Background: Head and neck cancer is one of the leading cancers among Indian population. Early diagnosis and treatment is cornerstone for improving survival in any malignancy, any delay leads to advanced form of disease, leading to higher morbidity and mortality. Given the location, head and neck cancers are easily visible or palpable on clinical examination. In spite of this, many patients are diagnosed at advanced stage.Methods: A cross sectional observational study was conducted at a tertiary care center of western india including 156 newly diagnosed head and neck cancer patients. Delay in seeking medical attention was defined as time interval of more than 3 months from the first symptom recognition to the first medical consultation. Subjects were then divided into delay and non-delay group and compared to identify the factors associated with delay in seeking medical attention.Results: Delay in seeking medical consultation was seen in 109 (69.9%) patients. The factors found significantly associated with delay were older age (p<0.001), rural background (p<0.001), illiteracy (p<0.001), joint family (p<0.001), poor socioeconomic status (p<0.001), longer distance from hospital (p<0.001), tobacco chewing (p=0.018), insufficient knowledge (p<0.001) and fear (p=0.031) of the disease.Conclusions: Many of the identified factors for delay in seeking medical attention in head and neck cancer patients are amenable to improvement. Improving health coverage and awareness of available health services, specially in far rural areas could prevent delay in diagnosis and treatment and thus significantly reduce morbidity and mortality as well as burden on health system.
Context:In India, a considerable proportion of patients with head and neck cancer present with locoregionally advanced disease. Symptom palliation becomes a major objective in these cases when they could not be considered for a curative approach.Aims:The aim of this study is to assess the role of palliative radiotherapy for symptom control in patients with locally advanced head and neck cancer.Settings and Design:This was a retrospective study.Subjects and Methods:Between July 2015 and June 2016, 98 patients with stage IV head and neck cancer were treated with palliative radiotherapy 25 Gray (Gy)/4 fractions (fr)/1 fraction (6.25 Gy)/week. Presenting symptoms were noted. The primary end point was relief of symptoms in the 4th week after radiotherapy. Percentage symptom relief was quantified by the patient using a rupee scale. Treatment response was noted using the WHO criteria. Acute toxicity was graded as per the Radiation Therapy Oncology Group (RTOG) criteria.Results:The most common presenting symptom was pain. At 4 weeks after radiotherapy completion, all patients had >50% pain relief. Dysphagia was improved in 82% of patients. Respiratory distress was improved in all the symptomatic patients. Tumor complete response (CR) was seen in 2 patients, partial response in 89, stable disease in 3, and progressive disease in 4. RTOG Grade 2 and 3 acute skin and mucosal toxicities were seen in 29% and 27% cases, respectively. No patient had Grade 4 adverse effect.Conclusions:Hypofractionated radiation could provide effective symptom palliation in advanced head and neck cancers. The weekly schedule was well tolerated and found convenient by the patients.
Cisplatin and paclitaxel both can cause peripheral neurotoxicity as an adverse effect; however, central nervous system neurotoxicity in the form of seizures is rare. We report a case of a 36-year-old female patient of metastatic carcinoma cervix, who developed seizure shortly after cisplatin infusion. Her laboratory investigations were within normal limits. Computed tomography scan and magnetic resonance imaging of the brain did not reveal brain primary metastasis or meningeal carcinomatosis. She had no complaints of fever, no signs and symptoms of infection, and no history of seizure nor was she on any medication predisposing to such an event. Excluding several causes, seizure was thought to be most likely related to the chemotherapy and cisplatin was the more likely agent in view of observed temporal relationship with the adverse event.
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