Background: There are various drugs tried for relieving pain associated with radiation-induced mucositis. This paper aims to study role of honey in relieving pain due to radiation induced mucositis in head and neck cancer patients receiving concomitant chemoradiation. Materials and Methods: A randomized controlled trial on 78 subjects (40 in test group and 38 in control group) was undertaken to study the analgesic effect of honey, but the analysis of 69 patients was done as nine patients (four in test and five in control group) were lost to follow-up or left treatment in between the study. All patients were advised to do salt-soda and benzydamine mouth gargles, alternatively every 3 hours. Test group patients additionally received 20 ml honey three times a day during the entire course of radiation treatment and 3 months following radiation therapy (RT). Results: Honey significantly reduced the severity of mucositis associated pain and resulted in lesser treatment gaps and a decrease in overall radiotherapy treatment duration. None of the test group and majority of controls (51.5%) had severe pain score during the 7^th week of RT. The same pattern was seen in the post-RT period. Mean pain score was significantly different in both groups during all weeks during and upto 6 weeks post-RT (mean score of 3.08 and 6.54 for test and control respectively at 7^th week RT, P < 0.001). Conclusion: Honey being a cheap, palatable, and natural medicament can be used for decreasing pain associated with radiation-induced mucositis in cancer patients.

Nts on active cancer treatment were enrolled to the study. Functional assessment of chronic illness therapy-spirituality (FACIT-Sp) and FACIT-Fatigue scales were used to assess spiritual well-being and fatigue scores during their cancer treatment. Data were analyzed using one-way analysis of variance and bivariate relationships determined using the Spearman Correlation analysis. Linear regression analysis was performed to determine predictors of fatigue score during treatment. Results: Mean spiritual well-being score was 20.96 out of 48 and scores were significantly higher in females compared with males (P = 0.03), lower with higher stage (P = 0.008) and lower in head and neck and gastrointestinal malignancies (P = 0.03) when compared with gynecological and breast malignancies. Fatigue was present in all the 200 patients studied and the mean fatigue score was 13.09. Higher fatigue scores were observed in patients with advanced stages of cancer (Stage IV) (F [3,199] = 5.67, P = 0.001). There was a significant inverse relationship between fatigue scores with spiritual well-being (P < 0.001). Spiritual well-being score emerged as a significant primary negative predictor (β = -0.23, P = 0.001) for fatigue scores followed by stage of disease (β =0.23, P = 0.001) and gender (β = -0.18, P = 0.01) as significant secondary predictors. Conclusion: Fatigue during cancer directed treatment is influenced by spiritual wellbeing, disease stage and gender. Further studies should examine the mediating variables that influence fatigue....

The advent of molecular profiling has revolutionized the treatment of lung cancer by comprehensively delineating the genomic landscape of the epidermal growth factor receptor (EGFR) gene. Drug resistance caused by EGFR mutations and genetic polymorphisms of drug metabolizing enzymes and transporters impedes effective treatment of EGFR mutant and resistant lung cancer. This review appraises current literature, opportunities, and challenges associated with liquid biopsy and pharmacogenomic (PGx) testing as precision therapy tools in the management of EGFR mutant and resistant lung cancers. Liquid biopsy could play a potential role in selection of precise tyrosine kinase inhibitor (TKI) therapies during different phases of lung cancer treatment. This selection will be based on the driver EGFR mutational status, as well as monitoring the development of potential EGFR mutations arising during or after TKIs treatment, since some of these new mutations may be druggable targets for alternative TKIs. Several studies have identified the utility of liquid biopsy in the identification of EGFR driver and acquired resistance with good sensitivities for various blood-based biomarkers. With a plethora of sequencing technologies and platforms available currently, further evaluations using randomized controlled trials (RCTs) in multicentric, multiethnic and larger patient cohorts could enable optimization of liquid-based assays for the detection of EGFR mutations, and support testing of CYP450 enzymes and drug transporter polymorphisms to guide precise dosing of EGFR TKIs.

Distress is commonly seen in head and neck cancer patients undergoing radiotherapy. Causal factors of distress are multifactorial; which encompasses physical, psychological, spiritual, and existential factors with complex interrelationship among the factors. Thirty patients undergoing head and neck radiotherapy were included in the study. Patients were screened for pain scores, distress scores, physical and psychological symptoms, and spiritual and emotional distress. Significant increasing trend seen for pain score, distress score, and total number of symptoms during 2(nd) week, 4(th) week, and on completion of radiotherapy treatment (all P's < 0.001) compared to pretreatment. Those who had chemotherapy (CT) along with radiation had significantly greater pain score (t = 5.54, P = 0.03) and distress score (t = 3.9, P = 0.05) at 2 weeks into radiotherapy compared to those who did not receive CT. There was significantly higher grade of skin toxicity in those with spiritual distress (Somers' d = 0.36, P = 0.02) and higher grade of mucositis in those with existential distress (d = 0.34, P = 0.02) at 4 weeks into radiotherapy. Positive correlation between distress score and pain score and occurrence of physical symptoms. Increasing trend seen for pain score, distress score, and total number of symptoms during 2(nd) week, 4(th) week, and completion of radiotherapy treatment compared to pretreatment. Increase in distress score in those with existential and spiritual distress.