Prashant Mathur

Background: Cancer is a significant public health challenge in India, contributing to 8.3% of deaths and 5.0% of disability-adjusted life years in 2016—nearly twice its contribution in 1990. Fragmented service delivery, limited specialist availability, late presentation, and significant financial hardship continue to hinder access to timely and effective cancer care, particularly in rural and underserved regions. A comprehensive, system-level assessment is essential to inform evidence-based planning and strengthen cancer services nationwide. Objective: This study aims to assess the availability, readiness, accessibility, and quality of cancer care services across primary, secondary, and tertiary health care facilities in India. Specifically, it will evaluate infrastructure, human resources, diagnostic and treatment capacity, referral pathways, and service delivery across the 6 Institute of Medicine quality domains (equitable, effective, patient-centered, safe, efficient, and timely); compare rural-urban and public-private disparities; and use these findings to develop an evidence-informed framework for strengthening cancer care services and informing national policy and program planning. Methods: A 3-year cross-sectional descriptive study was conducted across 31 states and union territories using proportionate district sampling based on rural-urban population distribution. Nodal hospitals coordinated data collection from primary, secondary, and tertiary health care facilities. Facility-level data were collected using 3 standardized electronic forms—developed separately for primary, secondary, and tertiary levels of care—covering infrastructure, workforce, diagnostic and treatment services, referral systems, and service. Descriptive statistics will be used to summarize service availability and readiness, and chi-square tests to compare rural-urban, public-private, and facility-level differences. Results: The study received funding in October 2023. Facility-level data collection took place between July 2024 and March 2026. We enrolled 6896 health facilities (4353 primary, 1979 secondary, and 564 tertiary) from 352 districts across 31 states and union territories, with participation rates of 64.6% (4353/6735) for primary health centers, 75.7% (1979/2612) for secondary-level facilities, and 63.9% (564/902) for tertiary hospitals. Data cleaning and quality checks are complete, and analysis is complete but unpublished; we will report results on service availability, readiness, and regional variation separately. Conclusions: This nationwide assessment is expected to provide one of the most comprehensive evaluations of cancer care preparedness undertaken in India. Findings are anticipated to inform national policy and program planning, including investment priorities under the NP-NCD, Ayushman Bharat, and related initiatives to support progress toward equitable, comprehensive cancer care and universal health coverage.

Introduction: Although accurate information on cancer stage at diagnosis is critical for surveillance, cancer registries in low‐ and middle‐income countries (LMICs) report incomplete stage data. The use of multiple stage classification systems—UICC/AJCC‐TNM‐system, SEER‐Summary‐Stage (SSS), Essential‐TNM (ETNM), and Condensed‐TNM (CTNM) complicates their utility and interoperability. The lack of a unified framework for translating between their categories limits data harmonization for global epidemiological analyses. Materials and Methods: This study introduces a mapping framework for translating these four staging systems for common screening‐amenable cancers (breast, cervical, colorectal, and oral). Using the TNM criteria as reference, all categories were systematically compared and mapped to corresponding categories in SSS, ETNM, and CTNM. The fields were color‐coded to visualize prognostic gradients across classifications. This mapping was then validated using a registry‐wide representative sample of 4,000 cancer cases with an assigned TNM stage. Matches were categorized as either being complete or as first‐ or second‐degree mismatches to assess the extent of concordance and discordance. Results: Our analysis highlighted cancer‐specific variations in prognostic gradation and concordance. Cervical and colorectal cancers had a steady gradient, representing the best‐case scenarios, while breast and oral cancers showed greater discordance. Overall, SSS aligned with TNM categories, depicting maximal one‐to‐one associations. While ETNM is more concordant for colorectal cancer (100% match vs. 89%), SSS is most concordant for cervical cancer (80%), and to a lesser extent, breast cancer (77%). CTNM offers the least concordance with traditional TNM across cancer sites. Localized and metastatic stages aligned almost universally, except in oral cancer. Conclusion: This mapping exercise provided a comprehensive framework for translating cancer stage categories, offering LMIC registries a way to balance clinical relevance, epidemiological utility, and operational feasibility. Concordance among the systems varied by cancer type, underscoring the need for cancer‐specific adaptations.

Background: Cervical cancer remains a leading cause of cancer mortality in low- and middle-income countries, where access to comprehensive radiotherapy is limited. Although brachytherapy is a key component of definitive chemoradiation for locally advanced cervical cancer, omission remains common in resource-constrained settings We aimed to quantify the survival benefit obtained from integration of brachytherapy to EBRT using hospital-based registry data from India.Methods: This multicentre observational study used data from the Patterns of Care and Survival Study under India’s National Cancer Registry Programme. Women aged 15 years or older with stage I–IVA cervical cancer diagnosed between January 1, 2009, and December 31, 2020, with follow-up until April 30, 2024, were included. The primary endpoint compared was overall survival, and the secondary endpoint was recurrence-free survival. Propensity scores were estimated using multivariable logistic regression, followed by 1:1 nearest-neighbour matching with replacement. Weighted Kaplan–Meier and Cox proportional hazards models with robust variance estimation were used.Findings: Among 49,798 registered female cases, 22,922 were included in the final propensity score–matched cohort. EBRT plus brachytherapy was associated with significantly improved overall survival compared with EBRT alone (HR 0·78, 95% CI 0·70–0·87; p<0·0001). Five-year overall survival was 74·4% with EBRT plus brachytherapy versus 69·8% with EBRT alone. Advanced stage disease, pelvic and para-aortic nodal involvement, adenocarcinoma histology, higher tumour grade, and radiotherapy duration longer than 56 days were independently associated with poorer survival, whereas chemotherapy improved survival. Radiotherapy type was not independently associated with recurrence-free survival after adjustment.Interpretation: Brachytherapy remains an essential component of definitive radiotherapy for cervical cancer, and omission is associated with inferior survival. Expanding timely and equitable access to brachytherapy-based chemoradiation in carcinoma cervix, which remains a global health concern, should remain a priority in resource-constrained settings.

Profiling of tumour board characteristics and functioning for cancer care under hospitals registered under National Cancer Registry Programme in India Goku

Background: India is facing a growing burden of stroke due to population aging, lifestyle changes, and increased exposure to risk factors. However, longitudinal data on stroke patterns and outcomes in India are limited. Objectives: This study assessed stroke patterns, risk factors, management practices, and outcomes using data from the Hospital-Based Stroke Registries (HBSRs) in India. Methods: This prospective hospital-based registry included 34,792 stroke cases from 30 centers across India, recorded between 2020 and 2022. Data on demographics, clinical features, risk factors, diagnostics, treatments, and outcomes were collected, with follow-up at 28 days and 3 months. Functional outcome was assessed using the modified Rankin Scale (mRS), along with data on recurrence. Results: The mean age was 59.4 years; 13.8% were aged under 45, 63.4% were male, and 72.1% were from rural areas. Hypertension (74.5%) was the most common risk factor, followed by smokeless tobacco use (28.5%) and diabetes mellitus (27.3%). Ischemic stroke accounted for 60% of cases. Only 20.1% were presented within 4.5 h of symptom onset, while 37.8% of cases presented after 24 h. Motor impairment (74.8%) followed by speech disturbance (51.2%) were the commonest symptoms at onset. Thrombolysis was given in 4.6%, and thrombectomy in 0.7%, of ischemic strokes. At 3 months, 27.8% had died, 29.7% had significant disability (mRS 3-5), and 1.1% had a recurrent stroke. Conclusion: In this study, one in 7 stroke were in the young, 2 in 5 patients arrived after 24 h of symptom onset, and thrombolysis and mechanical thrombectomy were underutilized. Over half had poor 3-month outcomes, highlighting the need for improving comprehensive stroke care across India.

Gallbladder cancer is the fifth most common gastrointestinal cancer worldwide, often diagnosed incidentally after cholecystectomy for presumed benign disease. Previous studies have reported geographic variations in the incidence of incidental gallbladder cancer (IGBC), but comprehensive pooled estimates examining multiple predictors of IGBC are lacking. The study aims to synthesize the risk factors and clinical predictors associated with IGBC in patients undergoing cholecystectomy for benign gallbladder conditions. This systematic review and meta-analysis assessed studies published between January 2010 and February 2024 in databases from EMBASE, PUBMED-MEDLINE, and Scopus. Eligible studies included observational study designs evaluating risk or predictive factors for IGBC diagnosed during or after cholecystectomy for presumed benign gallbladder disease. Heterogeneity across studies was assessed using the I² statistic. Sensitivity analyses were conducted to explore the robustness of the pooled estimates. Of 2899 studies screened, 18 were included in the systematic review and 9 of these were included in the meta-analysis, covering 788,214 patients undergoing cholecystectomy. Advancing age (OR:1.09; 95% CI:1.07-1.12, I²=55.9%), female gender (OR:1.91; 95% CI:1.33-2.75, I² = 72.1% ), elevated alkaline phosphatase (OR:1.68; 95% CI:1.41-2.00, I² = 0%), polyp size > 10 mm (OR:8.63; 95% CI:1.95-38.26, I² = 0%), and open cholecystectomy (OR:9.20; 95% CI:5.68-14.89, I² = 83.5%) were found to have association with IGBC. Large gallstones (> 3 cm) showed no significant association. Risk of bias was low, and sensitivity analyses confirmed model robustness. This review identifies key demographic, and clinical factors associated with IGBC. These findings support the need for risk-based preoperative evaluation and careful intraoperative vigilance, particularly in patients with advanced age, female gender, elevated alkaline phosphatase, and larger gallbladder polyps. Incorporating these predictors into clinical decision-making may guide targeted histopathological examination policies, leading to earlier GBC detection and improved patient outcomes. PROSPERO Registration No: CRD42024528982.

Background: Medical Certification of Cause of Death (MCCD) coverage in India is only 22.5%, largely due to a significant proportion of deaths occurring outside hospitals (noninstitutional deaths). The cause of death (CoD) in such cases is unlikely to be certified by any doctor. This study attempts to address this gap by developing an MCCD system for noninstitutional deaths in India. Objective: This study will assess the feasibility of a physician-derived cause of death (PhyCoD) approach for deducing CoD in noninstitutional deaths in a selected area of Kolar Taluk, Karnataka, and validate this approach. Methods: This population-based feasibility and validation study will be conducted in 4 selected hospitals and 2 Primary Health Centre (PHC) areas in Kolar taluk, Kolar district, Karnataka, India. We developed 4 PhyCoD questionnaires: maternal, neonatal, child, and adult. Institutional deaths that occurred over the previous 10 months in these selected hospitals with detailed case records available were selected as “gold standard” cases. Trained investigators abstracted the history from these case records into the questionnaires and deduced the CoD sequence of events. The investigators then elicited the history from the deceased’s relatives using the PhyCoD questionnaire and deduced the CoD sequence of events. This will be compared with the gold standard CoD sequence of events deduced from medical records. The extent of agreement will be measured. The tool will be revised based on the pilot phase experiences. For all brought dead cases to the 4 hospitals and home deaths in the 2 PHC areas over a 3-month period, doctors in these hospitals and PHC medical officers, respectively, will elicit the history from the deceased’s kin using the PhyCoD questionnaires and arrive at a CoD sequence of events. This CoD sequence of events will be validated against the gold standard autopsy whenever possible (in brought dead cases). The PhyCoD approach will also be tested for inter-rater reliability by independent investigators on a random sample of noninstitutional deaths. Results: Institutional ethics committee clearance (January 2024), recruitment and training of project staff (January 2024-January 2025), preparation of questionnaires and application (August 2024-February 2025), pilot phase data collection (48 cases; August 2024-December 2024), and training of the doctors in the participating hospitals and PHC medical officers (December 2024) are complete. A total of 48 cases (32 adult, 7 child, 3 maternal, and 6 neonatal) were included in the pilot phase. Data review and analysis of the pilot phase data are underway. Conclusions: The study is expected to provide information about the validity and feasibility of the PhyCoD approach. Depending on the study’s outcomes, the tool may be adopted by more states, leading to increased coverage of noninstitutional deaths under MCCD, improved accuracy, and reduced delay of CoD reporting for noninstitutional deaths. International Registered Report Identifier (IRRID): DERR1-10.2196/72330