was 27.3% versus 15.2% (p=0.23), progression free survival at 1 year was 39% vs 27%, (p = 0.29) and mean score of global health status was 68.1 versus 61.6 in epidermal growth factor receptor mutated versus non-mutated (p = 0.036). Conclusions: The frequency of epidermal growth factor receptor mutation in patients with adenocarcinoma of the lung was lower than in Eastern Asian studies, but higher than in western populations. epidermal growth factor receptor mutated patients had improved survival, better treatment response and quality of life in comparison with non-mutated. Keywords: Adenocarcinoma of lung; EGFR; quality of life

Introduction: Malnutrition is one of the most frequent disorders among cancer patients. It is seen in 50-90% of cancer patients. This high prevalence of malnutrition is very concerning as it is associated with reduced effective treatment, functional status, quality of life and survival. The aim of the study was to find out the prevalence of malnutrition among cancer patients in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among 95 cancer patients in the Department of Clinical Oncology of a tertiary care centre from 25 January 2022 to 25 July 2022. Ethical approval was obtained from the Institutional Review Committee (Reference number: 1192/2078/79). Convenience sampling was done. Patients were screened using Patient-Generated Subjective Global Assessment for malnutrition. Point estimate and 95% Confidence Interval were calculated. Results: Among 95 cancer patients, 22 (23.15%) (15.10-32.90, 95% Confidence Interval) were malnourished. Conclusions: The prevalence of malnutrition was found to be lower than in other studies done in similar settings. Nutritional assessment and support should be an integral part of care for gastrointestinal cancer.

PURPOSE Patients with GI cancers in Nepal often present with advanced disease and poor outcomes. The purpose of the study was to determine the time to presentation, diagnosis, and treatment of GI cancer and the baseline factors that may be associated with delays. PATIENTS AND METHODS An institutional review board–approved study was performed in Kathmandu, Nepal, from July 2018 to June 2019. Patients with newly diagnosed GI cancers were asked to fill out a standardized questionnaire. Baseline factors such as residence, literacy, and use of self-medication were recorded. Patients were asked to report the time from first symptom to presentation, time from primary care visit to pathologic diagnosis, and time from diagnosis to surgery and/or treatment. Baseline factors were analyzed using 2-tailed t tests (Prism 8.0; GraphPad, La Jolla, CA) to determine whether any factors were associated with longer time delays in these 3 intervals. RESULTS The cohort comprised of 104 patients with a median age of 53.5 years (range, 22-77 years); 61.5% were men, 46.2% had upper GI cancers, and 83.7% presented with stage III or IV disease. The median time to presentation was 150 days, time to diagnosis was 220 days, and time to treatment was 50 days. There was no statistically significant difference in time intervals between upper and lower GI cancers. Use of self-medication (88.5%) was the only factor associated with longer time intervals to presentation, diagnosis, and treatment. CONCLUSION Patients in Nepal have long time intervals to presentation, diagnosis, and treatment of GI cancer. Self-medication led to longer delays. Reasons for self-medication and other potential barriers will be explored in future studies in the hopes of improving outcomes.

Background: In recent years, the incidence of prostate cancer (PCa) is increasing. Advanced PCa has a poor prognosis and high cost, which seriously affects the quality of life of patients. Therefore, how to improve the diagnosis rate and prognosis of early PCa is the focus of clinical research. This paper aims to investigate the value of P504s, 34βE12, Ki-67 and prostate-specific antigen (PSA) in the diagnosis and prognosis of PCa. Objective: To investigate the expression of P504s, 34βE12, Ki67 and PSA in prostate tissues and their clinical significance. Methods: Twenty four cases in the study group were selected from PCa confirmed by pathology in the urology department of Chengde Affiliated Hospital from October 2018 to August 2020, and 33 cases of Benign Prostate Hyperplasia (BPH) confirmed by pathology in the same period were selected as the control group. The expression of P504s, 34βE12 and Ki-67 in prostate tissues were determined by immunohistochemistry. Results: The positive expression rates of P504s, 34βE12 and TPSA or F/TPSA in PCa patients were 95.8%, 12.5%and 87.5%, respectively. The positive rates in BPH patients were 9.1%, 93.9% and 27.3%, The difference between the two groups was statistically significant (p<0.05). PCa bone or lymph node metastasis was positively correlated with Ki-67 (r=0.423, p<0.05) and Gleason score (r=0.446, p<0.05), indicating a stronger correlation with Gleasonscore. Conclusion: The combined detection of P504s, 34βE12 and PSA is helpful for the diagnosis and differential diagnosis of PCa. High Gleason score and ki-67 expression may indicate high risk of PCa metastasis and poor prognosis.

Background Myelosuppression remains a major toxicity in cancer patients receiving chemotherapy, and is associated with considerable morbidity, mortality and cost. Objective The present study aims to investigate the prevalence and incidence of myelotoxicity, anemia and neutropenia in the adult cancer population, and further to determine the factors influencing them. Methods This was a cross-sectional observational study conducted at National Academy of Medical Sciences, Bir Hospital, Kathmandu. A total of 170 subjects eligible for the study were enrolled for analysis. Prevalence and incidence of myelotoxicity anemia, neutropenia and myelotoxicity at enrollment and during study were investigated. Factors influencing development of myelotoxic event were determined. Results Of 170 enrolled patients, the prevalence of myelotoxicity, anemia and neutropenia at enrolment was 54 (31.8%), 20 (11.8%) and 28 (16.6%), respectively, with 27 (16%) mild and 12 (7.1%) moderate type of anemia. Incidence of myelotoxicity, anemia and neutropenia during treatment was 90 (52.94%), 44 (26%) and 53 (31.2%) respectively, with 70 (41.2%) mild, 39 (22.9%) moderate and 5 (2.9%) severe type of anemia. Age (OR: 0.49; p < 0.047), and baseline Hb (OR: 1.29; p < 0.01) were found to be independent predictors associated with anemia. Hb (OR: 2.42, CI: 1.79-3.28; p < 0.001) and smoking (OR: 0.49: p = 0.03) were found to be independent factors associated myelotoxicity. Conclusion Our study confirmed a high incidence rate of myelotoxicity, neutropenia and anemia in a considerable number of Nepalese cancer patients receiving chemotherapy, and that baseline Hb, smoker and older adults are at more risk, these patients should be evaluated carefully and a prophylactic measure should be adopted accordingly so as to prevent toxicity and improve quality of life during cancer treatment.

e18042 Background: Nepal is a developing country with about 29 million populations. The incidence of cancer is 100-120 per 100 thousand populations and the number is increasing. The most common cancers in Nepal are of lung (13.2%), cervix (9.5%) and breast (8.6%). More than 80% of cancer patients present in advanced or metastatic stage where palliation can only be the goal of treatment. Radiotherapy is one of the essential treatment modalities for cancer, for both curative and palliative intent. This study aims to find the availability of radiotherapy machines throughout the country. Methods: Data regarding Radiotherapy machines in the country were collected by on site visit and by telephone conversations. Results: There are only seven centers having radiotherapy machines. Bir hospital was the first to start radiotherapy with telecobalt machine. At present there are 4 Tele-Cobalt machines, 5 Linear Accelerators and 5 High Dose Rate (HDR) Brachytherapy machines in the country. Most of the centers do only conventional 2-dimensional radiotherapy treatment. Newer centers which are non-government centers have high end linear accelerators with IMRT and IGRT facilities. HDR brachytherapy are used for intracavitory radiotherapy for endometrial and cervical cancers only. Conclusions: Nepal is far below the World Health Organization (WHO) recommendation of one megavoltage machine per million populations which means that Nepal should have at least 29 megavoltage machines. Combined efforts of public, government and international agencies are required to upgrade the situation.[Table: see text]

Multiple myeloma is less frequently diagnosed in our part of the world. As per the hospital based cancer registry of Nepal, it accounts for 0.4% of all cancer cases diagnosed annually1. Usually they present with symptoms of chronic renal failure which is part of CRAB: elevated calcium (C), renal failure (R), anemia (A) and bone lesions (B). The symptoms and signs vary greatly as many organs can be affected by myeloma. Furthermore, the incidence is high in older age group with co morbidities demanding the patient tailored treatment. Here, we present a case of multiple myeloma which was treated with single agent dexamethasone. On initial evaluation patient had stage III disease with features of cord compression, so was started with immediate radiation therapy to the cervical and lumbar vertebrae followed by single agent dexamethasone as he denied further cytotoxic treatment. The patient is on regular follow up and in remission after six years of treatment. We are in the era where there is armor of chemotherapeutic agents along with bone marrow transplantation for the treatment of multiple myeloma. This case may represent an example and single agent dexamethasone can be an option for the treatment of the patient who is in poor general condition to receive the cytotoxic chemotherapy or denies to such therapy but it should be a choice only to a selected subgroup of patient population.Journal of Kathmandu Medical College, Vol. 4(1) 2015, 26-28

To evaluate the accuracy of radiation dose delivered to the cancer patients by using HDR Brachytherapy and to know proposed methods for the initial source installation tests, acceptance testing and a quality assurance program are done on Nucletron MicroSelectron 192Ir HDR Brachytherapy Afterloader at NAMS, Bir Hospital. The observation of sweet spots (maximum dose distribution) by using well chamber (SI HDR 1000) and electrometer (SI CDX 2000). On the basis of the observed sweet spot, Air Kerma Strength of the source is determined. Beside this includes the conformation of step size, radioactivity of the nuclides and safety measures of the machine. A careful radiation survey has been undertaken around the brachytherapy by using well calibrated TBM-IC Mark V is a small ion chamber radiation monitor. Acceptance testing and commissioning of the HDR brachytherapy unit has been completed. Air Kerma strength in newly installed source exhibit small variation but within the limit. The step size has standard deviation 0.05 with the planned step size. The measurement of radiation level around brachytherapy shows the level is within the criteria. Nucletron MicroSelectron 192Ir HDR brachytherapy system has been implemented in our unit. The acceptance test shows that status of brachytherapy and its components are functioning well. Radiation dose which will be delivered to the cancer patients are within planned dose.Scientific World, Vol. 12, No. 12, September 2014, page 85-88