COVID-19 has abruptly and radically changed the landscape of cancer care delivery throughout the world, including the Philippines. The Philippine General Hospital is the academic hospital of the University of the Philippines. Its cancer centre is a primary referral centre that takes care of Filipinos-many resource-constrained-that are burdened by malignancy. As the global pandemic challenges healthcare delivery, centres are forced to rethink how to care for their patients. This paper discusses how a national, academic, referral cancer institute in a low-middle income country is trying to meet the challenges of COVID-19.

Follicular thyroid carcinoma is the second most common cancer of the thyroid, which usually presents as a solitary thyroid nodule. Diagnosis of follicular thyroid cancer involving the appendicular skeleton is very rare. In this paper, we report a case of a 65-year-old woman who previously underwent partial lobectomy of the left thyroid gland, and who consequently presented with a 2-year history of gradually enlarging left arm mass. Initial whole-body bone imaging revealed a large osteolytic lesion in the humerus. An MRI (magnetic resonance imaging) of the left arm showed a heterogeneously enhancing, encapsulated, soft tissue mass with humeral involvement, and the initial impression was osteosarcoma versus fibrosarcoma. Biopsy reading of the humeral mass was morphologically compatible with a well-differentiated metastatic thyroid carcinoma. She subsequently underwent right lobectomy where histopathology showed Hashimoto’s thyroiditis. A slide review was requested and the biopsy of the humeral mass revealed adenocarcinoma with follicular architecture, compatible with a metastatic thyroid carcinoma. Meanwhile, the findings on the right thyroid lobe revealed a multinodular colloid adenomatous goiter with hyperplastic features in a background of Hashimoto’s thyroiditis. This report demonstrated a rare presentation of follicular thyroid carcinoma metastasizing to the humerus that can be confused with primary bone tumors, both clinically and radiologically. Early diagnosis and a high index of suspicion is foremost for immediate and appropriate management. Publication Date: 09 August 2020 (online) © . Thieme Medical and Scientific Publishers Private Ltd. A-12, Second Floor, Sector -2, NOIDA -201301, India

Current treatments for metastatic non-small cell lung cancer (NSCLC) have improved survival but remain non-curative, primarily aiming to control disease and to extend life. Structured exercise has demonstrated clinical and quality-of-life benefits in early-stage NSCLC. This systematic review assesses the impact of adjunctive exercise programs on health-related quality of life (HRQoL) in advanced NSCLC patients, with safety as a secondary outcome. Of 1168 studies screened, 13 met the inclusion criteria. All eligible studies were included in the systematic review, and three underwent meta-analysis. Using Synthesis Without Meta-analysis (SWiM), the findings were heterogeneous: four studies showed positive outcomes, two had mixed results, and seven showed negative outcomes. Meta-analysis of studies utilizing the EORTC-C30 tool demonstrated a positive mean difference of 1.57 (95% CI: 0 to 3.14), indicating a trend toward HRQoL improvement. Safety analyses largely revealed no major adverse events related to exercise interventions. Future studies must therefore be designed to account for confounders intrinsic to the underlying disease of study participants to better determine both the efficacy and the safety of structured, adjunctive exercise programs in this patient population.