Background:Non-communicable diseases (NCDs) are the fastest-growing global health burden, and air pollution is a major threat to human health. Growing evidence suggests that air pollution especially PM2.5 is associated with diabetes mellitus and hypertension, which are currently major public health concerns. There has not yet been any study on the association between air pollution and NCDs at a national level in India. We used the National NCD Monitoring Survey (NNMS) surveyed diabetes and hypertension data (2017-2018) of 9,759 individuals in India and superimposed it on a 20-year average concentration of PM2.5 in ambient air, measured by satellite-based imagery (2000-2019), to find the association of PM2.5 with diabetes and hypertension. Methods:Spatial and geostatistical methods were employed to assess the association and examine the distribution of PM2.5, diabetes, and hypertension rates across geographic regions in India. Results:We observed a weak positive correlation between hypertension and PM2.5 levels, whereas diabetes showed both positive and negative correlations across geographic spaces, albeit with low strength. We did not find any statistically significant results that explain an association, suggesting a lack of association between the two. Conclusions:Since we did not find any significant result of the association, which may be evidence of not having any direct association, conducting prospective cohort studies may help find if there is any association at all.

ABSTRACT The rising burden of noncommunicable diseases (NCDs) in India requires a holistic approach to disease control efforts. This review synthesizes evidence from articles, government reports, policy briefs, and guidelines to describe lessons learnt, challenges in surveillance, and propose a comprehensive framework for surveillance. Nationwide surveys have been periodic, expensive, time-consuming exercises generating evidence on four main risk factors (unhealthy diet, inadequate physical activity, and alcohol and tobacco use) and on major NCDs (cancer, cardiovascular diseases, diabetes, and chronic respiratory diseases). Although the country has demonstrated capacity in conducting surveys, registries, and risk factor assessments, there has been no cohesive linking of such information to action and evaluation to complete the surveillance cycle. Many of the surveys do not reflect state or district-level patterns that can enable better health planning. India lacks a systematic ongoing NCD surveillance system, even though there is a huge demand for it in the context of the rising NCD burden. The challenge is that no single model of surveillance can assess the interconnected risk factors, their social, commercial, and health system drivers, and NCD morbidity and mortality. A well-defined policy for institutionalizing NCD surveillance with well-defined objectives, standard methods, definitions, risk factors, health conditions, and health system response is the need of the hour. An exposome framework of endogenous and exogenous lifetime exposures and health effects monitoring can be instituted through a combination of active and passive models, digital data, a whole-of-society and whole-of-government approach. These shall support NCD surveillance and guide NCD prevention and control efforts.

Background: Cervical cancer remains a leading cause of cancer mortality in low- and middle-income countries, where access to comprehensive radiotherapy is limited. Although brachytherapy is a key component of definitive chemoradiation for locally advanced cervical cancer, omission remains common in resource-constrained settings We aimed to quantify the survival benefit obtained from integration of brachytherapy to EBRT using hospital-based registry data from India. Methods: This multicentre observational study used data from the Patterns of Care and Survival Study under India’s National Cancer Registry Programme. Women aged 15 years or older with stage I–IVA cervical cancer diagnosed between January 1, 2009, and December 31, 2020, with follow-up until April 30, 2024, were included. The primary endpoint compared was overall survival, and the secondary endpoint was recurrence-free survival. Propensity scores were estimated using multivariable logistic regression, followed by 1:1 nearest-neighbour matching with replacement. Weighted Kaplan–Meier and Cox proportional hazards models with robust variance estimation were used. Findings: Among 49,798 registered female cases, 22,922 were included in the final propensity score–matched cohort. EBRT plus brachytherapy was associated with significantly improved overall survival compared with EBRT alone (HR 0·78, 95% CI 0·70–0·87; p<0·0001). Five-year overall survival was 74·4% with EBRT plus brachytherapy versus 69·8% with EBRT alone. Advanced stage disease, pelvic and para-aortic nodal involvement, adenocarcinoma histology, higher tumour grade, and radiotherapy duration longer than 56 days were independently associated with poorer survival, whereas chemotherapy improved survival. Radiotherapy type was not independently associated with recurrence-free survival after adjustment. Interpretation: Brachytherapy remains an essential component of definitive radiotherapy for cervical cancer, and omission is associated with inferior survival. Expanding timely and equitable access to brachytherapy-based chemoradiation in carcinoma cervix, which remains a global health concern, should remain a priority in resource-constrained settings.

Background: Multidisciplinary tumour board (MTB) plays an important role in cancer care by collaborating specialist from various disciplines to discuss diagnosis, treatment plan and patient management. Despite its importance, a systematic evaluations of tumour board in hospital registered under hospital-based cancer registries (HBCRs) is limited. This study aims to assess the characteristics, composition and functioning of tumour board in these hospital to identify gaps and challenges to improve the tumour board operations. Methods: The study was conducted from October 1st to 31st 2024 using cross sectional design among hospital under HBCR. Aset of structured questionnaires was administered using Google Form, which consists of both qualitative and quantitative questionnaires. Descriptive statistics and chi-square test were used to analyze the quantitative data, while manual thematic analysis was carried out to analyze the qualitative responses. Result: Of 229 hospitals, only 172 (75%) responded. Among them, 137 (79.7%) reported having a functional tumour board. Most of the tumour boards were established in tertiary care centres (45.3%) and medical colleges (43.6%). In-person meeting (73.7%) was the most common with 24.8% following a hybrid model. Only 5.1% of hospitals engaged in cross-hospital case discussions; 16.8% maintained electronic medical record notes; and 48.2% lacked any follow-up mechanisms to track tumour board recommendations and outcomes. Involvement of palliative care specialists and other supportive paramedical health professionals was low. In addition to that, thematic analysis also identified that there was inadequate documentation, inconsistent follow-up and limited tumour board participation. Conclusion: Although MTBs are established widely in most of the HBCR-affiliated hospitals, variation exist in structure, composition and functionality. Strengthening MTBs through standardised protocol, participation of diverse specialities, increased cross-hospital collaboration, virtual tumour boards and proper documentation practices through electronic data recording systems could enhance the decision making and cancer care outcomes.

ABSTRACT Introduction Although accurate information on cancer stage at diagnosis is critical for surveillance, cancer registries in low‐ and middle‐income countries (LMICs) report incomplete stage data. The use of multiple stage classification systems—UICC/AJCC‐TNM‐system, SEER‐Summary‐Stage (SSS), Essential‐TNM (ETNM), and Condensed‐TNM (CTNM) complicates their utility and interoperability. The lack of a unified framework for translating between their categories limits data harmonization for global epidemiological analyses. Materials and Methods This study introduces a mapping framework for translating these four staging systems for common screening‐amenable cancers (breast, cervical, colorectal, and oral). Using the TNM criteria as reference, all categories were systematically compared and mapped to corresponding categories in SSS, ETNM, and CTNM. The fields were color‐coded to visualize prognostic gradients across classifications. This mapping was then validated using a registry‐wide representative sample of 4,000 cancer cases with an assigned TNM stage. Matches were categorized as either being complete or as first‐ or second‐degree mismatches to assess the extent of concordance and discordance. Results Our analysis highlighted cancer‐specific variations in prognostic gradation and concordance. Cervical and colorectal cancers had a steady gradient, representing the best‐case scenarios, while breast and oral cancers showed greater discordance. Overall, SSS aligned with TNM categories, depicting maximal one‐to‐one associations. While ETNM is more concordant for colorectal cancer (100% match vs. 89%), SSS is most concordant for cervical cancer (80%), and to a lesser extent, breast cancer (77%). CTNM offers the least concordance with traditional TNM across cancer sites. Localized and metastatic stages aligned almost universally, except in oral cancer. Conclusion This mapping exercise provided a comprehensive framework for translating cancer stage categories, offering LMIC registries a way to balance clinical relevance, epidemiological utility, and operational feasibility. Concordance among the systems varied by cancer type, underscoring the need for cancer‐specific adaptations.

Cancer is a significant public health challenge in India, contributing to 8.3% of deaths and 5.0% of DALYs in 2016—nearly double its burden in 1990. Fragmented service delivery, limited specialist availability, late presentation, and significant financial hardship continue to hinder access to timely and effective cancer care, particularly in rural and underserved regions. National initiatives such as the NP-NCD and Ayushman Bharat have expanded diagnostic and treatment coverage; however, critical gaps remain in infrastructure, human resources, and quality of care. A comprehensive, system-level assessment is essential to inform evidence-based planning and strengthen cancer services nationwide. This study aims to evaluate the availability, readiness, and geographic distribution of cancer care services in India and to identify disparities across rural–urban settings and healthcare sectors. A secondary objective is to develop a framework to strengthen cancer service delivery across the continuum of care. A cross-sectional, descriptive study will be conducted across 32 States/UTs over three years. Using proportionate sampling, districts will be selected based on rural and urban population distribution. Nodal hospitals—preferably those hosting Hospital-Based Cancer Registries—will coordinate data collection from primary, secondary, and tertiary cancer care facilities. A structured electronic pro forma will capture data across six quality-of-care domains: equitable, effective, patient-centred, safe, efficient, and timely. Data will be entered through an online portal and monitored centrally. Descriptive statistics will summarise service availability, while Chi-square tests will assess differences across facility types, sectors, and geographic strata. Ethical approval was obtained from the ICMR-NCDIR Institutional Ethics Committee (NCDIR/IEC/3058/2022); no individual patient data will be collected, all responses will be anonymised, and participation will be voluntary This situational analysis will generate critical evidence on India’s cancer care landscape, highlighting disparities and system gaps. Findings will support policymakers and programme managers in strengthening infrastructure, workforce deployment, and service delivery to advance equitable and comprehensive cancer care nationwide.

Background: Contemporary population-based evidence on stroke incidence, subtype-specific burden, temporal trends, and short-term fatality remains limited in India. We aimed to quantify the incidence of ischemic, haemorrhagic, and undetermined stroke, describe geographical and temporal variation, and compare 28-day case fatality across stroke subtypes. Methods: We analysed data from five population-based stroke registries spanning diverse geographic regions across India. First-ever strokes among adults aged 18 years or older between 2018 and 2024 were identified through standardized, multiple-source population-based surveillance. Crude and age-standardized incidence rates (ASIRs) were estimated using the Indian (ISP) and World Standard Populations (WSP). Temporal trends were assessed using Joinpoint regression and expressed as annual percentage change (APC). Twenty-eight-day case fatality rates (CFRs) were estimated overall and by stroke subtype. Findings: Among 53,371 First-ever stroke cases, 37,293 (69.9%) were ischemic (IS), 11,787 (22.1%) haemorrhagic (HS), and 4,291 (8.0%) undetermined (UD). The pooled ASIR was 137.6 per 100,000 population (95% CI 136.5–138.8) using the ISP and 167.9 (166.4–169.3) using the WSP. Incidence varied substantially across registries, from 90.6 to 188.1 per 100,000 population. HS incidence increased significantly over time (APC 6.04%, 95% CI 0.92–11.41), whereas trends for all stroke and IS were not significant. Overall 28-day CFR was 17.0%, compared with 11.1% for IS, 30.8% for HS, and 48.1% for UD.Interpretation: Stroke incidence in India remains substantial and geographically heterogeneous. The increasing incidence and high case fatality of HS underscore the need to strengthen hypertension and tobacco control, improve timely access to stroke care, and expand standardized population-based surveillance.

Background and objectives Cerebral venous thrombosis (CVT) is an uncommon cause of stroke, with limited multicentre data from India. This study describes the clinical profile, risk factors, management, and outcomes of CVT from ICMR-NINE Hospital-Based Stroke Registry Programme. Methods A cross-sectional analysis of CVT cases reported from 30 hospitals across India (January 2020-December 2022) was conducted. Sociodemographic, clinical, imaging, treatment, and outcome data were analysed. Functional outcome was assessed using the modified Rankin Scale (mRS). Multivariable logistic regression identified predictors of 3-month mortality. Results Among 34,792 registered stroke cases, 575 (1.6%) had CVT. Mean age was 37.5 years, with 72.4% (n= 416) aged 18-44 years, and 60% (n=345) were male. Headache (n=468, 81.4%), motor impairment (n=285, 49.6%), and seizures (n=259 ,45%) were the common presentations. Haemorrhagic infarction (n=177, 30.8%) was the predominant parenchymal imaging finding, with multiple sinus involvement in 62.4% (n=339). Anaemia (n=186, 32.6%), alcohol use (n=174, 30.9%), and hyperhomocysteinemia (n=152, 26.6%) were the leading risk factors. At 3 months, 74.8% (n=430) achieved good outcomes (mRS 0-2), (n=60) 10.4% remained with some disability, and 9.2% (n=53) died. Mortality was independently associated with age ≥45 years [Odds ration (OR) 12.11 to 18.32 depending on age group], impaired consciousness [OR =2.41, 95% confidence interval (CI): 1.03-5.67; P=0.044], dysphagia at onset (OR =3.36, 95% CI: 1.48-7.65, P=0.004), and delayed arrival at hospital between 12-24 h after symptom onset (OR =4.25, 95% CI: 1.08-16.74, P=0.038). Interpretation and conclusions In India, CVT-related stroke predominantly affects young males. Anaemia, alcohol use, and hyperhomocysteinemia are the major risk factors. Older age, delayed hospital presentation between 12-24 h, impaired consciousness, and dysphagia at onset, predict higher mortality.

Background:Breast cancer is the most common cancer among women in India, and a substantial proportion present with metastatic disease, which worsens prognosis. Evidence on socio-demographic, clinical, and health system determinants of metastasis remains limited. We aimed to identify factors associated with metastatic breast cancer using hospital-based cancer registry data. Methods:This multicentre observational study included 76,356 women older than or equal to 15 years diagnosed with primary breast cancer between 2009 and 2020. The primary outcome was metastasis at diagnosis. Multivariable Poisson regression estimated incidence risk ratios (IRRs) for metastasis risk with 95% confidence intervals, and random forest models assessed variable importance. Findings:Among 76,356 women, metastasis occurred in 12.96%, with bone as the most frequent metastatic site (2487 [25.1%]). Metastasis risk was higher for diagnoses occurred during 2015-2020 compared with 2009-2014 (IRR 1.15, 95% CI 1.04-1.28). Lower incidence of metastasis was observed in private (IRR 0.50, CI 0.38-0.65) and NGO hospitals (IRR 0.32, CI 0.20-0.51) compared with government hospitals. Larger tumour size (5 to <10 cm: IRR 2.92, CI 1.76-4.83; 10-20 cm: IRR 3.72, CI 2.21-6.27) and grade 2 tumours (IRR 1.62, CI 1.01-2.59) were associated with increased risk. Random forest analysis identified supraclavicular node involvement, tumour size, skin involvement, lympho-vascular invasion, and receptor status as key predictors. Interpretation:Metastatic breast cancer in India is strongly associated with indicators of tumour burden and disease progression. Strengthening early detection, improving diagnostic completeness, and ensuring equitable access to specialised cancer care may help reduce metastatic disease burden. Funding:Intramural grant of the ICMR-NCDIR, India.

BACKGROUND:India is facing a growing burden of stroke due to population aging, lifestyle changes, and increased exposure to risk factors. However, longitudinal data on stroke patterns and outcomes in India are limited. OBJECTIVES:This study assessed stroke patterns, risk factors, management practices, and outcomes using data from the Hospital-Based Stroke Registries (HBSRs) in India. METHODS:This prospective hospital-based registry included 34,792 stroke cases from 30 centers across India, recorded between 2020 and 2022. Data on demographics, clinical features, risk factors, diagnostics, treatments, and outcomes were collected, with follow-up at 28 days and 3 months. Functional outcome was assessed using the modified Rankin Scale (mRS), along with data on recurrence. RESULTS:The mean age was 59.4 years; 13.8% were aged under 45, 63.4% were male, and 72.1% were from rural areas. Hypertension (74.5%) was the most common risk factor, followed by smokeless tobacco use (28.5%) and diabetes mellitus (27.3%). Ischemic stroke accounted for 60% of cases. Only 20.1% were presented within 4.5 h of symptom onset, while 37.8% of cases presented after 24 h. Motor impairment (74.8%) followed by speech disturbance (51.2%) were the commonest symptoms at onset. Thrombolysis was given in 4.6%, and thrombectomy in 0.7%, of ischemic strokes. At 3 months, 27.8% had died, 29.7% had significant disability (mRS 3-5), and 1.1% had a recurrent stroke. CONCLUSION:In this study, one in 7 stroke were in the young, 2 in 5 patients arrived after 24 h of symptom onset, and thrombolysis and mechanical thrombectomy were underutilized. Over half had poor 3-month outcomes, highlighting the need for improving comprehensive stroke care across India.

To analyse the clinicopathological characteristics of prostate cancer using data from Hospital Based Cancer Registries (HBCRs) under India’s National Cancer Registry Programme (NCRP), providing real-world insights into its management across health care institutions despite existing standardised treatment guidelines. We conducted a descriptive analysis of prostate cancer, examining key parameters such as age, diagnostic techniques, primary histological classification (categorised using the ICD –O3), disease stage at presentation(localised, loco regional, or distant metastasis), treatment intent modalities and the time interval between diagnosis and treatment initiation, utilising the data from Hospital Based Cancer Registries(HBCRs). 75.6

Background & objectives India has the second highest number of adults with diabetes in the world, and more than one-fourth of adults have hypertension. This article describes the preparedness of public and private health facilities for type 2 diabetes mellitus and hypertension management. Methods A cross-sectional survey of the health facilities was conducted in 19 districts of seven States in India, which included an assessment of both public and private health facilities. We used the Indian Public Health Standards and other relevant guidelines for assessment. The service domain score for four domains: equipment, medicine, diagnostics capacity, staff, including the availability of guidelines, and overall readiness score, was calculated following the Service Availability and Readiness Assessment manual of the World Health Organisation. The study considered a readiness score of ≥70 per cent to classify a facility as prepared for providing hypertension and diabetes services. Results Out of 415 health facilities covered in the survey, 75.7 per cent were public facilities. Most were primary care facilities (57.6%) and were located in rural areas (53.3%). The overall readiness score for providing hypertension and diabetes services was lowest for Sub-Centres (SCs; 61%) and Community Health Centres (CHCs; 59%), compared to other facilities. The readiness score for public Primary Health Centres (PHCs) and private primary care facilities (level 2) was 73 and 57 per cent, respectively. The readiness score of district hospitals, government private medical colleges, and other private tertiary care facilities was above 70 per cent, and they were considered prepared for services. Interpretations & conclusions PHCs were better prepared for diabetes and hypertension care than SCs, CHCs, and SDHs. By ensuring adequate human resources availability and uninterrupted supply of essential medicines, programme managers can further improve the preparedness of all public health facilities.

Problem considered: Cancer is the second leading cause of death globally and in India, following cardiovascular diseases, with most cases linked to modifiable risk factors. This study aimed to determine the prevalence of cancer-related modifiable and metabolic risk factors and assess disparities by rural-urban status and gender in Northeast India. Methods: A population-based cross sectional study was conducted from 2019 to 2021 in 12 Population-Based Cancer Registries across eight northeastern states, involving 23,040 adults aged >18. Data on socio-demographics, lifestyle, anthropometric, and biochemical parameters were analysed using weighted sampling and SPSS software. Results were reported as means and proportions with 95 % confidence intervals. Results: A total of 21321 respondents completed the survey, indicating a response rate of 92.5 %. Tobacco use was reported by 48.6 %, significantly higher in rural men (64.2 %) than in urban men (58.3 %) (p < 0.001). Smokeless tobacco use was significantly more in women (30.7 %) than men (22.9 %) (p < 0.001). Ever consumption of alcohol consumption was significantly higher among men (47.2 %) and rural residents (33.1 %) (p < 0.001). Women (91.7 %) and rural residents (93.3 %) were more physically active than men (88.2 %) and urban residents (85.7 %) (p < 0.001). Hypertension (stages 1 and 2) affected more men (29.1 %) and urban residents (28.9 %) (p < 0.001). Overweight affected 22.4 %, obesity 5.2 %, with significantly higher obesity rates in women (6.3 %) and urban residents (7 %) (p < 0.001). Clustering of more than three risk factors was observed in 31.3 % of participants, significantly higher among men (37.1 %) and urban participants (37.3 %) (p < 0.001). Conclusion: The higher prevalence of risk factors compared to national estimates may contribute to elevated cancer incidence rates in Northeast India. Understanding these burdens highlights opportunities for cancer prevention and control. Findings underscore the importance of sustained cancer risk factor surveillance in cancer registry areas.

Gallbladder cancer is the fifth most common gastrointestinal cancer worldwide, often diagnosed incidentally after cholecystectomy for presumed benign disease. Previous studies have reported geographic variations in the incidence of incidental gallbladder cancer (IGBC), but comprehensive pooled estimates examining multiple predictors of IGBC are lacking. The study aims to synthesize the risk factors and clinical predictors associated with IGBC in patients undergoing cholecystectomy for benign gallbladder conditions. This systematic review and meta-analysis assessed studies published between January 2010 and February 2024 in databases from EMBASE, PUBMED-MEDLINE, and Scopus. Eligible studies included observational study designs evaluating risk or predictive factors for IGBC diagnosed during or after cholecystectomy for presumed benign gallbladder disease. Heterogeneity across studies was assessed using the I² statistic. Sensitivity analyses were conducted to explore the robustness of the pooled estimates. Of 2899 studies screened, 18 were included in the systematic review and 9 of these were included in the meta-analysis, covering 788,214 patients undergoing cholecystectomy. Advancing age (OR:1.09; 95

ObjectiveTo explore the stakeholders' perspectives on barriers and facilitators influencing childhood cancer care delivery in India.MethodsA nationwide survey was conducted across 26 states and 4 Union Territories, involving childhood cancer physicians from tertiary and secondary hospitals, state nodal officers (SNOs) for the National Programme for Control of Non-Communicable Diseases (NP-NCD), and representatives from Civil Society Organizations (CSOs) and Non-Governmental Organizations (NGOs). A hub-and-spoke sampling model was employed, with designated tertiary hospitals coordinating data collection from secondary hospitals. An online survey tool assessed perceived challenges and facilitators in childhood cancer care. Data collection occurred from July to September 2021, and descriptive statistics were used for analysis.ResultsResponses were received from 137 tertiary hospitals (100%), 92 secondary hospitals (91%), 16 SNOs (53.3%), and 9 CSO/NGO representatives (23.1%). Key barriers to diagnosis and treatment included shortage of human resources, beds, and equipment, along with advanced-stage presentation and inadequate back-referrals from tertiary to secondary hospitals. Treatment abandonment and denial were highlighted as major concerns. SNOs and CSOs identified financial constraints, limited insurance coverage, and reliance on traditional healers as additional challenges. Facilitators included strengthening referral networks, expanding diagnostic capabilities, ensuring free treatment and medications, and improving infrastructure and workforce capacity.ConclusionResource constraints, late-stage presentation, treatment abandonment, and financial challenges are the significant barriers to childhood cancer care in India. Addressing these through improved referral systems, expanded diagnostic services, financial support mechanisms, and policy-level interventions are needed to enhance childhood cancer care outcomes and quality of life.

Importance India accounts for more than one-third of oral cancer (OC) cases globally. Cancer survival measures the effectiveness of the health care system’s cancer control efforts and the proportion of people who survive during a specified time. Objective To estimate the 5-year survival rates among patients with OC diagnosed in India and assess the association of survival with age, place of residence, histologic type, and clinical extent of OC. Design, Setting, and Participants This retrospective cohort study evaluated survival of patients diagnosed with primary OC ( International Classification of Diseases for Oncology, Third Revision, codes C01-C06) between January 1, 2012, and December 31, 2015, and followed up until June 30, 2021. Patients were included from 10 population-based cancer registries (PBCRs). Data were analyzed between March 15 and August 20, 2024. Exposures Demographic factors (patient age, sex, and place of residence) and disease factors (clinical extent of disease and histologic type). Main Outcomes and Measures The main outcome was 5-year age-standardized relative survival (ASRS) for OC among male and female patients. A multivariable Cox proportional hazards model estimated hazard ratio (HR) and 95% CI, adjusting for covariates. Results Data from the 10 PBCRs encompassed 14 059 patients of all ages (median age, 55 [IQR, 45-65] years; 10 380 male [73.8%]) diagnosed with OC. The overall 5-year ASRS rate for OC was 37.2% (range, 20.9%-58.4%). The estimated ASRS rates at 5 years were 36.0% (range, 20.7%-59.3%) for male and 39.6% (range, 21.4%-54.8%) for female patients. Ahmedabad urban had the highest 5-year ASRS at 58.4% (95% CI, 56.3%-60.4%) for both sexes, while Manipur had the lowest rates at 20.9% (95% CI, 14.9%-27.6%). Survival rates differed significantly between rural areas (34.1%; 95% CI, 31.4%-36.9%) and urban areas (48.5%; 95% CI, 47.4%-49.7%). Pooled data from Kollam and Thiruvananthapuram revealed that individuals 65 years or older (HR, 1.76; 95% CI, 1.44-2.14) and those with distant metastasis (HR, 3.95; 95% CI, 2.78-5.60) had a significantly higher risk of death. Conclusions and Relevance In this cohort study from India, significant survival disparities were observed among patients with OC based on demographic factors and clinical characteristics. Survival rates were lower in rural areas compared with urban regions, underscoring the inequalities in quality of care and services and emphasizing the need to improve OC survival rates in India.

Background & objectives Heart failure is a major health burden globally. While the prevalence of heart failure is increasing, limited research has focused on the specific characteristics and outcomes of patients with heart failure belonging to different age groups in India. This study aimed to describe the clinical characteristics, treatment patterns and outcomes of patients with heart failure in India with a focus on comparing these aspects among young (16 to 40 yr), middle-aged (41-64 yr), and elderly (≥ 65 yr) individuals. Methods A multicentre, hospital-based study was conducted in five small- to medium-sized cities in India. Participants included admitted cases of heart failure between June 2018 and March 2022. Demographic and clinical information, including comorbidities, and data on aetiology, treatment, and outcomes, were collected using a standardised proforma. Statistical analyses were conducted to compare variables across age groups. Results Out of 6018 participants, 613 (10.2%) were young adults, 3207 (53.3%) were middle-aged, and 2198 (36.5%) belonged to the elderly age group. Most of the patients (>60%) were from rural areas. Ischemic heart disease (IHD) was the most common aetiology across all three age groups (52.4%, 75.1%, and 76.9%), and the 90-day mortalities for the three age groups were 12.6, 13.4 and 19 per cent, respectively. Young patients presented with milder symptoms, distinct aetiologies, and fewer comorbidities than older age groups. Treatment patterns varied across age groups. Young patients had longer hospital stays and higher in-hospital mortality rates. However, long-term mortality rates were higher among the older age groups. Interpretation & conclusions This study provides valuable insights into the clinical characteristics, treatment patterns and mortality rates of individuals with heart failure in India, particularly from rural areas. The findings highlight the need for tailored approaches for different age groups in the prevention and management of heart failure, with a special focus on the young and rural population.

AIM:Radiotherapy is a cornerstone of cancer treatment in India, yet its expansion is hindered by high investment costs. Effective planning and target estimation based on cancer burden are crucial to meet the radiotherapy demands of patients with cancer. METHODS:Data from Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) were used. Epidemiological data on stage, subsite and histology from National cancer registry programme were used to assess the optimal utilization proportion for India. A sensitivity analysis was carried out. Similarly optimal radiotherapy fraction has also being calculated. These measures have been used to estimate the existing radiotherapy utilization gap by comparing with the current radiotherapy utilization from cancer registry as well as estimate the optimal radiotherapy machines required for the country. RESULTS:Optimal radiotherapy utilization rate in India is 58.4% (95% CI: 57.6-58.9), whereas the actual utilization rate is 28.5% (95% CI: 28.0-31.5). The estimated number of radiotherapy machines required to meet demand ranges from 1,585 to 2,545. CONCLUSION:The study highlights a substantial shortfall in radiotherapy utilisation across all cancer types and underscores the need for interventions to meet the gap in machines required for an equitable cancer care. Efforts to reduce the cancer burden in the country shall influence the radiotherapy requirement through early stage diagnosis and treatment. Advancement in other modalities of treatment shall need to watch closely.