Ongoing Projects

Summary: The treatment practices for endometrial cancer have significantly changed over the last two decades. Nowadays, in addition to standard pathology, additional tests are performed to understand  the behaviour of tumour so that personalized treatment can be advised for every patient. This approach ensures that patients with good cancer cell features receive minimum  essential radiotherapy or surgery treatment with fewer side effects, while those with poor cell features undergo more aggressive treatment to improve their chances of survival. However, this approach is not widely adopted in Asian countries. To address this, we are launching a project to gather data from various hospitals across Asia. The project aims to understand how different cancer cell factors impact treatment decisions and identify better ways to select additional treatment plans based on a patient's cancer cell features. The project will gather data from around 250-300 patients who were evaluated or treated between January 2021 and December 2023. It will run for two years to improve our understanding and gain insights into the best ways to treat endometrial cancer.

Summary: Gynecological cancer poses as significant public health issue, especially in Asian countries, where it is a leading cause of cancer-related deaths among women. Cervical cancer accounts for around 311,000 deaths annually, with over 85% occurring in low- and middle-income nations, primarily in Asia. Factors contributing to this burden include limited access to preventive care, inadequate screening, high rates of human papillomavirus infection, and cultural barriers that delay medical attention. For patients with advanced cervical cancer, the standard treatment involves external beam radiation therapy along with chemotherapy followed by internal radiation, known as Brachytherapy. This technique uses unique set of devices placed internally at the tumor site giving localized radiation to the residual tumor tissue. While advanced brachytherapy techniques have been developed and practiced in Europe and American countries yielding excellent clinical outcomes, there is insufficient data on the use and results of such advanced brachytherapy techniques in Asian populations, leading to a lack of standardized practices. To address these issues, the Asian Gynecological Brachytherapy Registry (ABGR) has been established as a collaborative platform for data collection and analysis on the use of Brachytherapy techniques. This registry aims to consolidate information from various healthcare settings across Asia, enhancing understanding of cervical cancer's epidemiology, evaluating treatment effectiveness, and identifying areas for improvement in patient care.

Summary: Cancer treatment is an expensive affair as it not only entails higher direct cost but also leads to increased indirect cost due to out-of-pocket expenditure and wage loss. This pushes patient and family to medical impoverishment thereby leading to financial toxicity (FT). Moreover, inequitable distribution of cancer care forces vulnerable patients to face inaccessibility and unaffordability. This leads to diagnostic delay and inability to receive timely cancer treatment. Socioeconomic impact of cancer has been studied earlier by the Association of Southeast Asian Nations (ASEAN). In this study, it was observed that at 3 months from diagnosis, 31% of participant’s experienced financial catastrophe (FC), 8% had died and 23% of them had discontinued treatment. The percentage of patients experiencing FC and death had alarmingly increased two-three-fold by the end of one year. Such data from other regions of “The Federation of Asian Organizations for Radiation Oncology (FARO)” is not available. Studying the risk and extent of financial toxicity will not only help to recognize the vulnerable population but also allow us to know the potential drivers of FC. The delay in diagnostics and surgical/radiotherapy waitlist have a compounding effect on this vulnerability. Hence studying the key components of FC will help in better understanding of the roadblocks for reducing FIT. As the out-of-pocket expenditure and wage loss forms the main component of FC, it is important to assess the diagnostic delays and waiting times for surgery/systemic therapy/radiation therapy. Prolongation of treatment duration increases the indirect cost on food, travel, and accommodation in addition to loss of productivity. This study will provide opportunity to assess the incidence of FT and correlate the risk of FT with the key quality parameters of the respective cancer diagnostic and treatment modalities. Thus, key areas for future collaborative research within the FARO region to improve the quality of cancer care can be identified. This will also enable integrated data capture and uniform data reporting platform that can be used for future health-economic research within the member countries of the FARO.

Summary: The standard treatment approach of localised rectal adenocarcinoma involves neoadjuvant radiotherapy and chemotherapy followed by assessment for surgery and optional adjuvant chemotherapy.  However, such patients who achieve  complete  of  near  complete  clinical response after neoadjuvant therapy are increasingly being managed with the ‘Watch-and-Wait strategy’ in the recent years. Although safety of such policy has been established, the patient population in the published studies are not represented well by Asian population. Moreover, the data about safety of such policy in the setting of modern neoadjuvant strategies is limited. We propose a multinational collaborative prospective database study in Asia to systematically collect data on patients being managed with such a strategy. The target population is patients with localised rectal adenocarcinoma achieving near complete or complete response being managed by the Watch-and-Wait strategy. The primary end point being local regrowth and other survival and quality of life end points will be evaluated as well. A secure multinational database will be generated over 5 years with an estimated expected minimal sample size of 337 patients over  5  years  across  7-10  Asian  institutes  to  precisely  evaluate  the  required endpoints. Ethical and legal requirements will be met at each participating institute.