manjeshwar baliga

Anxiety is a significant psychological challenge for patients newly diagnosed with cancer and scheduled for chemotherapy, potentially affecting their treatment adherence. This study aimed to evaluate the impact of watching the Tom and Jerry cartoon on reducing anxiety in individuals undergoing chemotherapy for the first time. This pilot study employed a prospective, non-randomized, observational, two-arm, pre-and post-test design involving literate English-speaking patients (test group) and non-literate patients (control group) who were about to receive cytotoxic chemotherapy for their cancer. The test group viewed Tom and Jerry cartoons via video systems, whereas the control group was exposed to Kannada movies. An 11-point Likert scale featuring facial expressions assessed patients' anxiety levels three times: 20 minutes before, 30 minutes after, and following the chemotherapy session. Data analysis included frequency, percentage, chi-square tests for patient and treatment data, and repeated measures ANOVA with Bonferroni correction for anxiety scores at three-time intervals. A P-value of <0.05 was considered statistically significant. The anxiety assessment outcomes indicated a significant reduction in anxiety levels among the test group patients who watched Tom and Jerry compared to the control group (P ≤ 0.001). Inter-group comparisons, analyzed using the Bonferroni test, revealed significant differences in anxiety reduction 30 minutes post-viewing (P = 0.001) and after the treatment (P = 0.04). To the authors' knowledge, this is the first study demonstrating the efficacy of the Tom and Jerry cartoon in alleviating anxiety among cancer patients undergoing chemotherapy, suggesting broad clinical applicability.

Reports correlating changes in salivary flow rate and amylase with radiation dose to parotid glands and development of salivary dysfunction for Head and Neck cancers (HNC) are lacking. In the current study, an attempt was made at understanding this. This was a prospective study carried out on people newly diagnosed with HNC requiring curative radiotherapy of more than 60 Gy. The salivary flow rate and levels of salivary α-amylase were evaluated before the start of radiation [day 1, before exposure to the first fraction of 2 Gy radiation], after 2 Gy [24 hours after the 1st fraction of 2 Gy, before exposure to 2nd fraction of 2 Gy on day 2 of the treatment], and on the completion of 30 Gy [(15 fraction of 2 Gy), before start of the 16th fraction, at the start of the fourth week on day 22] of radiation and development of salivary dysfunction was evaluated on a weekly basis. The demographic data were subjected to frequency and percentage, while biochemical data were stratified depending on dose to parotids and subjected to unpaired “t-test”. We also employed chi square/Fishers exact test to ascertain changes in the number of patients developing various degrees of salivary dysfunction on a weekly basis. A P value of <0.05 was considered significant. Radiation decreased salivary flow rate from 0.29 ± 0.02 to 0.20 ± 0.04 (P = 0.0001) and amylase from 147.69 ± 11.15 to 109.07 ± 23.21 U/L (P = 0.0005). Both salivary flow rate and amylase was less in patients with severe salivary gland dysfunction (P = 0.014) and cumulative dose of radiation to the parotid glands (P = 0.014). The number of patients with a severe degree of salivary dysfunction was seen in people exposed to more than 25 Gy to the parotids (P = 0.04). The results suggested that the evaluation of salivary amylase on day 22 could be a useful predictive marker to understand the development of radiation-induced dysfunction in patients with curative radiotherapy for their head and neck cancer.

Radiation dermatitis is known to be a major side-effect occurring following cancer treatment. We conducted the present study to understand whether salivary lactate dehydrogenase (LDH) could be conducive to predict the development of radiation-dermatitis in the head and neck cancer (HNC) patients undergoing curative radiotherapy (60-70 Gy). This was a prospective study performed on HNC patients requiring curative radiotherapy. Saliva was collected at two points from the willing volunteers. The first time point was prior to the first fraction of 2 Gy radiation and the second one was 24 hours after the first fraction and before exposure to the second fraction. The saliva collected at the both time points were analyzed for the levels of salivary LDH using standard procedure. The patients were provided with the standard care throughout the treatment period and the incidence and severity of radiation dermatitis was noted down using a proforma sheet throughout the 7-week treatment period. The results suggested that with exposure to 2 Gy fraction, there was an increase in the level of salivary LDH (387.11 ± 18.98 IU/L vs. 368. 13 ± 19.56IU/L); this increase was significant (t = 20.06 and P < 0.001). The LDH data was stratified based on the severity of dermatitis [mild (grades 1 and 2) vs. severe (grades 3 and 4)] in accordance to the Radiation Therapy Oncology Group/European Organization for Research and Treatment Cancer (RTOG) grading. The LDH values were subjected to Karl Pearson’s correlation analysis with the grade of dermatitis and the results indicated a P value of 0.019 and R value of 0.24. For the first time, our study revealed that salivary LDH could be a useful marker to understand the development of radiation-induced dermatitis in HNC patients undergoing curative radiotherapy. The most advantageous aspect herewith is that the collection of saliva does not require skilled people or special equipment; it cou ld be done at repeated intervals and without causing any invasive process.

Cervical cancer patients undergoing chemo-radiotherapy experience considerable amounts of stress. In the present study, we attempted to ascertain the effectiveness of yoga nidra, a mind-based structured relaxation exercise, in mitigating the stress. We conducted this prospective two-arm study on 48 volunteers randomly allocated into experimental (n=24) and control groups (n=24) using simple random sampling (lottery method). We collected the pretest data using a stress scale. The experimental group was then provided with yoga nidra sessions during the course of the treatment. We collected the post-test data using the same tool at the end of the radiation treatment with 50 Gy (2 Gy for five days a week for five consecutive weeks). We presented the demographic details in frequency and percentage and analyzed the stress data using ANOVA with Tukey’s multiple comparison test. P<0.05 was considered as significant. The volunteers in both cohorts experienced moderate to severe stress at the beginning of the study. Compared to the control group, the stress was significantly less in the groups that practiced yoga nidra (79.46 vs. 64.42) (P<0.0001). The results of the study clearly suggested that yoga nidra was effective in reducing the stress in cervical cancer patients undergoing curative radiation therapy.

Ethical problems routinely arise in the healthcare profession and more so in hospitals providing cancer diagnosis and care. Literature study indicates that almost all studies addressing ethical issues in cancer have been qualitative and reported from the developed countries, while there has been no study reported from developing countries. For the first time, we performed a questionnaire study to quantify the ethical issues plaguing the healthcare fraternity in the diagnosis and care of people with cancer. This prospective study was conducted under the aegis of UNESCO Bioethics Education and Research Unit of the UNESCO Chair in Bioethics, Haifa at Mangalore Institute of Oncology Mangalore, India. The investigators approached the healthcare professionals involved in diagnosis, treating, and caring for patients with cancer and ascertained various ethical issues they faced. Data were tabulated and subjected to frequency and percentage. The results indicated that discussing end-of-life issues with the patient and breaking bad news were the two most difficult ones while discussing end of life issues with family caregivers was the least. According to this study, oncology treatment involves a series of dilemmatic issues and breaking bad news. Based on the detailed studies and emphasis on handling these issues, it is possible to develop a teaching module for training the health care professionals and workers for managing the ethical issues effectively.

In this study, we sought to understand the usefulness of salivary lactatedehydrogenase as a predictive marker for the development of radiation-inducedmucositis. This was a prospective study with head and neck cancer patients whorequired curative radiotherapy (>60Gy). We collected patients’ saliva before the onsetof radiation and after 2 Gy of radiation to assess lactate dehydrogenase levels. The patientsreceived the stipulated oral and dental care. Data on incidence and severity of mucositiswas collected using a preform sheet and oral mucositis assessment scale published bythe Radiation Therapy Oncology Group throughout the 7-week treatment period. Salivary lactate dehydrogenase increased with exposure to radiation(P<0.0001) and there was an observed association with mucositis severity (P<0.0001;r = 0.515). The present results have established, for the first time, that salivarylactate dehydrogenase could be a useful predictive marker to understand the developmentof radiation-induced mucositis in patients with head and neck cancer. The proximityof the oral cavity for regular observation and saliva collection is an added advantage.