Browsing by Author "Nishu Kesh"

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Efficacy and safety of cetuximab-based versus platinum-based chemoradiation in HNSCC: evidence from a meta-analysis of 10 randomized controlled trials
(Springer Science and Business Media Deutschland GmbH, 2025) Tarun Kumar; Nishu Kesh; Atindra Kumar Pandey; Ankita Chakrawal; Bhavana Singh; Manjusha Pal; Monika Rajput; Ruhi Dixit; Esha Pai; Manoj Pandey
Background: Platinum-based chemoradiotherapy (CTRT) is the standard treatment for head and neck squamous cell carcinoma (HNSCC). While cetuximab-based radiotherapy (CxRT) has been proposed as an alternative, its efficacy remains controversial. Multiple meta-analyses have compared CxRT with CTRT for HNSCC though they combined randomized controlled trials (RCTs) with lower-evidence studies, compromising result validity. This study presents the first meta-analysis using exclusively RCT data, providing the highest level of evidence for clinical decision-making. Methods: We systematically searched MEDLINE, Embase, Cochrane, and SCOPUS, identifying 10 RCTs (n = 2,557 patients). Primary outcomes included overall survival (OS), disease-free survival (DFS), and all-cause mortality; secondary outcomes were Grade ≥ 3 toxicities. Hazard ratios (HRs) and odds ratios (ORs) were pooled using random effect models. Results: CxRT was associated with a 50% higher recurrence risk (HR 1.50, 95% CI 1.07–2.10) and 27% increased all-cause mortality (OR 1.27, 95% CI 1.05–1.55) compared to CTRT. OS did not differ significantly (HR 1.33, 95% CI 0.79–2.22). Toxicity profiles varied: CxRT had higher mucositis (OR 1.17, 95% CI 1.04–1.32) and skin rash (OR 3.46, 95% CI 1.28–9.36), while CTRT showed more anemia (OR 0.15, 95% CI 0.05–0.52) and nausea/vomiting (OR 0.31, 95% CI 0.19–0.53). Conclusion: CxRT is inferior to CTRT in HNSCC, with poorer disease control and survival outcomes. The lack of biomarker (EGFR/RAS) stratification in trials may have contributed to suboptimal patient selection. While CxRT may be an option for cisplatin-ineligible patients, platinum-based therapy appears to be the standard. Future research should optimize cetuximab’s role through biomarker-driven selection. © The Author(s), under exclusive licence to Federación de Sociedades Españolas de Oncología (FESEO) 2025.
Influence of Health‑Seeking Behavior on Treatment Initiation of Cancer Patients at a Tertiary Care Hospital in Varanasi
(Wolters Kluwer Medknow Publications, 2025) Nishu Kesh; Manoj Pandey; Sangeeta Kansal
Background: Cancer is one of the leading causes of death worldwide, and in order to prevent it, it is vital to understand cancer patients’ health-seeking behavior that contributes to patient delays in receiving cancer treatment globally; however, no similar studies have been conducted in India. Therefore, this study made an effort to know health-seeking behavior among delayed cancer patients receiving treatment at a tertiary care hospital, Varanasi. Methods: A cross-sectional study was conducted at the Department of Surgical Oncology OPD, Sir Sunder Lal Hospital, IMS, BHU, Varanasi. Randomly selected 440 registered patients were interviewed with the help of semi-structured questionnaire. Binary logistic regression analysis and 2-test were used in this study. Results: Out of total 440 patients included in this study, 207 (47.05%) were males and 233 (52.95%) were females. The majority (59.32%) of patients were more than 45 years of age group. Most (80%) of the patients had delay in cancer treatment of more than 60 days from onset of symptoms. Only 29.55% of patients were aware of any symptoms of Cancer. Those patients who were doing self-medication (P=0.03) and did not attend any cancer screening program (P=0.04) showed a statistically significant association with delayed initiation of treatment. Patients referred from another centre (P = 0.03) also show a significant association with delayed treatment initiation. Cancer patients who visited the screening program (AOR= 0.22, P=0.003) were significantly associated with a lower likelihood of delayed treatment initiation. Conclusion: The study showed that 80% of patients were delayed in seeking treatment for Cancer and highly influenced by low awareness, self-medication and visiting multiple health centres for diagnosis and treatment. Therefore, there is a strong need to address the reasons for the delay in seeking treatment. © 2024 Indian Journal of Community Medicine.
Study on technical, behavioral and organizational factors affecting the performance of mother and child tracking system in rural area of Varanasi district, Uttar Pradesh: A qualitative study
(Indian Association of Preventive and Social Medicine, 2020) Pooja Verma; Sangeeta Kansal; Madhutandra Sarkar; Nishu Kesh; Alok Kumar
Background: The Mother and Child Tracking System (MCTS) portal captures and tracks all pregnant women right from conception up to 42 days after delivery and all children below five years. Objectives: This study was conducted to find out the technical, behavioral and organizational factors that affect the process and performance of MCTS. Material and Methods: This was an exploratory qualitative study conducted in Varanasi district by using multistage random sampling method. Data were collected by in-depth interviews of 48 health care providers. Results: Majority of the ANMs and ASHAs were not aware of the meaning of “Tracking System” and the use of MCTS ID. Inappropriate training of ASHAs, absence of supervision and monitoring by ANMs, overburdened DEOs and ANMs, poor internet connection, slow server speed, software problem and frequent power failures were identified as major factors for poor performance of MCTS. Conclusion: The most effective measure to improve the performance of MCTS would be to properly train grass root level workers so that more efficient data can be fed into MCTS. © 2020, Indian Association of Preventive and Social Medicine. All rights reserved.