oncology

Importance Globally, 968 350 new cases and 659 853 deaths from gastric cancer were reported in 2022. In the US, 30 300 new cases and 10 780 deaths were estimated in 2025.

Observations Gastric cancer is more common in men, and the median age at diagnosis is 68 years. Most gastric cancers (>90%) are adenocarcinomas. Worldwide, 85% of cases arise from the stomach body or antrum and 15% from the cardia. In the US, more than 90% of patients diagnosed with gastric cancer present with symptoms such as weight loss and abdominal pain. At presentation, approximately 13% have localized disease (limited to the stomach), 15% to 25% have locally advanced disease, defined as a tumor that has spread to regional lymph nodes, and 35% to 65% have metastatic disease. Helicobacter pylori infection is a treatable risk factor associated with 90% of gastric body and antrum cancers globally. Additional modifiable risk factors include smoking, alcohol, obesity, and salt intake. In countries with high incidence such as Japan and Korea, routine endoscopic screening beginning at age 40 years is associated with improved survival. Diagnosis is made by endoscopic biopsy. Patients with localized gastric cancer are treated with surgical resection and have a 5-year relative survival rate of 75% with treatment. Patients with more advanced-stage disease should receive gastrectomy, perioperative chemotherapy with 5-fluorouracil, oxaliplatin, and docetaxel and immunotherapy (durvalumab). Metastatic or unresectable disease may be treated with chemotherapy, immunotherapy, and/or targeted therapy depending on biomarkers, including programmed cell death ligand 1 (PD-L1), human epidermal growth factor receptor 2 (ERBB2; formerly HER2 or HER2/neu), and claudin-18, isoform 2 (CLDN18.2). For PD-L1–expressing gastric cancer, adding immune checkpoint inhibitors, such as nivolumab and pembrolizumab, is associated with an additional 3 months of survival when compared with chemotherapy alone. For gastric cancers overexpressing the ERBB2 or CLDN18.2 proteins, the addition of trastuzumab or zolbetuximab, respectively, is associated with an additional 3 to 4 months’ survival. Early supportive care focusing on symptom management and on nutritional and psychosocial support is associated with 3 months of survival benefit. Less than 10% of patients with metastatic gastric cancer survive more than 5 years.

Conclusions and Relevance Approximately 30 300 new cases of gastric cancer are diagnosed annually in the US. Localized gastric cancer is treated with gastrectomy, and locally advanced disease is treated with surgery and chemoimmunotherapy. For patients with unresectable or metastatic gastric cancer, chemotherapy with immune checkpoint inhibitors and targeted therapies such as trastuzumab or zolbetuximab improves survival by several months.

Author/s:

Anuj Kishor Patel, Nilay S. Sethi

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Megan George — Thu, 04 Sep 2025 19:41:24 +0000

Date Added:

September 4, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

June 6, 2025

URL:

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.2971

Keywords

PMID (1):

40478588

MeSH

Uterine Cervical Neoplasms* / diagnosis

Single-Blind Method

Safety-net Providers*

Early Detection of Cancer* / methods

In community health centers, use of self-collection of specimens for cervical cancer screening was significantly more effective than telephonic reminders. James W. Mold, MD, MPH

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Importance There are limited data on the effectiveness of mailed self-collection to increase cervical cancer screening (CCS) participation in underresourced health care settings.

Objective To compare the effectiveness of mailed self-collection kits, with and without patient navigation, to telephone reminders to increase CCS in a safety-net health system.

Design, Setting, and Participants This pragmatic, parallel, single-blinded, randomized clinical trial within a publicly funded safety-net health system in Houston, Texas, compared (1) telephone reminder (TR) for clinic-based screening, (2) TR with mailed self-collection (SC), and (3) TR with mailed SC and patient navigation among a random sample of CCS-eligible patients not up to date with CCS, including those with no CCS on record. The trial was conducted from February 20, 2020, to August 31, 2023.

Interventions All groups received a TR by a patient navigator to attend clinic-based CCS. In the SC and SC with patient navigation groups, participants were additionally mailed a self-collection kit to their home as an alternative to clinic-based CCS. In the SC with patient navigation group, the mailed kit was followed by a patient navigation telephone call.

Main Outcomes and Measures CCS participation was defined as attendance for clinic-based screening or return of a mailed self-collection kit within 6 months of randomization and determined through electronic health record review.

Results Of the 2474 participants in the intent-to-screen analyses (median [IQR] age, 49 [39-57] years), 2325 (94.0%) were from racial or ethnic minoritized populations (1655 [66.9%] identifying as Hispanic or Latino, 82 [3.3%] as non-Hispanic Asian, 535 [21.6%] as non-Hispanic Black or African American, and 53 [2.1%] as other or unknown race, including American Indian or Alaska Native and Native Hawaiian or Other Pacific Islander), and 1388 (56.1%) were covered by the county’s publicly funded financial assistance program. At 6 months, 144 of 828 participants (17.4%) in the TR group, 340 of 828 (41.1%) in the SC group, and 381 of 818 (46.6%) in the SC with patient navigation group had participated in CCS. Compared to TR, relative participation was 2.36 (95% CI, 1.99-2.80) times higher for SC and 2.68 (95% CI, 2.27-3.16) times higher for SC with patient navigation; screening difference was 23.7% (95% CI, 19.4%-27.9%) for SC and 29.2% (95% CI, 24.9%-33.5%) for SC with patient navigation.

Conclusions and Relevance In this randomized clinical trial in a safety-net health system, SC was effective for increasing CCS participation among underscreened patients; there were modest additional gains from SC with patient navigation. The large increase in CCS participation using SC compared to TR suggest that SC should be considered in safety-net settings with suboptimal CCS coverage.

Trial Registration ClinicalTrials.gov Identifier: NCT03898167

Author/s:

Jane R. Montealegre, Susan G. Hilsenbeck, Shaun Bulsara

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Megan George — Thu, 04 Sep 2025 19:41:13 +0000

Date Added:

September 4, 2025

Journal/Publication:

JAMA Internal Medicine

Publication Date:

June 6, 2025

URL:

Self-Collection for Cervical Cancer Screening in a Safety-Net Setting: The PRESTIS Randomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamainternmed.2025.2971

Keywords

PMID (1):

40478588

MeSH

Uterine Cervical Neoplasms* / diagnosis

Single-Blind Method

Safety-net Providers*

Early Detection of Cancer* / methods

In community health centers, use of self-collection of specimens for cervical cancer screening was significantly more effective than telephonic reminders. James W. Mold, MD, MPH

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Importance There are limited data on the effectiveness of mailed self-collection to increase cervical cancer screening (CCS) participation in underresourced health care settings.

Objective To compare the effectiveness of mailed self-collection kits, with and without patient navigation, to telephone reminders to increase CCS in a safety-net health system.

Trial Registration ClinicalTrials.gov Identifier: NCT03898167

Author/s:

Jane R. Montealegre, Susan G. Hilsenbeck, Shaun Bulsara

Cutaneous Melanoma: A Review

Megan George — Tue, 26 Aug 2025 14:23:17 +0000

Date Added:

August 26, 2025

Journal/Publication:

JAMA

Publication Date:

August 25, 2025

URL:

Cutaneous Melanoma: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.13074

Keywords

Targeted and Immune Therapy

PMID (1):

40853557

MeSH

Proto-Oncogene Proteins B-raf

sunscreening agents

Hutchinson's Melanotic Freckle

Sentinel Lymph Node Biopsy

Melanoma, Cutaneous Malignant

Immunotherapy

Skin Diseases* / therapy

A review of current knowledge regarding diagnosis and treatment of patients with cutaneous melanoma. James W. Mold, MD, MPH

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Importance: Melanoma, the fifth most common cancer in the US, has increased from 8.8 per 100 000 in 1975 to 28.42 per 100 000 in 2022. Cutaneous melanoma comprises 94% of cases, with 104 960 US cases projected for 2025.

Observations: Cutaneous melanoma presents as a new, changing, or irregularly pigmented skin lesion. Cutaneous melanoma subtypes include superficial spreading (≈70%), lentigo maligna (≈15%), nodular (≈5%), desmoplastic (≈4%), amelanotic (2%-8%), spitzoid (<2%), and acral (≈1%). Risk factors for cutaneous melanoma include UV radiation exposure, skin type (eg, skin that always burns, never tans), presence of benign and atypical nevi, and personal or family history of melanoma. Primary prevention consists of avoiding direct sunlight and indoor tanning, and photoprotection (sunscreen and sun-protective clothing). Based on United States Cancer Statistics data from 1999 to 2021, 77% of patients with cutaneous melanoma had localized disease (involving only the primary site), 9.5% had regional (nodal) disease, 4.7% had distant metastasis, and 8.8% were unstaged. Melanoma staging, which includes tumor thickness and ulceration and presence of lymph node or distant metastasis, ranges from stage 0 (melanoma in situ) to stage IV (distant metastasis). Localized melanoma (stage IA-IIA) is surgically excised, with margins of 0.5 cm to 2 cm based on depth of invasion. Sentinel lymph node biopsy is recommended for cutaneous melanoma that is ulcerated or 0.8 mm or more thick. Following surgery, patients with stage IIB-C melanoma have improved recurrence-free survival with adjuvant anti-PD-1 immunotherapy compared with placebo (hazard ratio [HR] for recurrence or death, 0.62 [95% CI, 0.49-0.79] for pembrolizumab and 0.42 [95% CI, 0.30-0.59] for nivolumab). For stage III disease, recurrence risk is decreased with nivolumab (HR, 0.72 [95% CI, 0.60-0.86]), pembrolizumab (HR, 0.61 [95% CI, 0.51-0.72]), or BRAF + MEK inhibitor therapy (dabrafenib + trametinib) (HR, 0.52 [95% CI, 0.43-0.63]). First-line treatment for distant metastatic or unresectable melanoma is dual checkpoint blockade with ipilimumab (anti-CTLA-4) and nivolumab. In 2017, 10-year melanoma-specific survival rates were 98% to 94% for stage IA-B, 88% to 75% for stage IIA-C, 88% for stage IIIA, 77% to 60% for stage IIIB-C, and 24% for stage IIID. In 2024, patients with distant metastatic or unresectable melanoma treated with ipilimumab and nivolumab had a 10-year overall survival rate of 43%.

Conclusions and relevance: Melanoma is a common cancer in the US. Treatment for stage IA-IIA melanoma is surgical resection. Anti-PD-1 immunotherapy after surgical excision improves recurrence-free survival in stages IIB-C melanoma. For stage III melanoma, anti-PD-1 immunotherapy or BRAF + MEK inhibitor therapy decreases risk of melanoma recurrence. First-line therapy for metastatic melanoma is dual checkpoint blockade with ipilimumab and nivolumab.

Author/s:

Urvashi Mitbander Joshi, Mohammed Kashani-Sabet, John M. Kirkwood

What Is Prostate Cancer?

Megan George — Fri, 25 Jul 2025 13:49:16 +0000

Date Added:

July 25, 2025

Journal/Publication:

JAMA Patient Page

Publication Date:

July 24, 2025

URL:

What Is Prostate Cancer?

Type:

Patient Education Materials

DOI (1):

10.1001/jama.2025.10177

Keywords

Patient Information

jama Patient Information

MeSH

Prostate-Specific Antigen

Digital Rectal Examination

early detection of cancer

Early Detection of Cancer* / methods

Information for patients about prostate cancer. James W. Mold, MD, MPH

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Prostate cancer is a common malignancy in older men. Prostate cancer typically affects older men (average age at diagnosis is 67 years) and is more common among Black men than White men.1 More than half of prostate cancer risk is due to genetic factors. Prostate cancer is the second most common cause of cancer in men worldwide, with about 1.5 million cases diagnosed in 2021. In the US, 3.4 million men were living with prostate cancer in 2021.

Author/s:

Rebecca Voelker, MSJ

Ovarian Cancer: A Review

Megan George — Fri, 25 Jul 2025 13:29:18 +0000

Date Added:

July 25, 2025

Journal/Publication:

JAMA

Publication Date:

July 21, 2025

URL:

Ovarian Cancer: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2025.9495

Keywords

Obstetrics and Gynecology

MeSH

Neoplasms, Glandular and Epithelial

Salpingo-oophorectomy

Lymph Node Excision

Chemotherapy, Adjuvant

Cytoreduction Surgical Procedures

A review of what we currently know about ovarian cancer. James W. Mold, MD, MPH

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Importance: Ovarian cancer is the eighth most common cause of cancer and cancer death in women worldwide. In 2022, ovarian cancer was diagnosed in approximately 324 398 individuals, and 206 839 died of ovarian cancer worldwide. In 2025, it is estimated that 20 890 US women will be diagnosed with ovarian cancer and 12 730 patients will die of ovarian cancer.

Observations: Approximately 90% of ovarian cancers are epithelial malignancies, of which 70% to 80% are high-grade serous ovarian cancers. Less common epithelial subtypes include endometrioid, clear cell, low-grade serous, mucinous, and carcinosarcoma. The median age at diagnosis of ovarian cancer is 63 years. Risk factors include older age, family history of breast or ovarian cancer, endometriosis, and nulliparity. Hereditary factors are associated with 25% of cases, predominantly linked to BRCA1/2 gene variants. At diagnosis, approximately 95% of patients experience nonspecific symptoms, such as abdominal pain, bloating, and urinary urgency and frequency, and about 80% have advanced-stage disease (stage III-IV), including extrapelvic disease, ascites, and abdominal masses. Diagnostic and staging evaluation includes pelvic ultrasound; computed tomography of the chest, abdomen, and pelvis; and serum tumor markers such as carbohydrate antigen 125, carbohydrate antigen 19-9, and carcinoembryonic antigen. First-line treatment for early-stage ovarian cancer, defined as limited to the ovary or fallopian tube (stage I) or confined to the pelvis (stage II), is surgery (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy), followed by adjuvant chemotherapy (carboplatin and paclitaxel). With treatment, early-stage ovarian cancer has a 5-year overall survival of 70% to 95%. Advanced-stage ovarian cancer may be treated with primary cytoreductive surgery (removal of all visible cancer in the abdominal cavity) and adjuvant chemotherapy (carboplatin and paclitaxel) or with neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy. Most patients with advanced-stage ovarian cancer receive maintenance therapy with bevacizumab (a monoclonal antibody that blocks angiogenesis) and/or poly–adenosine diphosphate ribose polymerase (PARP) inhibitors. With treatment, the 5-year overall survival rate for advanced-stage ovarian cancer is 10% to 40%. However, individuals with BRCA-related gene variants have a 5-year overall survival rate of approximately 70% with PARP inhibitor treatment. Despite an initial remission rate of 80%, approximately 75% of patients with advanced-stage disease have ovarian cancer relapse within 2 years.

Conclusions and Relevance: Approximately 21 000 women are diagnosed with ovarian cancer annually in the US, and approximately 80% have advanced-stage ovarian cancer at diagnosis. First-line treatment of early-stage ovarian cancer is surgery and adjuvant platinum-based chemotherapy. Treatment of advanced-stage ovarian cancer includes cytoreductive surgery, platinum-based chemotherapy, and targeted maintenance therapies such as bevacizumab and/or PARP inhibitors.

Author/s:

Giuseppe Caruso, MD, S. John Weroha, MD, PhD, William Cliby, MD

Diagnosis and Treatment of Polycythemia Vera: A Review

Erin Blanchette — Wed, 20 Nov 2024 22:28:21 +0000

Date Added:

November 20, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

November 18, 2024

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.20377

Keywords

Venous Thromboembolism

Leukemias

PMID (1):

39556352

MeSH

Primary Myelofibrosis

Leukemia, Myeloid, Acute

A review of the diagnosis and treatment of polycythemia vera. James W. Mold, MD, MPH

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Importance: Polycythemia vera (PV), a myeloproliferative neoplasm characterized by an increased red blood cell mass and increased risk of thrombosis, affects approximately 65 000 people in the US, with an annual incidence of 0.5 to 4.0 cases per 100 000 persons.

Observations: Erythrocytosis (hemoglobin >16.5 mg/dL in men or >16.0 mg/dL in women) is a required diagnostic criterion, although thrombocytosis (53%) and leukocytosis (49%) are common. Patients may have pruritus (33%), erythromelalgia (5.3%), transient visual changes (14%), and splenomegaly (36%) with abdominal discomfort. More than 95% of patients have a JAK2 gene variant, which helps distinguish PV from secondary causes of erythrocytosis, such as tobacco smoking or sleep apnea. Among 7 cohorts (1545 individuals), the median survival from diagnosis was 14.1 to 27.6 years. Prior to or at the time of PV diagnosis, arterial thrombosis occurred in 16% of patients and 7% had venous thrombotic events, which could involve unusual sites, such as splanchnic veins. PV is also associated with an increased bleeding risk, especially in patients with acquired von Willebrand disease, which can occur with extreme thrombocytosis (platelet count, ≥1000 × 109/L). All patients with PV should receive therapeutic phlebotomy (goal hematocrit, <45%) and low-dose aspirin (if no contraindications). Patients who are at higher risk of thrombosis include those aged 60 years or older or with a prior thrombosis. These patients and those with persistent PV symptoms may benefit from cytoreductive therapy with hydroxyurea or interferon to lower thrombosis risk and decrease symptoms. Ruxolitinib is a Janus kinase inhibitor that can alleviate pruritus and decrease splenomegaly in patients who are intolerant of or resistant to hydroxyurea. About 12.7% of patients with PV develop myelofibrosis and 6.8% develop acute myeloid leukemia.

Conclusions and Relevance: PV is a myeloproliferative neoplasm characterized by erythrocytosis and is almost universally associated with a JAK2 gene variant. PV is associated with an increased risk of arterial and venous thrombosis, hemorrhage, myelofibrosis, and acute myeloid leukemia. To decrease the risk of thrombosis, all patients with PV should be treated with aspirin and therapeutic phlebotomy to maintain a hematocrit of less than 45%. Cytoreductive therapies, such as hydroxyurea or interferon, are recommended for patients at high risk of thrombosis.

Author/s:

Douglas Tremblay, Marina Kremyanskaya, John Mascarenhas, Ronald Hoffman

What Is Childhood Leukemia?

Erin Blanchette — Mon, 19 Feb 2024 16:59:17 +0000

Date Added:

February 19, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 9, 2024

URL:

What Is Childhood Leukemia?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2023.24648

Keywords

PMID (1):

38334982

MeSH

Bone Marrow

Precursor Cell Lymphoblastic Leukemia-Lymphoma

Leukemia

Myeloid

Acute

A summary for patients of our current understanding of childhood leukemia. James W. Mold, MD, MPH

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Childhood leukemia is the most common type of cancer that affects children. Leukemia is a cancer of white blood cells that starts in bone marrow (the soft center part of bones), which produces blood cells. Once a leukemic cell develops, it multiplies quickly in the bone marrow and can prevent healthy blood cells from forming. Leukemic cells can spread to various parts of the body, including the fluid that surrounds the brain and spinal cord (cerebrospinal fluid) and other organs such as the liver and kidneys. The cause of childhood leukemia is usually unknown, but in some rare cases, inherited genetic factors may play a role in development of childhood leukemia.

Author/s:

Jenny Ruiz, Colleen Mathews, Erika Friehling

Thyroid Cancer: A Review

Erin Blanchette — Mon, 19 Feb 2024 16:44:44 +0000

Date Added:

February 19, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

February 6, 2024

Issue:

Volume:

331

Pages:

425-435

URL:

Thyroid Cancer: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.26348

Keywords

Targeted and Immune Therapy

PMID (1):

38319329

MeSH

Thyroid Epithelial Cells

An update on thyroid cancer detection, types, and treatment. James W. Mold, MD, MPH

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Importance: Approximately 43 720 new cases of thyroid carcinoma are expected to be diagnosed in 2023 in the US. Five-year relative survival is approximately 98.5%. This review summarizes current evidence regarding pathophysiology, diagnosis, and management of early-stage and advanced thyroid cancer.

Observations: Papillary thyroid cancer accounts for approximately 84% of all thyroid cancers. Papillary, follicular (≈4%), and oncocytic (≈2%) forms arise from thyroid follicular cells and are termed well-differentiated thyroid cancer. Aggressive forms of follicular cell-derived thyroid cancer are poorly differentiated thyroid cancer (≈5%) and anaplastic thyroid cancer (≈1%). Medullary thyroid cancer (≈4%) arises from parafollicular C cells. Most cases of well-differentiated thyroid cancer are asymptomatic and detected during physical examination or incidentally found on diagnostic imaging studies. For microcarcinomas (≤1 cm), observation without surgical resection can be considered. For tumors larger than 1 cm with or without lymph node metastases, surgery with or without radioactive iodine is curative in most cases. Surgical resection is the preferred approach for patients with recurrent locoregional disease. For metastatic disease, surgical resection or stereotactic body irradiation is favored over systemic therapy (eg, lenvatinib, dabrafenib). Antiangiogenic multikinase inhibitors (eg, sorafenib, lenvatinib, cabozantinib) are approved for thyroid cancer that does not respond to radioactive iodine, with response rates 12% to 65%. Targeted therapies such as dabrafenib and selpercatinib are directed to genetic mutations (BRAF, RET, NTRK, MEK) that give rise to thyroid cancer and are used in patients with advanced thyroid carcinoma.

Conclusions: Approximately 44 000 new cases of thyroid cancer are diagnosed each year in the US, with a 5-year relative survival of 98.5%. Surgery is curative in most cases of well-differentiated thyroid cancer. Radioactive iodine treatment after surgery improves overall survival in patients at high risk of recurrence. Antiangiogenic multikinase inhibitors and targeted therapies to genetic mutations that give rise to thyroid cancer are increasingly used in the treatment of metastatic disease.

Author/s:

Laura Boucai, Mark Zafereo, Maria E Cabanillas

The Key Role of Nonpharmacologic Management of Cachexia in Persons With Advanced Illness: A Teachable Moment

Devin Evans — Thu, 29 Apr 2021 05:00:00 +0000

Date Added:

April 29, 2021

Journal/Publication:

Journal of the American Medical Association Internal Medicine

Publication Date:

April 26, 2021

URL:

The Key Role of Nonpharmacologic Management of Cachexia in Persons With Advanced Illness: A Teachable Moment

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2021.1533

Keywords

weight loss

Colon cancer

oncology

nonpharmacological treatment

Cachexia

PMID (1):

33900359

MeSH

Practical guidance for non-pharmacologic management of cachexia. James W. Mold, MD, MPH

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A man in his 80s with advanced colon cancer and malignant ascites presented to the oncology clinic to discuss next steps. He reported weight loss (approximately 15 kg in 2 months), and his daughter commented on his limited appetite, weakness, and that he was “just bones.” Recent computed tomography staging scans had demonstrated progression of the cancer. On examination, temporal wasting and an indwelling peritoneal catheter were noted.

The oncologist discussed the lack of further meaningful chemotherapy or clinical trial options. The daughter requested that something be done for appetite and weight loss. The patient expressed food aversion. The oncologist prescribed a 2-week supply of megestrol acetate solution for anorexia and/or cachexia. The co-pay was $57. Three days later, the daughter called the oncologist and was distressed because her father was now weaker and bedbound. The patient enrolled in home hospice and died the next day. The daughter expressed guilt that she was unable to nourish her father during his last days.

Author/s:

Kabani, A., Dy, S.M., Gupta, A.