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Article: Approach Toward Oncoplastic Breast Surgery: Local (Flap) Solutions for Indian Problems.

Joshi, Shalaka / Kothari, Bhavika / Jaiswal, Dushyant / Wadasadawala, Tabassum / Badwe, R A

2023 Volume 15, Issue 1, Page(s) 95–102

Language	English
Publishing date	2023-10-19
Publishing country	India
Document type	Case Reports
ZDB-ID	2568289-1
ISSN	0976-6952 ; 0975-7651
ISSN (online)	0976-6952
ISSN	0975-7651
DOI	10.1007/s13193-023-01830-9
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Article ; Online: Socio-economic variations of breast cancer treatment and discontinuation: a study from a public tertiary cancer hospital in Mumbai, India.

Mohanty, Sanjay K / Wadasadawala, Tabassum / Sen, Soumendu / Khan, Pijush Kanti

BMC women's health

2023 Volume 23, Issue 1, Page(s) 113

Abstract: Background: The study examined the socio-economic variation of breast cancer treatment and treatment discontinuation due to deaths and financial crisis.: Methods: We used primary data of 500 patients with breast cancer sought treatment at India's one ...

Abstract	Background: The study examined the socio-economic variation of breast cancer treatment and treatment discontinuation due to deaths and financial crisis. Methods: We used primary data of 500 patients with breast cancer sought treatment at India's one of the largest cancer hospital in Mumbai, between June 2019 and March 2022. This study is registered on the Clinical Trial Registry of India (CTRI/2019/07/020142). Kaplan-Meier method and Cox-hazard regression model were used to calculate the probability of treatment discontinuation. Results: Of the 500 patients, three-fifths were under 50 years, with the median age being 46 years. More than half of the patients were from outside of the state and had travelled an average distance of 1,044 kms to get treatment. The majority of the patients were poor with an average household income of INR15,551. A total of 71 (14%) patients out of 500 had discontinued their treatment. About 5.2% of the patients died and 4.8% of them discontinued treatment due to financial crisis. Over one-fourth of all deaths were reported among stage IV patients (25%). Patients who did not have any health insurance, never attended school, cancer stage IV had a higher percentage of treatment discontinuation due to financial crisis. Hazard of discontinuation was lower for patients with secondary (HR:0.48; 95% CI: 0.27-0.84) and higher secondary education (HR: 0.42; 95% CI: 0.19-0.92), patients from rural area (HR: 0.79; 95% CI: 0.42-1.50), treated under general or non-chargeable category (HR: 0.60; 95% CI:0.22-1.60) while it was higher for the stage IV patients (HR: 3.61; 95% CI: 1.58-8.29). Conclusion: Integrating breast cancer screening in maternal and child health programme can reduce delay in diagnosis and premature mortality. Provisioning of free treatment for poor patients may reduce discontinuation of treatment.
MeSH term(s)	Child ; Humans ; Middle Aged ; Female ; Breast Neoplasms/diagnosis ; Cancer Care Facilities ; Educational Status ; Proportional Hazards Models ; India/epidemiology
Language	English
Publishing date	2023-03-20
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2050444-5
ISSN	1472-6874 ; 1472-6874
ISSN (online)	1472-6874
ISSN	1472-6874
DOI	10.1186/s12905-023-02275-6
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Article ; Online: Socio-economic and regional variation in breast and cervical cancer screening among Indian women of reproductive age: a study from National Family Health Survey, 2019-21.

Sen, Soumendu / Khan, Pijush Kanti / Wadasadawala, Tabassum / Mohanty, Sanjay K

BMC cancer

2022 Volume 22, Issue 1, Page(s) 1279

Abstract: Background: In India, breast and cervical cancers account for two-fifths of all cancers and are predominantly prevalent among women in the reproductive age group. The Government of India recommended screening of breast and cervical cancer among women ... ...

Abstract	Background: In India, breast and cervical cancers account for two-fifths of all cancers and are predominantly prevalent among women in the reproductive age group. The Government of India recommended screening of breast and cervical cancer among women aged 30 years and over. This study examines the socio-economic and regional variations of breast and cervical screening among Indian women in the reproductive age. Methods: A full sample of 707,119 women aged 15-49 and a sub-sample of 357,353 women aged 30-49 from National Family Health Survey-5 (2019-21) were used in the analysis. Self-reported ever screening for breast and cervical cancer for women aged 15-49 and women aged 30-49 were outcome variables. A set of socio-economic and risk factors associated with breast and cervical cancer screening were used as the predictors. Logistic regression was used to understand the significant correlates of cancer screening and, concentration index and concentration curve were used to assess the socio-economic inequality in breast and cervical cancer screening. Results: The proportion of breast and cervical cancer screening among women aged 30-49 were 877 and 1965 per 100,000 women respectively. Cancer screening was lower among women who were poor, young, had lower educational attainment and resided in rural areas. The concentration index was 0.2 for ever screening of breast cancer and 0.15 for cervical cancer among women aged 30-49 years. The concertation curve for screening of both breast and cervical cancers was pro-rich. Women with higher educational attainment [OR:1.46, 95% CI: 1.31-1.62], aged 40-49 years [OR:1.35; 95% CI: 1.28-1.43], resided in the western [OR:1.62; 95% CI:1.4-1.87] or southern [OR:6.66; 95% CI:5.93-7.49] region had significantly higher odds of up taking either of the screening. The pattern of breast and cervical cancer screening among women aged 15-49 was similar to that of women 30-49. Conclusion: The overall proportion of cancer screening among women in 30-49 age group is low in India. Early screening and treatment can reduce the burden of these cancers. Creating awareness and providing knowledge on cancer could be a key strategy for reducing the burden of breast and cervical cancers among women in the reproductive age in India.
MeSH term(s)	Female ; Humans ; Adult ; Middle Aged ; Early Detection of Cancer ; Uterine Cervical Neoplasms/diagnosis ; Uterine Cervical Neoplasms/epidemiology ; India/epidemiology ; Health Surveys
Language	English
Publishing date	2022-12-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2041352-X
ISSN	1471-2407 ; 1471-2407
ISSN (online)	1471-2407
ISSN	1471-2407
DOI	10.1186/s12885-022-10387-9
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Article ; Online: Adopting Health Economic Research in Radiation Oncology: A Perspective From Low- or Middle-Income Countries.

Sinha, Shwetabh / Laskar, Sarbani Ghosh / Wadasadawala, Tabassum / Krishnatry, Rahul / Lievens, Yolande / Agarwal, Jai Prakash

JCO global oncology

2022 Volume 8, Page(s) e2100374

Abstract: Establishing a new radiation therapy (RT) setup is resource-intensive as it involves substantial capital costs and the recruitment of a skilled workforce. It is essential to incorporate health economic analysis that estimates recurring and nonrecurring ... ...

Abstract	Establishing a new radiation therapy (RT) setup is resource-intensive as it involves substantial capital costs and the recruitment of a skilled workforce. It is essential to incorporate health economic analysis that estimates recurring and nonrecurring expenses on the basis of the national and local needs, infrastructure, and future projections. RT costing exercises can be especially relevant for low- or middle-income countries (LMICs) with more than 70% of the global cancer burden, with access to < 20% of the available resources. This review article summarizes the scope of RT costing exercises in LMICs, the hurdles in conducting them, and possible ways to circumvent them. The purpose of performing costing studies in RT lies in their utility to improve the efficiency of the investment while at the same time helping to address the issues of uniformity and equitable distribution of resources. This will help assess the net benefit from RT in terms of utility and outcome-linked parameters like Quality-Adjusted Life Years. There are numerous barriers to conducting economic evaluations in LMICs, including the lack of national costing values for equipment, data on manpower salary, cost for public and private setups, and indirect costs. The situation is further complicated because of the nonuniform pay structure, lack of an organizational framework, robust real-world data on outcomes, and nonavailability of country-specific reference utility values. Collaborative national efforts are required to collect all elements required to perform health technology assessments. Information from the national and hospital databases can be made available in the public domain to ease access and broader adoption of health economic end points in routine care. Although resource-intensive at the onset, costing studies and health economic assessments are essential for improving the coverage and quality of RT in LMICs.
MeSH term(s)	Cost-Benefit Analysis ; Developing Countries ; Economics, Medical ; Income ; Radiation Oncology
Language	English
Publishing date	2022-07-19
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2687-8941
ISSN (online)	2687-8941
DOI	10.1200/GO.21.00374
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Article ; Online: Prospective Study of Incidence and Impact of Comorbidities on Breast Cancer Survival from India.

Wadasadawala, Tabassum / Datta, Debanjali / Puchali, Namita / Rane, Pallavi / Sen, Soumendu / Mohanty, Sanjay / Gupta, Sudeep / Sarin, Rajiv / Parmar, Vani

Asian Pacific journal of cancer prevention : APJCP

2023 Volume 24, Issue 11, Page(s) 3805–3814

Abstract: Purpose: To report comorbidity burden in newly-diagnosed treatment-naïve breast cancer patients and its effect on survival.: Methods: Prospective observational study in which demographic, comorbidity and outcome data from a consecutive cohort of ... ...

Abstract	Purpose: To report comorbidity burden in newly-diagnosed treatment-naïve breast cancer patients and its effect on survival. Methods: Prospective observational study in which demographic, comorbidity and outcome data from a consecutive cohort of patients diagnosed and treated between September 2019 to September 2021 were collected. Charlson Comorbidity Index (CCI) score was calculated for all and proportion of each comorbidity was determined at diagnosis (baseline), at conclusion and six-months post-treatment. Univariate and multivariate analysis was done for impact of various demographic and disease-related factors on the incidence of comorbidities as well as on progression free survival (PFS) and overall survival (OS). Results: Out of five hundred patients who consented for the study, 416 patients completed planned treatment and only 206 patients had physical follow-up due to COVID-19 pandemic. Incidence of comorbidity at the three time-points was 24%, 32% and 26% respectively. The difference was significant compared to baseline at both the time-points (p<0.05). Hypertension and diabetes were the most common types (incidence 15%-21% and 12-18% respectively) of comorbidities. Advancing age, post-menopauusal status and not being married were significant factors for presence of comorbidities. Median follow-up was 27 months (95% CI 26.25-28.55 months). Presence of multiple comorbidities was a poor prognostic factor for both PFS (2-yr PFS 85% vs 77%) and OS (2-yr OS 89% vs 79%) (both p=0.04) but no such correlation for CCI score. Conclusion: Breast cancer treatment impacted incidence of comorbidities. Presence of multiple comorbidities had an adverse impact on survival. Hence, further research on treatment optimization is required in patients with substantial comorbidities.
MeSH term(s)	Humans ; Female ; Breast Neoplasms/epidemiology ; Breast Neoplasms/therapy ; Prospective Studies ; Incidence ; Pandemics ; Comorbidity ; India/epidemiology
Language	English
Publishing date	2023-11-01
Publishing country	Thailand
Document type	Observational Study ; Journal Article
ZDB-ID	2218955-5
ISSN	2476-762X ; 1513-7368
ISSN (online)	2476-762X
ISSN	1513-7368
DOI	10.31557/APJCP.2023.24.11.3805
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Article ; Online: Health-Related Quality of Life (HRQoL) Using EQ-5D-5L: Value Set Derived for Indian Breast Cancer Cohort.

Wadasadawala, Tabassum / Mohanty, Sanjay K / Sen, Soumendu / Khan, Pijush Kanti / Pimple, Sharmila / Mane, Jaykumar V / Sarin, Rajiv / Gupta, Sudeep / Parmar, Vani

Asian Pacific journal of cancer prevention : APJCP

2023 Volume 24, Issue 4, Page(s) 1199–1207

Abstract: Objective: The purpose of this study was to report quality of life of newly diagnosed breast cancer patients from India in a large cohort using the EQ-5D-5L instrument.: Methods: The study used longitudinal data of 500 breast cancer and 200 non- ... ...

Abstract	Objective: The purpose of this study was to report quality of life of newly diagnosed breast cancer patients from India in a large cohort using the EQ-5D-5L instrument. Methods: The study used longitudinal data of 500 breast cancer and 200 non-cancer subjects registered at our centre, during June 2019 and March 2022. The EQ-5D-5L and EQ-VAS instruments were used to measure and compare utility scores among cancer and non-cancer subjects. Descriptive statistics were analyzed and Tobit regression model were used to confirm the predictors of the utility score. Results: The cancer subjects had a mean EQ-ED-5L utility score of 0.8703 (SD=0.121), 0.8745 (SD=0.094) and 0.8902 (SD=0.107) at the time of baseline, completion and follow up surveys respectively. EQ-5D-5L values had significantly worsened after diagnosis of cancer as compared to the non-cancer cohort (0.87 vs. 0.93, p value 0.000). EQ-5D-5L utility scores as per stage for the cancer cohort were 0.88, 0.86 and 0.83 respectively for stage I-II, III and IV. Similarly, the EQ-VAS scores for stage I-II, III and IV were 74.9, 72.6 and 73.2 respectively. Multivariate analysis confirmed strong association of age, religion and income with the utility-values. Conclusion: This is the first longitudinal study reporting the utility scores derived from a large cohort of breast cancer patients demonstrating lower utility scores compared to non-cancer cohort. The utility scores also improve post treatment completion for cancer patients and decrease with higher stage at diagnosis. This information will be useful for future health economic research in India pertaining to breast cancer.
MeSH term(s)	Humans ; Female ; Quality of Life ; Breast Neoplasms/therapy ; Longitudinal Studies ; Surveys and Questionnaires ; Psychometrics ; Health Status
Language	English
Publishing date	2023-04-01
Publishing country	Thailand
Document type	Journal Article
ZDB-ID	2218955-5
ISSN	2476-762X ; 1513-7368
ISSN (online)	2476-762X
ISSN	1513-7368
DOI	10.31557/APJCP.2023.24.4.1199
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Article ; Online: Grossing and reporting of breast cancer specimens: An evidence-based approach.

Shet, Tanuja / Pai, Trupti / Wadasadawala, Tabassum / Nair, Nita / Gulia, Seema

Indian journal of cancer

2020 Volume 57, Issue 2, Page(s) 144–157

Abstract: A histopathology report offers important prognostic and predictive information that helps plan systemic therapy in breast cancer. However, in many cases a pathologist fails to provide relevant information chiefly due to the lack of awareness of the ... ...

Abstract	A histopathology report offers important prognostic and predictive information that helps plan systemic therapy in breast cancer. However, in many cases a pathologist fails to provide relevant information chiefly due to the lack of awareness of the impact of these parameters in clinical decision-making. This review seeks to put forth common practice points in grossing and reporting of specimens harboring breast cancer with focus on latest revisions in the same. Just as it is important to document tumor size, tumor type, margins, estrogen receptor/progesterone receptor, and human epidermal growth factor (ER/PR/HER2) in breast cancer, we need to also focus on sentinel node grossing, nodal burden, size of nodal metastasis, and extranodal extension. In parallel, increasing number of patients are getting neoadjuvant chemotherapy in breast cancer and points in grossing and reporting of such specimens are also alluded to. This article will serve as reference guide to pathologists on what we do and why we do the same.
MeSH term(s)	Breast Neoplasms/epidemiology ; Disease Notification/methods ; Evidence-Based Medicine/methods ; Female ; Humans
Language	English
Publishing date	2020-06-13
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	410194-7
ISSN	1998-4774 ; 0019-509X
ISSN (online)	1998-4774
ISSN	0019-509X
DOI	10.4103/ijc.IJC_157_20
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Article ; Online: Defining dose constraints for catheter insertion sites to minimize toxicity after interstitial breast brachytherapy.

Krishnamurthy, Revathy / Wadasadawala, Tabassum / Rane, Pallavi / Phurailatpam, Reena / Sarin, Rajiv

Brachytherapy

2020 Volume 19, Issue 5, Page(s) 694–699

Abstract: Purpose: The purpose of this study was to define dose constraints for catheter insertion sites to minimize probability of prominent post-therapy skin marks after interstitial breast brachytherapy.: Methods and materials: Forty patients who had ... ...

Abstract	Purpose: The purpose of this study was to define dose constraints for catheter insertion sites to minimize probability of prominent post-therapy skin marks after interstitial breast brachytherapy. Methods and materials: Forty patients who had undergone interstitial breast brachytherapy were studied at followup at least 2 years after the procedure. Their implant marks were compared with background skin and areola and scored as Gr0 = invisible (same color as surrounding skin), Gr1 = darker than surrounding skin but lighter than areola or hypopigmentation, and Gr2 = same color as areola or darker. Highest point doses received in each plane of implant and their corresponding closest distances from clinical target volume, 85% isodose, and closest catheter dwell point were used for analysis. A logistic regression was performed to ascertain effects of various dosimetric parameters on the probability of Gr2 marks. Receiver operating characteristic curve was generated to derive cutoffs. Results: A total of 280 dose points were studied. Median values for various parameters were 1.4 Gy (0.24-3.74) for Dose max and 1.6 cm, 1.5 cm, and 1.0 cm for Dist CTV min, Dist Iso min, and Dist Dwell min, respectively. On logistic regression, increasing Dose max alone was associated with an increased likelihood of developing Gr2 marks. Each unit increase of Dose max increased probability of development of Gr2 skin marks by 5.0% (2.391-10.328). Receiver operating characteristic analysis also showed greatest odd ratio (8.0), sensitivity (74.8%), and specificity (73%) for Dose max. Conclusions: It seems prudent to restrict dose to catheter insertion sites for better cosmesis.
MeSH term(s)	Aged ; Brachytherapy/methods ; Breast ; Breast Neoplasms/radiotherapy ; Catheters ; Female ; Humans ; Hyperpigmentation/epidemiology ; Hypopigmentation/epidemiology ; Mastectomy, Segmental ; Middle Aged ; Radiation Injuries/epidemiology ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy, Adjuvant/methods ; Skin ; Skin Pigmentation
Language	English
Publishing date	2020-07-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2098608-7
ISSN	1873-1449 ; 1538-4721
ISSN (online)	1873-1449
ISSN	1538-4721
DOI	10.1016/j.brachy.2020.06.008
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Article: CONcurrent ChEmotherapy and RadioTherapy in adjuvant treatment of breast cancer (CONCERT): a phase 2 study.

Wadasadawala, Tabassum / Anup, Akanksha / Carlton, Johnny / Sarin, Rajiv / Gupta, Sudeep / Parmar, Vani / Pathak, Rima / Ghosh, Jaya / Bajpai, Jyoti / Gulia, Seema / Krishnamurthy, Revathy

Ecancermedicalscience

2023 Volume 17, Page(s) 1510

Abstract: Purpose: This phase 2 study evaluated the safety of adjuvant chemoradiation (CTRT) for breast cancer.: Methods: From April 2019 to 2020, 60 patients with stage II-III invasive breast cancer planned for adjuvant taxane-based chemotherapy and ... ...

Abstract	Purpose: This phase 2 study evaluated the safety of adjuvant chemoradiation (CTRT) for breast cancer. Methods: From April 2019 to 2020, 60 patients with stage II-III invasive breast cancer planned for adjuvant taxane-based chemotherapy and radiotherapy (RT) were accrued. Local ± regional (excluding the internal mammary nodal region) RT (40 Gy in 15 fractions ± boost) was started with the third cycle of an adjuvant taxane in a 3-weekly schedule or with the eighth cycle in a weekly schedule. Results: Thirty-six patients received 3-weekly paclitaxel regimen and 24 received weekly paclitaxel regimen. The commonly used technique was three-dimensional conformal RT which was employed in 58% of patients. Regional RT, including the medial supraclavicular region, was done in 42 patients (70%). No dose-limiting (grade 3 or 4) toxicity was documented and all patients completed CTRT without any treatment interruption. The median ejection fraction pre and post CTRT 6 months was 60% ( Conclusion: Taxane-based adjuvant CTRT is a safe option and results in minimal toxicity and excellent compliance. It has favourable impact on cardio-pulmonary profile and QOL scores.
Language	English
Publishing date	2023-02-23
Publishing country	England
Document type	Case Reports
ISSN	1754-6605
ISSN	1754-6605
DOI	10.3332/ecancer.2023.1510
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Article: Can knowledge based treatment planning of VMAT for post-mastectomy locoregional radiotherapy involving internal mammary chain and supraclavicular fossa improve performance efficiency?

Phurailatpam, Reena / Sah, Muktar Kumar / Wadasadawala, Tabassum / Khan, Asfiya / Palottukandy, Jithin / Gayake, Umesh / Jain, Jeevanshu / Sarin, Rajiv / Pathak, Rima / Krishnamurthy, Revathy / Joshi, Kishore / Swamidas, Jamema

Frontiers in oncology

2023 Volume 13, Page(s) 991952

Abstract: Introduction: To validate and evaluate the performance of knowledge-based treatment planning for Volumetric Modulated Arc Radiotherapy for post-mastectomy loco-regional radiotherapy.: Material and methods: Two knowledge-based planning (KBP) models ... ...

Abstract	Introduction: To validate and evaluate the performance of knowledge-based treatment planning for Volumetric Modulated Arc Radiotherapy for post-mastectomy loco-regional radiotherapy. Material and methods: Two knowledge-based planning (KBP) models for different dose prescriptions were built using the Eclipse RapidPlanTM v 16.1 (Varian Medical Systems, Palo Alto, USA) utilising the plans of previously treated patients with left-sided breast cancer who had undergone irradiation of the left chest wall, internal mammary nodal (IMN) region and supra-clavicular fossa (SCF). Plans of 60 and 73 patients were used to generate the KBP models for the prescriptions of 40 Gy in 15 fractions and 26 Gy in 5 fractions, respectively. A blinded review of all the clinical plans (CLI) and KBPs was done by two experienced radiation oncology consultants. Statistical analysis of the two groups was also done using the standard two-tailed paired t-test or Wilcoxon signed rank test, and p<0.05 was considered significant. Results: A total of 20 metrics were compared. The KBPs were found to be either better (6/20) or comparable (10/20) to the CLIs for both the regimens. Dose to heart, contralateral breast,contralateral lung were either better or comparable in the KBP plans except of ipsilateral lung. Mean dose (Gy) for the ipsilateral lung are significantly (p˂0.001) higher in KBP though the values were acceptable clinically. Plans were of similar quality as per the result of the blinded review which was conducted by slice-by-slice evaluation of dose distribution for target coverage, overdose volume and dose to the OARs. However, it was also observed that treatment times in terms of monitoring units (MUs) and complexity indices are more in CLIs as compared with KBPs (p<0.001). Discussion: KBP models for left-sided post-mastectomy loco-regional radiotherapy were developed and validated for clinical use. These models improved the efficiency of treatment delivery as well as work flow for VMAT planning involving both moderately hypo fractionated and ultra-hypo fractionated radiotherapy regimens.
Language	English
Publishing date	2023-04-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2023.991952
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