Future Plans

A) AUGMENTING CARE PATTERN:

There is lack of staff and ever increasing patient numbers .It is  difficult to maintain quality with the quantity, however , we can introduce innovative ideas inclusive of layering  and introduction of efficient medical & paramedical staff  to bridge the gap. Same time we can triage patients  to be judicious in registering the ones where in we can make significant difference in prognosis and for others a collaboration with peripheral teams can be an option.

• Physician Assistant
• Chemo-nurses
• Reaction -Team
• Home based care –especially for palliative patients

Triaging Patients at presentation to treat at the institution versus elsewhere based on life expectancy , nature of the disease , options available and prior treatment received versus not.

B) PRECISION CARE:

My vision for coming years is to introduce a “Precision care model” , wherein, focused, enhanced care delivery can be delivered  via the dedicated clinics. I believe there is a scope and need to develop focused care clinic where in segregation metrics could be age, gender and prevalence of cancer.

I envisioned ,focused  adolescents and young adults, fertility & pregnancy associated cancers clinic, geriatric, gender medicine, nutrition , enhanced supportive care clinic , and a dedicated molecular and Immuno-oncology unit. These subdivisions empower us to deliver precise, tailor- made care to our patients and improve the care pattern.

I wish to enhance collaborative efforts nationally and internationally to enhance the care patterns and mutually learn and improve multi-pronged patient care and research.

There are certain measures which were opted in order to move in this direction as follows:

Immuno-oncology

Immuno-oncology has entered in oncology armamentarium in a big way and is actually revolutionized the management of many difficult to treat cancers. This is of special interest to me and I wish to develop it in our center as well as in the country.  In India, cancer immunotherapy is at a relatively nascent stage and somewhat dependent on import and adoption of technologies and drugs patented in the more developed countries. India, with its huge cancer burden and a largely poor populace is in dire need of new technologies that can rapidly be taken through trials and brought to our patients at affordable costs. This will only be possible if the clinical and scientific community from across diverse fields with an interest in the interplay of immunology and oncology get together and focus their knowledge, skills and energies on this emerging field.

Along with an interest group of people I established a Society dedicated to the academic pursuit and growth of this field, the Immuno-Oncology Society of India (IOSI) and Iam the founding General Secretary for the same. The society is a registered legal entity with government. The aim of the Society will be to “promote development, implementation, and dissemination of scientific, evidence-based and comprehensive management of cancers by immunotherapy, and encourage basic and clinical research in the complex interplay of immunology and oncology.” Our registry study from an abbreviated IO protocol which is cost effective and with wider applicability especially in LMICs and got published in IJC as follows:

• Abraham G et al. (corresponding author-Bajpai J)."The clinical utility and safety of Short Course Immune check point inhibitors (ICI) in multiple tumors - A real world multicentric study from India". International Journal of Cancer. Int J Cancer. 2021 Nov 9. doi: 10.1002/ijc.33868. Online ahead of print.
• Srinivas S, Bajpai J. Immunotherapy in special and rare situations: a brief review. J Immunother Precis Oncol. Published online. DOI: 10.36401/JIPO-21-6.
• Bajpai J. Cancer Immunotherapy for immuno compromised Patients: An Often Ignored, yet Vital Puzzle. Journal of Immunotherapy and Precision Oncology (2020)3 (1): 1–2https://doi.org/10.4103/2666-2345.278414

We have organised regular annual I-OSI congresses, which were attended by world leaders including the Nobel laureates in the field and increased awareness of IO substantially. Both these congress have projected our institute TMH, I-OSI and country as a whole in world map as far as IO is concerned and will help in bringing more international trials to India to increase patient access to these lifesaving drugs.

I-OSI is collaborating with international societies with the common goals and notably, World Immuno-Council (WIC) has recognized I-OSI as partner and we are regularly invitee in their symposiums. There are collaborative efforts with Society of Immunotherapy in cancers (SITC) and European society of Medical Oncology (ESMO) as well. ESMO has included me as their investigational IO track faculty for 4 years block. SITC has involved me in their global access and impact committee as core member.

Furthermore, I wish to establish a dedicated Immuno-oncology unit I the institute, this will be the first of its kind in the country and will impact patient care substantially. I had exposure to a focused IO unit in Memorial Sloan Catering Institute and that experience and global connect with world leaders in the field who are ready to support this Endeavour ensures that this dream can turn into reality with my efforts and institutional support.

Work Force Disparity-Women for Oncology (W4O):

I am having a keen interest in working towards workforce inequity including related to gender. Women are inadequately represented in oncology leaderships and this is an inadequately addressed area. Developing gender-neutral environment in oncology sector in national and international forums.

My work is recognized by the international Societies like ESMO and I am part of ESMO Core Committee for women in oncology as well as I am an international adviser for Hong Kong and Egypt W4O committee.

Furthermore, with an interest group I have started the W4O-India group under the banner of ISMPO in India as well as W4O- SAARC group under SAARC federation of oncology.

Along with the colleagues from SAARC nations and Egypt, I have developed global women for oncology (GLOWS) group and 20 courtiers leaders actually supported us. I am mentoring many underprivileged women and working with ESMO W4O, YO and ISMPO to hold hands in systemic manner of these women oncologists in various phases.

I have completed a large national study to explore the challenges of women oncologist in India, the study was presented in ESMO Asia and is published as follows. There are other projects.

• Bajpai J et al.Gender climate in Indian oncology: national survey report Esmoopen-April2020; 5(2):e000671; DOI: 10.1136/esmoopen-2020-000671.
• Garrido1 P., Adjei A. A., Bajpai J. et al. Has COVID-19 had a greater impact on female than male oncologists? Results of the ESMO Women for Oncology (W4O) Survey. ESMO Open.https://doi.org/10.1016/j.esmoop.2021.100131
• Linardou H, Adjei AA, Bajpai J et al .Challenges in oncology career: are we closing the gender gap? Results of the new ESMO Women for Oncology Committee survey. https://doi.org/10.1016/j.esmoop.2023.100781

I am invited faculty for Society for Immunotherapy of Cancer -Women in Cancer Immunotherapy Network’s (SITC-WIN) for successive years to discuss about the challenges women oncologist face and possible solutions.

Furthermore, this year I am selected for the “Women Lift Health leadership Journey” as well which will further help me in strengthening my methods and networking. I wish to start a dedicated Women empowerment programme in the institution and country as a whole to help several women oncologists and other staff, trainees in navigating various challenges.

Supportive Care:

There is tremendous advancement in cancer therapy and cure rates have increased substantially including in LMICs. Hence, quality of life (QOL) issues are even more relevant today.

I am extremely passionate to improve supportive care including QOL of cancer patients. There are ongoing randomized trials with respect to supportive care:

One of the  trial “A randomized, open label phase III trial Evaluating Low-Dose Vs standard- dose Olanzapine with standard triple Antiemetic therapy for Prevention of highly emetogenic chemotherapy induced Nausea and vomiting in subjects with osteosarcoma and other solid tumors (OLAnzaPiNE)” is looking towards better antiemetic therapy. It’s about to complete and will answer this important question.

Peripheral neuropathy is a dreaded complication of taxane chemotherapy and man therapies has been tried with suboptimal results. Acupuncture is one of the modality which shown promise in early phase trials. We are testing the hypothesis in  a phase III RCT titled as “Acupuncture as a modality of treatment for Chemotherapy-Induced Peripheral Neuropathy in Breast Cancer-A Phase 3 Randomized Controlled Trial (ABC-CIPN)’’ to definitely prove or refute the role of acupuncture in improving peripheral neuropathy. We are about to complete the accrual and the result of this trial will be potentially practice-changing.

Body image issues:

I am keen to focus on Young women’s cancer and their challenges related to body image, in this direction I have carried out a RCT for scalp cooling for alopecia prevention in breast cancer and demonstrated success, the results are published as follows and later we have generated a code in our institute to implement this as a routine service with revenue generation to the hospital.

• Bajpai J et.al."Randomised controlled trial of scalp cooling for the prevention of chemotherapy induced alopecia". The Breast. 2019 Dec 12; 49:187-193. doi: 10.1016/j.breast.2019.12.004.
• Bajpai J, Kapu V, Rath S et al, Low-dose versus standard-dose olanzapine with triple antiemetic therapy for prevention of highly emetogenic chemotherapy-induced nausea and vomiting in patients with solid tumours: a single-centre, open-label, non-inferiority, randomised, controlled, phase 3 trial. The Lancet Oncology, Volume 25, Issue 2, 2024, Pages 246-254, ISSN 1470-2045, https://doi.org/10.1016/S1470-2045(23)00628-9.

 Now, I wish to streamline this process in day care first to give the benefit to all young women with breast cancer and then gradually expand to other young patients in various cancers.

Another trial conceptualized to delineate the best renal protective method with Cisplatinum chemotherapy as well. We have received Terry Fox funding for this trial titled, “A Double Blind Randomized Controlled Trial of Renal Protective Effects of Normal Saline plus Placebo Versus Normal Saline plus Mannitol Prior to Cisplatin Containing Chemotherapy Regimens in Osteosarcoma and other Solid Tumors” and it is currently recruiting patients.

Patient information/awareness booklets:

Along with my colleagues, I have conceptualized the following booklets for patients which are well perceived and helping patients in various areas especially to improve supportive care aspects.

1. Early Breast cancer
2. Metastatic breast cancer
3. Exercise lymph edema
4. Breast reconstruction
5. Coping with hair loss
6. Cervical cancer
7. Immuno -therapy
8. Chemotherapy

Rare cancers including adolescent and young adult cancers:

(Young breast cancer and Pregnancy associated Cancers, Sarcomas)

Many young women are breast cancer patients especially in this part of the world and many women experience this during or within one year of pregnancy (PABC). We do not know what the true incidence esp. of PABC and pattern of care is varied and suboptimal.

I am keen in young breast cancer treatment, supportive care and quality of life issues, as I strongly believe to cure but also to rehabilitate these patients so that they can lead a normal life.

Hence, I am making special effort to establish national registry for “Pregnancy Associated Breast Cancer patients to collate data on epidemiology and treatment patterns & outcomes of PABC in India.”

Presently we have started it in Tata Memorial Center and soon we will explore the possibility to expand it nationwide. Also at a later point, I want to do genomic analysis of these patients to see if there are any specific genetic signatures associated with the condition.

Women with breast cancer rate chemotherapy-induced alopecia as one of the most severe, troublesome and distressing side effects of chemotherapy. In this direction we have successfully completed the project “Scalp Cooling for the prevention of chemotherapy induced alopecia in breast cancer from a tertiary care cancer center in India”, and our published result suggested it was very useful for these patients. Following are the publications with this regards:

• Bajpai J et.al. "Unique Challenges and Outcomes of Young Breast Cancers from a Tertiary Care Cancer Centre in India. Breast. 2021 Dec;60:177-184. doi: 10.1016/j.breast.2021.09.008. Epub 2021 Oct 6.
• Bajpai J et.al. Pregnancy associated breast cancer (PABC): Report from a gestational cancer registry from a tertiary cancer care centre, India. The Breast. Volume, April 2021, Pages 88-95
• Bajpai J et.al."Randomised controlled trial of scalp cooling for the prevention of chemotherapy induced alopecia". Breast. 2019 Dec 12; 49:187-193. doi: 10.1016/j.breast.2019.12.004.
• Bajpai J., Panda G. S.,Chandrasekharan A., et.al. Adolescent–adult nonmetastatic Ewing sarcoma—Experience from a large developing country; Paediatric Blood and Cancer Journal; Volume68, Issue9, September 2021, e29081; 15 May 2021; https://doi.org/10.1002/pbc.29081.
• Breakout session chair and presenter –Global AYA congress 2023, long beach Californea, June 2023“Bridging the Divide: Care Patterns and Focus Areas for Adolescents and Young Adults”

Beside I am trying to establish a registry study of Triple negative breast cancers (TNBC) titled as “Retrospective study of demographics, pattern of care and outcome of TNBC patients from a tertiary care cancer centre in India”.

Dedicated clinic for “Rare tumors”

Melanoma clinic:

I have initiated a dedicated Melanoma clinic at TMC to improve care of this rare cancer in our part of the world. Collected and published largest data in this disease from country and highlighted unique epidemiology and access issue of Immune check point-therapy(ICI) and targeted therapy(following is the publication). Brought a phase 4 trial of ICI which provided free access to many eligible patients of this expansive therapy.  We are getting referrals for this clinic from all across the country and even neighboring courtiers .

• Bajpai J et.al. Demographics, Pattern of Care, and Outcome Analysis of Malignant Melanomas - Experience from a Tertiary Cancer Centre in India. Front. Oncol, 08 September 2021 https://doi.org/10.3389/fonc.2021.710585

Adolescent and Young Adult care clinic:

I have initiated a dedicated AYA clinic at TMC to improve care of this extra challenging group of patients and survivors and to address their unique needs with the help of Indian cancer society

I am collaborating with ESMO, MSKCC, CTOS, EORTC and MDA in this regard and passionate to develop a holistic AYA unit in the institute .Our work in the field is well recognized and we presented and got the  best poster award in CTOS 2022.Our work got accepted as  a breakout session in prestigious Global AYA congress in California in 2023. I am optimistic to develop many more collaborations to enhance AYA care pattern.