Background The impact of the coronavirus disease 2019 (COVID-19) pandemic on well-being has the potential for serious negative consequences on work, home life, and patient care. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration set out to investigate well-being in oncology over time since COVID-19. Methods Two online anonymous surveys were conducted (survey I: April/May 2020; survey II: July/August 2020). Statistical analyses were performed to examine group differences, associations, and predictors of key outcomes: (i) well-being/distress [expanded Well-being Index (eWBI; 9 items)]; (ii) burnout (1 item from eWBI); (iii) job performance since COVID-19 (JP-CV; 2 items). Results Responses from survey I (1520 participants from 101 countries) indicate that COVID-19 is impacting oncology professionals; in particular, 25% of participants indicated being at risk of distress (poor well-being, eWBI ≥ 4), 38% reported feeling burnout, and 66% reported not being able to perform their job compared with the pre-COVID-19 period. Higher JP-CV was associated with better well-being and not feeling burnout ( P < 0.01). Differences were seen in well-being and JP-CV between countries ( P < 0.001) and were related to country COVID-19 crude mortality rate ( P < 0.05). Consistent predictors of well-being, burnout, and JP-CV were psychological resilience and changes to work hours. In survey II, among 272 participants who completed both surveys, while JP-CV improved (38% versus 54%, P < 0.001), eWBI scores ≥4 and burnout rates were significantly higher compared with survey I (22% versus 31%, P = 0.01; and 35% versus 49%, P = 0.001, respectively), suggesting well-being and burnout have worsened over a 3-month period during the COVID-19 pandemic. Conclusion In the first and largest global survey series, COVID-19 is impacting well-being and job performance of oncology professionals. JP-CV has improved but risk of distress and burnout has increased over time. Urgent measures to address well-being and improve resilience are essential.

Treatment of head and neck cancers (HNCs) involves radiotherapy. Patients undergoing radiotherapy for HNCs are prone to dental complications. Radiotherapy to the head and neck region causes xerostomia and salivary gland dysfunction which dramatically increases the risk of dental caries and its sequelae. Radiation therapy (RT) also affects the dental hard tissues increasing their susceptibility to demineralization following RT. Postradiation caries is a rapidly progressing and highly destructive type of dental caries. Radiation-related caries and other dental hard tissue changes can appear within the first 3 months following RT. Hence, every effort should be focused on prevention to manage patients with severe caries. This can be accomplished through good preoperative dental treatment, frequent dental evaluation and treatment after RT (with the exception of extractions), and consistent home care that includes self-applied fluoride. Restorative management of radiation caries can be challenging. The restorative dentist must consider the altered dental substrate and a hostile oral environment when selecting restorative materials. Radiation-induced changes in enamel and dentine may compromise bonding of adhesive materials. Consequently, glass ionomer cements have proved to be a better alternative to composite resins in irradiated patients. Counseling of patients before and after radiotherapy can be done to make them aware of the complications of radiotherapy and thus can help in preventing them.

India has a rapidly growing population inflicted with cancer diagnosis. From an estimated incidence of 1.45 million cases in 2016, the cancer incidence is expected to reach 1.75 million cases in 2020. With the limitation of facilities for cancer treatment, the only effective way to tackle the rising and humongous cancer burden is focusing on preventable cancer cases. Approximately, 70% of the Indian cancers (40% tobacco related, 20% infection related and 10% others) are caused by potentially modifiable and preventable risk factors. We review these factors with special emphasis on the Indian scenario. The results may help in designing preventive strategies for a wider application.

Background: The COVID-19 pandemic has resulted in significant changes to professional and personal lives of oncology professionals globally. The European Society for Medical Oncology (ESMO) Resilience Task Force collaboration aimed to provide contemporaneous reports on the impact of COVID-19 on the lived experiences and well-being in oncology. Methods: This online anonymous survey (July-August 2020) is the second of a series of global surveys launched during the course of the pandemic. Longitudinal key outcome measures including well-being/distress (expanded Well-being Indexd9 items), burnout (1 item from expanded Well-being Index), and job performance since COVID-19 were tracked. Results: A total of 942 participants from 99 countries were included for final analysis: 58% (n ¼ 544) from Europe, 52% (n ¼ 485) female, 43% (n ¼ 409) 40 years old, and 36% (n ¼ 343) of non-white ethnicity. In July/August 2020, 60% (n ¼ 525) continued to report a change in professional duties compared with the pre-COVID-19 era. The proportion of participants at risk of poor well-being (33%, n ¼ 310) and who reported feeling burnout (49%, n ¼ 460) had increased significantly compared with April/May 2020 (25% and 38%, respectively; P < 0.001), despite improved job performance since COVID-19 (34% versus 51%; P < 0.001). Of those who had been tested for COVID-19, 8% (n ¼ 39/484) tested positive; 18% (n ¼ 7/39) felt they had not been given adequate time to recover before return to work. Since the pandemic, 39% (n ¼ 353/908) had expressed concerns that COVID-19 would have a negative impact on their career development or training and 40% (n ¼ 366/917) felt that their job security had been compromised. More than twothirds (n ¼ 608/879) revealed that COVID-19 has changed their outlook on their work-personal life balance. Conclusion:The COVID-19 pandemic continues to impact the well-being of oncology professionals globally, with significantly more in distress and feeling burnout compared with the first wave. Collective efforts from both national and international communities addressing support and coping strategies will be crucial as we recover from the COVID-19 crisis. In particular, an action plan should also be devised to tackle concerns raised regarding the negative impact of COVID-19 on career development, training, and job security.

INTRODUCTIONGliomas are the most common brain tumour with an annual incidence of 5-10/100,000 persons. Among gliomas, the most common histology is GBM [1]. Mean age of presentation of glioma is 40-45 years and that of GBM is 55-60 years. Patients diagnosed with anaplastic astrocytoma have a median survival of three years after diagnosis but the median survival is only 14 months following the diagnosis of GBM [1].The treatment of GBM has evolved over the years from surgery alone to surgery followed by postoperative Radiotherapy (RT). Studies have shown that extent of resection has prognostic importance. Pichlmeier U et al., reported that patients without residual contrastenhancing tumour had a higher overall median survival time than those with residual enhancing tumour (17.9 vs 12.9 months, respectively (p<0.001) [2].Randomized trials have demonstrated a clear survival benefit of the use of RT after surgery [3]. In a systemic review of postoperative RT in GBM, Laperriere N et al., showed significant (p<0.001) survival benefit of postoperative RT over supportive care [4]. Relative risk of GBM patients treated with postoperative RT for one-year mortality was 0.81. The understanding of tumour biology and recurrence patterns helped to shift from whole brain RT practice to partial brain irradiation.In a phase III trial comparing concurrent chemoradiation with TMZ and adjuvant six cycles TMZ 150-200 mg/m 2 every four weeks, Stupp R et al., showed increased median OS of 14.6 months compared to 12.1 months in the RT only arm and two year survival of 26.5% compared to 10.6% in the RT only arm [5]. Now, the standard of care for a newly diagnosed patient of GBM is maximal safe resection followed by concurrent chemoradiation with TMZ and then further adjuvant TMZ for six cycles as per regimen by Stupp R et al., and referred to as conventional TMZ (C-TMZ) further in this article [5].Several modifications are being tried in order to further improve the survival over that conferred by C-TMZ [5]. With a hypothesis that continuous daily administration of TMZ is more effective than a single dose, clinical trials with TMZ explored a wide range of dosing schedules aiming at maximum O 6 -Methylguanine Methyltransferase (MGMT) depletion in tumour cells [6]. However, this concept failed to show any improvement in the RTOG 0525 trial [7] which randomly assigned patients with newly diagnosed GBM to receive standard radiation and six cycle's maintenance TMZ or dose dense TMZ for 12 cycles.Another strategy postulated is to use extended cycles of adjuvant TMZ (E-TMZ) beyond the current standard of six cycles as used in C-TMZ regimen. Studies have shown promising survival with the use of E-TMZ; however, the reports are mostly limited to retrospective studies with significant bias [8,9].We did this prospective randomized study with a hypothesis that E-TMZ for total of 12 adjuvant cycles would improve OS of patients with newly diagnosed GBM as compared to C-TMZ. We also sought to assess the difference in the toxicity profiles of these two reg...

Background COVID-19 has had a significant impact on the well-being and job performance of oncology professionals globally. The ESMO Resilience Task Force collaboration set out to investigate and monitor well-being since COVID-19 in relation to work, lifestyle and support factors in oncology professionals one year on since the start of the pandemic. Methods An online, anonymous survey was conducted in February/March 2021 (Survey III). Key outcome variables included risk of poor well-being or distress (expanded Well-Being Index, eWBI), feeling burnout (single item from eWBI) and job performance since COVID-19. Longitudinal analysis of responses to the series of three surveys since COVID-19 was performed, and responses to job demands and resources questions were interrogated. SPSS V.26.0/V.27.0 and GraphPad Prism V9.0 were used for statistical analyses. Results Responses from 1269 participants from 104 countries were analysed in Survey III: 55% ( n = 699/1269) female, 54% ( n = 686/1269) >40 years, and 69% ( n = 852/1230) of white ethnicity. There continues to be an increased risk of poor well-being or distress ( n = 464/1169, 40%) and feeling burnout ( n = 660/1169, 57%) compared Survey I (25% and 38% respectively, P < 0.0001), despite improved job performance. Compared to the initial period of the pandemic, more participants report feeling overwhelmed with workload (45% vs 29%, P < 0.0001). There remain concerns about the negative impact of the pandemic on career development/training (43%), job security (37%) and international fellowship opportunities (76%). Alarmingly, 25% ( n = 266/1086) are considering changing their future career with 38% ( n = 100/266) contemplating leaving the profession. Conclusion Oncology professionals continue to face increased job demands. There is now significant concern regarding potential attrition in the oncology workforce. National and international stakeholders must act immediately and work closely with oncology professionals to draw up future-proof recovery plans.

Background The COVID-19 pandemic has impacted all aspects of modern-day oncology, including how stakeholders communicate through social media. We surveyed oncology stakeholders in order to assess their attitudes pertaining to social media and how it has been affected during the pandemic. Materials and methods A 40-item survey was distributed to stakeholders from 8 July to 22 July 2020 and was promoted through the European Society for Medical Oncology (ESMO) and the OncoAlert Network. Results One thousand and seventy-six physicians and stakeholders took part in the survey. In total, 57.3% of respondents were medical oncologists, 50.6% aged <40 years, 50.8% of female gender and mostly practicing in Europe (51.5%). More than 90% of respondents considered social media a useful tool for distributing scientific information and for education. Most used social media to stay up to date on cancer care in general (62.5%) and cancer care during COVID-19 (61%) given the constant flow of information. Respondents also used social media to interact with other oncologists (78.8%) and with patients (34.4%). Overall, 61.1% of respondents were satisfied with the role that social media was playing during the COVID-19 pandemic. On the other hand, 41.1% of respondents reported trouble in discriminating between credible and less credible information and 30% stated social networks were a source of stress. For this reason, one-third of respondents reduced its use during the COVID-19 pandemic. Regarding meeting attendance, a total of 59.1% of responding physicians preferred in-person meetings to virtual ones, and 51.8% agreed that virtual meetings and social distancing could hamper effective collaboration. Conclusion Social media has a useful role in supporting cancer care and professional engagement in oncology. Although one-third of respondents reported reduced use of social media due to stress during the COVID-19 pandemic, the majority found social media useful to keep up to date and were satisfied with the role social media was playing during the pandemic.

CERT is associated with better outcome with no significantly increased acute toxicities compared to BERT.