Background The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India. MethodsWe did an ambidirectional cohort study at 41 cancer centres across India that were members of the National Cancer Grid of India to compare provision of oncology services between March 1 and May 31, 2020, with the same time period in 2019. We collected data on new patient registrations, number of patients visiting outpatient clinics, hospital admissions, day care admissions for chemotherapy, minor and major surgeries, patients accessing radiotherapy, diagnostic tests done (pathology reports, CT scans, MRI scans), and palliative care referrals. We also obtained estimates from participating centres on cancer screening, research, and educational activities (teaching of postgraduate students and trainees). We calculated proportional reductions in the provision of oncology services in 2020, compared with 2019. FindingsBetween March 1 and May 31, 2020, the number of new patients registered decreased from 112 270 to 51 760 (54% reduction), patients who had follow-up visits decreased from 634 745 to 340 984 (46% reduction), hospital admissions decreased from 88 801 to 56 885 (36% reduction), outpatient chemotherapy decreased from 173634 to 109 107 (37% reduction), the number of major surgeries decreased from 17 120 to 8677 (49% reduction), minor surgeries from 18 004 to 8630 (52% reduction), patients accessing radiotherapy from 51 142 to 39 365 (23% reduction), pathological diagnostic tests from 398 373 to 246 616 (38% reduction), number of radiological diagnostic tests from 93 449 to 53 560 (43% reduction), and palliative care referrals from 19 474 to 13 890 (29% reduction). These reductions were even more marked between April and May, 2020. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months. Reductions in the provision of oncology services were higher for centres in tier 1 cities (larger cities) than tier 2 and 3 cities (smaller cities).Interpretation The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial.

Background: Breast cancer is the most prevalent cancer among women worldwide and it is found to be increasing. Breast cancer survivors are threatened with various problems due to disease itself or its treatment and might exist for a long period even after treatment. The existing knowledge on experiences and needs among breast cancer survivors in India is very limited. The present study aimed to explore the experiences and needs of breast cancer survivors. Methods: In the present study qualitative study design was used and 17 breast cancer survivors, post six months of completed cancer treatment were selected using purposive sampling technique. In-depth interviews were conducted, the data was transcribed and translated and codes and theme were developed. Results: The study explored the needs and experiences of breast cancer survivors. The experiences of breast cancer survivors were as follows; awareness, psychological expressions, spirituality and misconceptions, economic burden, confinement, body image and bashfulness, maintaining secrecy, family support and physical burden. The needs of breast cancer survivors were identified as financial, informational, breast reconstruction surgery, help in household activities, family support, counseling and emotional support. Conclusion: Recognizing the experiences and needs of the breast cancer survivors by the family members, health care workers, community members and policy makers after the end of treatment is important to facilitate optimal delivery of health care at the community settings to improve the quality of life of breast cancer survivors.

Cellular and molecular approaches are being explored to find a biomarker which can predict the development of radiation induced acute toxicity prior to radiation therapy. SNPs in radiation responsive genes may be considered as an approach to develop tools for finding the inherited basis of clinical radiosensitivity. The current study attempts to screen single nucleotide polymorphisms/deletions in DNA damage response, DNA repair, profibrotic cytokine as well as antioxidant response genes and its predictive potential with the normal tissue adverse reactions from 183 head and neck cancer patients undergoing platinum based chemoradiotherapy or radiotherapy alone. We analysed 22 polymorphisms in 17 genes having functional relevance to radiation response. Radiation therapy induced oral mucositis and skin erythema was considered as end point for clinical radiosensitivity. Direct correlation of heterozygous and mutant alleles with acute reactions as well as haplotype correlation revealed NBN variants to be of predictive significance in analysing oral mucositis prior to radiotherapy. In addition, genetic linkage disequilibrium existed in XRCC1 polymorphisms for >grade 2 oral mucositis and skin reaction indicating the complex inheritance pattern. The current study indicates an association for polymorphism in NBN with normal tissue radiosensitivity and further warrants the replication of such studies in a large set of samples.

Sample size determination is one of the central tenets of medical research. If the sample size is inadequate, then the study will fail to detect a real difference between the effects of two clinical approaches. On the contrary, if the sample size is larger than what is needed, the study will become cumbersome and ethically prohibitive. Apart from this, the study will become expensive, time consuming and will have no added advantages. A study which needs a large sample size to prove any significant difference in two treatments must ensure the appropriate sample size. It is better to terminate such a study when the required sample size cannot be attained so that the funds and manpower can be conserved. When dealing with multiple sub-groups in a population the sample size should be increased the adequate level for each sub-group.  To ensure the reliability of final comparison of the result, the significant level and power must be fixed before the sample size determination. Sample size determination is very important and always a difficult process to handle. It requires the collaboration of a specialist who has good scientific knowledge in the art and practice of medical statistics. A few suggestions are made in this paper regarding the methods to determine an optimum sample size in descriptive and analytical studies.Key Words: Sample size; Power analysis; Medical researchDOI: 10.3126/nje.v1i1.4100Nepal Journal of Epidemiology 2010;1 (1):4-10