Context: Breast cancer is the most common cancer in Indian women with an annual mortality of around 87,000. Treatment for breast carcinoma may lead to swelling of the ipsilateral arm, shoulder stiffness, arm pain, and cancer-related fatigue. Very few centers in India have reported the arm and shoulder morbidity treated in their hospitals. Aims: The aim was to evaluate the predictive factors of arm and shoulder morbidity and fatigue among breast cancer survivors. Settings and Design: This was a retrospective analysis based on a prospectively maintained database. Materials and Methods: Early and locally advanced cases of breast cancer patients were screened for the study during 2015–2018. Eligible participants were invited to fill up the predetermined questionnaire, and their demographic and treatment-related information was accrued from a file archive. Follow-up period was estimated from the date of tissue diagnosis to last contact/time of interview. Results: Shoulder stiffness was the most common complaint followed by arm numbness. Obesity and diabetes played a crucial role in most of the morbidities and fatigue. The median fatigue score was 34, and the median time of appearance of lymphedema was 13 months. Modified radical mastectomy and radiotherapy to axilla were statistically significantly ( P = 0.04 and 0.01, respectively) associated with greater shoulder stiffness and arm swelling. Conclusions: Obesity, diabetes, type of surgery, the extent of axillary dissection, and radiation plan are the major predictive factors of arm and shoulder morbidity. Further prospective validation is necessary for future breast cancer survivorship programs.

Background: Cancer care has suffered during the covid-19 pandemic due to diversion of manpower to treat covid patients and introduction of lockdown measures. Delay in treatment is detrimental to cancer patients. During the national lockdown, many patients were not able to visit our treatment facility. We conducted this study to evaluate the detriment caused by the pandemic on cancer care in terms of disease progression and the socio economic factors associated with delay in presentation.Materials and Methods: Patients visiting our OPD who were being treated at our department and could not visit the facility during the lockdown were selected. Present status of the disease was assessed using clinical examination and radiological tests. Psycho social distress was assessed using PO BADO SF questionnaire. Disease progression, cause of delay was assessed against various factors like per capita family income, cost of transportation etc. Appropriate statistics was used to analyse and represent the data. Results: 50% patients had disease progression. “High cost of transportation” was the most common response given by patients for not visiting the treatment facility during the lockdown. Most patients being treated with radiotherapy (69%) had responded either “high cost of transportation” or “lack of proper accommodation” as cause of delay (p 0.065). Patients with treatment gap of 80 days or more had higher per capita family income, higher cost of transportation during the lockdown and larger distance between residence and treatment facility. 77.5% patients had psycho social distress according to assessment by PO BADO SF questionnaire.Conclusion: COVID 19 pandemic control measures have impacted cancer care in resulting in disease progression, treatment delays and psycho-social distress. A number of factors may have contributed to the treatment delays like high cost of transportation during the lockdown, longer distance between residence and hospital.

No abstract

Submission of an original paper with copyright agreement and authorship responsibility.I (corresponding author) certify that I have participated sufficiently in the conception and design of this work and the analysis of the data (wherever applicable), as well as the writing of the manuscript, to take public responsibility for it. I believe the manuscript represents valid work. I have reviewed the final version of the manuscript and approve it for publication. Neither has the manuscript nor one with substantially similar content under my authorship been published nor is being considered for publication elsewhere, except as described in an attachment. Furthermore I attest that I shall produce the data upon which the manuscript is based for examination by the editors or their assignees, if requested.Thanking you.