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  Table of Contents  
NEWS
Year : 2021  |  Volume : 58  |  Issue : 1  |  Page : 147-148
 

News from the world of oncology



Date of Submission11-Mar-2021
Date of Decision11-Mar-2021
Date of Acceptance11-Mar-2021
Date of Web Publication24-Mar-2021

Correspondence Address:
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_282_21

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How to cite this article:
. News from the world of oncology. Indian J Cancer 2021;58:147-8

How to cite this URL:
. News from the world of oncology. Indian J Cancer [serial online] 2021 [cited 2021 Apr 16];58:147-8. Available from: https://www.indianjcancer.com/text.asp?2021/58/1/147/311852





  Metformin and GI cancers in patients with type 2 DM Top


Metformin is a common drug used to treat type 2 diabetes mellitus (DM). It has a long history with its first reported use for DM in 1957. Increased risk of lactic acidosis initially decreased its usage. Interest in metformin was renewed with the discovery of its ability to offset insulin resistance and improve adult-onset hyperglycemia without causing hypoglycemia. Its cardioprotective effect was later identified in the UK in 1998.

The anticancer effect of metformin has also been studied extensively. This effect is mainly mediated through its activation of the adenosine monophosphate-activated protein kinase (AMPK), which in turn causes inhibition of the mammalian target of rapamycin (mTOR) and the IGF1 (insulin-like growth factor 1) pathways. Both these pathways are mitogenic resulting in cell growth and proliferation.

A population-based study was published by Ji Hong You et al. in Clinical and Translational Gastroenterology 2020 (Metformin and gastrointestinal cancer development in newly diagnosed type 2 diabetes: A population-based study in Korea https://doi.org/10.14309/ctg.0000000000000254).

This was a retrospective study of patients with newly diagnosed type 2 DM from the Korean National Health Insurance Service database between January 1, 2005 and December 31, 2014. These patients had been prescribed antidiabetic medicines at least twice in this period and those who received insulin were excluded. Patients who had been prescribed metformin for >180 days, of 365 were considered metformin users and others were considered nonusers. In the final analysis, a matched sample of 131,877 metformin users and 131,877 metformin nonusers were assessed. They were evaluated for the development of four GI cancers (stomach, colon, liver, and pancreas). In addition, association with age, sex, cumulative metformin dose, and duration of metformin was also looked at.

A total of 19,458 patients were diagnosed with gastrointestinal (GI) cancers during this period. Incidence of stomach, colon, and liver cancers was much lower in metformin users, although incidence of pancreatic cancer was higher in this subgroup. Those less than 50 years had a reduced incidence of stomach and liver cancers. The cumulative dose and duration of metformin also influenced the occurrence of GI cancers in this population. Stomach and liver cancers were reduced at a cumulative dose of 240,000–1,200,000 mg, whereas the risks of colon and pancreatic cancers were reduced at a cumulative dose of >1,200,000 mg. The risks of all four cancers were reduced when the exposure duration was >2,000 days.

The study concluded that metformin use may reduce the risk of stomach, liver, and colon cancers and pancreatic cancers in some subgroups. Controlled trials would be necessary to evaluate its role in cancer prevention.

Uma Dangi

ORCID iD: https://orcid.org/0000-0001-5973-6379


  Telemedicine in COVID-19 times: Blessing in disguise for patients with cancer! Top


The coronavirus disease-2019 (COVID-19) pandemic bought new challenges of infection and potentially fatal complication related to severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection for patients with cancer. During the peak of COVID-19 pandemic, Tata Memorial Hospital at Mumbai had to de-escalate their treatment by 50%, leading to under reporting of new cancer cases, risk of cancer progression of the existing treatable disease, and later overwhelming the cancer care with advanced untreatable cases.

When people were apprehensive, with completely disrupted transport facility and strict government orders to stay home, telemedicine emerged as a platform for remote care of patients with cancer. Telemedicine is not unsubstantiated. When searched for “Telemedicine” and “Cancer” on PubMed search engine, a quarter (637) of all the publication up till now were published in 2020. Majority of the publication supported the newly discovered remote cancer care.

A prospective diagnostic cohort trial lead by Malik et al. conducted at Tata Memorial Centre titled “Outcomes of a telephone-based questionnaire for follow-up of patients who have completed curative-intent treatment for oral cancers” was published in JAMA Otolaryngology - Head & Neck Surgery (https://doi: 10.1001/jamaoto. 2020.2404).

The study was done in a pre-COVID era, with the primary aim of detecting recurrences in patients with radically treated oral cavity cancers. This diagnostic trial included 400 patients who were subjected to telephone-based questionnaire scheduled 2 weeks before their visit to be examined by a trained and blinded Head and Neck surgeon. They were followed-up to 2 years after their curative treatment. The telephone-based questionnaire was found to have sensitivity of 90.0% and negative predictive value of 99.3%. One-third of the patients were satisfied with telephone-based follow-up. This study has shown that telephone-based follow-up can be feasible for a subset of patients with cancer. It may also help avoid overcrowding in clinics, enhance proper use of healthcare resources, and deter unnecessary clinic visits for patients in COVID times when social distancing is paramount in potential comorbid patients with cancer.

Indian Medical Association has confirmed the importance of telemedicine by marking 24th March as the telemedicine day. However, there is a need to develop infrastructure in our country where majority of the population do not have access to hardware, advanced internet facility, and technical expertise to support this medium. We also need our healthcare worker to be trained with this field of medicine in order to develop the remote cancer care. Although we need to work hard on our limitations, telemedicine would still emerge as an independent stream in the near future. As aptly stated by Howard West in his perspective article published in the Frontiers in Oncology journal (Telemedicine in oncology: Delivering on an overdue promise in the COVID-19 Era, https://doi.org/10.3389/fonc.2020.578888), during COVID-era, telemedicine is not an interim solution rather it is a birth of new medicine for specific subset of patients with cancer.

Hitesh Rajendra Singhavi

ORCID iD: https://orcid.org/0000-0001-8191-0951






 

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