MIDDLE EAST JOURNAL OF CANCER
Year:2018 | Volume:9 | Issue:3|Papers Count:12

Background: Cancer is the leading cause of morbidity and mortality worldwide. Among gynecological cancers, ovarian cancer is the first cause of cancer-relateddeaths. However, only a few studies have evaluated the age-standardized incidence rateof ovarian cancer in Iranian women. Therefore, the present study aims to systematicallyreview the age-standardized incidence rate of ovarian cancer in Iran. Methods: We systematically reviewed the literature that pertained to the incidencerate of ovarian cancer among Iranian women. In May 2016, we performed searchesof national scientific databases that included SID, Magiran, IranMedex, and IranDoc. Searches of international databases included PubMed, Scopus, and ScienceDirect. Theretrieved studies were then assessed according to the study’ s inclusion criteria. Results: In this review, we included 14 from 115 articles obtained through searchingnational and international databases, grey literature, and hand searching. Based on therandom effects model, the age-standardized incidence rate of ovarian cancer was 3. 19(95% CI: 2. 78-3. 59). Conclusion: The study results indicated that the age-standardized incidence rateof ovarian cancer was considerably low in Iran. The registration methodology normallyused by cancer registries has probably led to an underestimation of the incidence rateof ovarian cancer among Iranian women. Thus, we recommend the establishment ofcancer registries that cover a broader population.

Background: The standard of care for glioblastoma is concurrent chemoradiotherapyand adjuvant chemotherapy with Temozolomide. In this trial, we have investigatedthe impact of MGMT promoter methylation on prognosis and benefit fromTemozolomide based chemotherapy in a group of patients with glioblastoma in ourregion. Methods: This retrospective study included glioblastoma patients treated in ourinstitute between 2006 and 2011. We used methylation specific PCR to detectmethylation in the promoter region of the MGMT gene. The Kaplan-Meier techniquewas used to calculate overall survival from the time of diagnosis to the time of death. We utilized the log-rank test and Cox-regression model for univariate and multivariateanalyses of potential prognostic factors. Results: There were 78 patient participants with a median age of 50 (range: 20 to75) years and a male to female ratio of 56/22. All patients underwent minimal surgicalresection which was considered as a biopsy. All patients received adjuvant radiotherapywith a median dose of 60 Gy (54-60 Gy) and 25 patients received concomitantTemozolomide. The MGMT promoter methylation was found in 19 (24. 4%) patientsand was relatively more frequent in men (28. 6%) compared to women (13. 6%; P=0. 16). This genetic change was associated with a significantly higher 2-year survivalin men (57. 2%) compared to women (16. 8%; P<0. 001). Multivariate analysis indicatedthat male sex and MGMT promoter methylation were independently associated withmore favorable prognosis. Conclusion: In our series, MGMT promoter methylation was a significantindependent prognostic factor. The finding of sex as an independent prognostic factorwould need further validation.

Background: Breast cancer is the most common cancer in females. At present, evidence exists to support an association of breast cancer with several risk factors suchas occupational risk factors. The aim of this study is to further characterize potentialassociations between breast cancer risk and occupation. Methods: In this case-control study, we reviewed records from 965 histologicallyconfirmed breast cancer cases. From these, 104 employed women were chosen. Thecontrol group consisted of 112 age-matched employed women. Required data weregathered through in-person interviews and medical records reviews. Occupationswere classified into four categories: teachers, administrative/clerical workers, healthcareworkers, and miscellaneous jobs. Data analysis was performed using the chi-square, t-test, and logistic regression model. Results: A higher proportion of cases (60. 6%) were teachers. Physical activity, smoking, and family history of cancer significantly differed between the case and controlgroups. After adjustment for potential confounders, we found that teachers had ahigher risk for breast cancer compared to other occupations (P<0. 001). Conclusion: The teaching profession can be an important risk factor for breast cancer. Emphasis on early screening programs seems necessary. According to the high percentof female teachers, we recommend a detailed evaluation of exposures in this occupation.

Background: Limited data exists to support the benefit from second-linechemotherapy in patients with metastatic urothelial carcinoma. Factors that predictsurvival following progression after first-line platinum-based regimens in patientstreated outside clinical trials are not clear. This study intends to evaluate differentprognostic factors and the impact of second-line chemotherapy on survival. Methods: We retrospectively reviewed patients with metastatic urothelial carcinomawho experienced disease progression following first-line platinum-based regimens formetastases. These patients received treatment and follow up visits at a single institution. The effect of demographic, disease characteristics, and second-line therapy on overallsurvival was examined through univariate and multivariate cox-regression analyses. Results: There were 64 patients included. A total of 27 (42%) patients did not receivesecond-line chemotherapy because of poor Eastern Cooperative Oncology Groupperformance status, 20 (31%) received combination chemotherapy (platinum-based in17), and 17 (27%) received a single agent chemotherapy. The median overall survivalfrom the date of documented progression after first-line therapy was 5. 0 months. Inmultivariate analysis, a correlation existed between poor overall survival and performancestatus of ≥ 1 (HR: 5. 74, 95% CI: 1. 4-45. 57, P=0. 036), no second-line chemotherapy(HR: 2. 72, 95% CI: 1. 39-5. 31, P=0. 003), and ≥ 2 metastatic sites (HR: 5. 19, 95% CI: 1. 74-15. 44, P<0. 001). Conclusion: A significant proportion of patients with metastatic urothelial carcinomawere not eligible for second-line chemotherapy because of poor performance status. Use of second-line chemotherapy, Eastern Cooperative Oncology Group performancestatus, and number of metastatic sites were important determinants of survival.

Background: Folate and vitamin B12 have a number of biologic roles that makethem important in hematological disorders and malignancy. In the present study, wehave assessed serum folate and vitamin B12 levels and their associated variables inpatients with leukemia, lymphoma, and solid tumors. Methods: This cross-section study investigated 98 patients (57 with leukemia, 16lymphoma, and 25 solid tumors) between April 2015 and March 2016 in Southern Iran. Complete blood counts and serum levels of folate, vitamin B12, lactate dehydrogenase, and homocysteine were measured. Clinical characteristics of the patients were alsogathered from their medical records. Results: Patients had the following mean serum levels: serum folate (12. 27± 6. 69ng/ml), vitamin B12 (331. 81± 183. 22 pg/ml), and homocysteine (11. 74± 26. 67 μ mole/L). Vitamin B12 showed a significant negative correlation with homocysteine levels (r=-0. 223, P=0. 043). Overall, there were 21(21. 9%) vitamin B12 and 9 (9. 8%) folatedeficient patients. Vitamin B12 patients had a longer remission time (time from offtherapy until study entry) of 18± 16. 97 months compared to those with normal vitaminB12 levels (8. 81± 8. 08 months, P=025). However, logistic regression analysis showedthat only mean corpuscular volume had a significant correlation with vitamin B12deficiency (B=-0. 105, odds ratio=0. 9, 95% CI: 0. 819-0. 990, P=0. 03). None of thevariables showed significant correlation with folate deficiency (P>0. 05). Conclusion: Vitamin B12 and folate deficiency are frequently seen in survivors ofchildhood malignancy, mainly due to the effects of chemotherapy. These vitamins haveimportant roles in hematopoiesis, as well as development and maintenance of the nervoussystem; therefore, timely detection of their deficiencies is of utmost importance. It ishighly recommended to check the serum levels of these vitamins in children whosuccessfully survive their cancer treatments.

Background: Coping strategies affect patients’ perceptions of pain severity, theirability to tolerate pain, duration of daily activities, and emotions. This study aims todetermine the relationship between pain coping and unpleasant emotions, and religiouscoping in cancer patients. Methods: This was a cross-sectional survey study. Sampling was conducted fromJune to December 2016. During that period, 363 cancer patients referred to Omid Hospitalin Mashhad city, Iran and 22 Bahman Hospital in Neyshabur city, Iran. Data collectiontools included a demographic questionnaire, religious coping scale, pain severityscale, Coping Strategies Questionnaire, and Depression Anxiety Stress Scale. The datasetwas analyzed using descriptive and inferential statistics that included chi-square andone-way ANOVA with SPSS v. 16 software. Results: The majority of cancer patients (231; 63. 6%) used the strategy of prayingand hoping as their coping mechanisms. There was a significant difference betweenreligious coping and pain coping strategies (P=0. 02). Patients with mild depression mostfrequently used the praying and hoping strategy, whereas those with moderate depressionmore frequently used the catastrophic strategy (P>0. 05). Conclusion: Designing and performing educational programs for coping withpain can be an effective solution for patients to improve their pain management, as wellas control and cope with their illness. These programs would help increase patient qualityof life and disease self-management, as well as decreasing psychological andcommunication problems.

Background: Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah(NORIN) is a newly established full-fledged healthcare facility for diagnosis, treatment, and research of all cancer types in rural areas of Sindh, Pakistan. Nuclear MedicineOncology and Radiotherapy Institute Nawabshah began its radiotherapy services inJanuary 2012. We have conducted this study to assess cancer patients who registeredin the Radiotherapy Department and received external beam radiotherapy at thisinstitute in Pakistan. Methods: We gathered institution-based data on cancer incidence distributedaccording to gender, age, district, tumor location, and stage of cancer when patientsregistered in the Radiotherapy Department of the Nuclear Medicine Oncology andRadiotherapy Institute Nawabshah. In total, we included 2116 patients in this study from2012 to 2016 who received irradiation administered by a cobalt-60 machine. Results: The most common cancers were located in the head and neck region inmales and breast in females. Most patients presented to the Nuclear Medicine Oncologyand Radiotherapy Institute Nawabshah with disease stages III and IV. Data frompatients treated by external beam radiotherapy has indicated that most were 40-85 yearsof age. The Nuclear Medicine Oncology and Radiotherapy Institute Nawabshah is locatedin Nawabshah District. Therefore, most patients who presented to this institution wereresidents of Nawabshah and neighboring districts. Conclusion: Late stage diagnosis, lack of awareness, and low socio-economic statusin rural areas of Sindh is of tremendous concern. The establishment of a cancerdetection campaign and initiation of a cancer control program is vital for an efficientfight against cancer.

Background: Neutrophil to lymphocyte ratio was initially used as a low costprognostic marker in a group of solid tumors and subsequently hypothesized to havea role in multiple myeloma. This retrospective analysis aimed to report the prognosticimportance of the neutrophil to lymphocyte ratio in multiple myeloma. Methods: Between November 2003 and February 2016, we included 175 patientsfrom two centers in this study. CBC differentials were primarily checked by a Sysmexanalyzer in both centers. In one center, differentials were rechecked by light microscopy. Analysis of survival was performed using a Kaplan-Meier estimate and we assessedthe effects of prognostic factors by Cox proportional hazards model. Results: Patients had a mean age of 63. 22± 10. 89 years. Although mean lymphocytepercent did not differ between the two centers, mean neutrophil percent and meanneutrophil to lymphocyte ratio were higher at the center that manually checked the CBCdifferentials. After adjustments for age and gender, we noted that the hazard ratio forelevated neutrophil to lymphocyte ratio when stratified for the centers was 1. 07 (95%CI: 1. 01– 1. 15, P=0. 034). Conclusion: A precisely checked neutrophil to lymphocyte ratio could act as apotentially inexpensive, accessible prognostic factor for multiple myeloma patients.

Background: Treatment of childhood brain tumours requires coordinated effortsby multiple specialities-neurosurgery, neuroradiology, neuropathology, oncology, and radiotherapy. The outcome is worse in developing countries compared todeveloped countries because of deficiencies in proper registry, failure of timelydiagnosis, lack of availability and co-ordination of multiple specialists required forcomprehensive management and high abandonment rates. Method: The pediatric neuro-oncology program was initiated in collaboration withthe neighbouring neurosurgery institution as a step towards improving care forpediatric brain tumor patients in our hospital. Epidemiology, treatment and followupof brain tumours in children aged 1-14 years attending the pediatric oncologydepartment were studied. Patients received multimodality treatment with surgery, radiotherapy and chemotherapy by specialists in both centres. The study periodwas from January 2008 to December 2012. Results: There were 375 pediatric brain tumour patients during the study period. 166 patients (44. 2%) had supratentorial tumors and 209 (55. 73%) had infratentorialtumors. 42. 6% of tumours were high-grade and 53. 6% were low grade. Thecommonest histopathological tumour type was astrocytoma (48. 8%) followed bymedullobastoma (24. 5%). 287 (76. 5%) patients underwent surgery, 216 (57. 6%)patients received radiotherapy, 97 (25. 8%) patients received chemotherapy and 94(25%) required follow-up only. Patient follow-up rates improved from 37. 2% to 82. 6%and treatment abandonment decreased from 35. 8% to 14. 8% over these years. Conclusions: Impact of the pediatric neuro-oncology program in our hospital hasmade it possible to provide comprehensive multidisciplinary treatment in a co-ordinatedmanner, describe the epidemiology of pediatric brain tumors, reduce treatmentabandonment, and improve the follow-up of pediatric brain tumour patients.

Background: Cervical cancer is the third most common cancer in women after breastand colorectal cancers, and one of the leading causes of cancer death among womenworldwide. The aim of this study is to determine the associations of cervical cancerincidence and mortality rates with the Human Development Index. Methods: Information of the incidence and mortality rates for cervical cancer wereobtained from the GLOBOCAN Cancer Project for 2012 and data for the HumanDevelopment Index for 2013 from the World Bank database. We used linear regressionmodels to assess the Human Development Index effect on cervical cancer occurrence rates. Inequality in the age-standardized incidence and mortality rates of cervical canceraccording to the Human Development Index were assessed by the concentration index. Results: The results showed substantially higher cervical cancer incidence andmortality rates in regions with low and medium Human Development Index comparedto regions that had substantially elevated Human Development Index. The death andincidence from cervical cancer were more concentrated in low Human DevelopmentIndex countries. There was a significant negative association between the cervical cancerincidence and mortality rates with all the components of the Human Development Index, including life expectancy (B=-0. 98, P<0. 001), mean years of schooling (B=-1. 86, P<0. 001), gross national income (B=-0. 38, P<0. 001), urbanization level (B=-0. 29, P<0. 001), and age standardized obesity (B=-0. 45, P<0. 001). Conclusion: Cervical cancer is a significant public health problem in countrieswith low Human Development Index and requires the implementation of preventionprograms and screening for early detection and treatment.

Background: Breast cancer is the most prevalent cancer among females worldwide. This study compares the results of the most cited published Iranian studies and studiesfrom other Middle East countries on breast cancer with data from the Ministry of Healthand Medical Education and approximately 2000 cases from the Cancer ResearchCenter of Shahid Beheshti Medical University of Iran. Methods: Data from the Cancer Registry System of the Ministry of Health andMedical Education and the Cancer Research Center were obtained in addition to datafrom other published Iranian articles to increase the accuracy of incidence, prevalence, disease burden, risk factors, clinical staging, clinical pathology, biological markers, clinical subtypes, and survival rate of breast cancer in the last decade and compare theepidemiological data with other areas of the world. Results: Overall, breast cancer was the most common cancer in Iran. The agestandardizedrate for breast cancer was 33. 21 per 100, 000 according to the latestnational databases. The mortality rate for breast cancer has not changed in the past 30years in Iran. The age-standardized rate for mortality was 14. 2 per 100, 000 with a meanage of 49. 84 years. The most common cancer in Iran is invasive ductal carcinoma. Inour last review, 65. 5%-70. 5% of cases were in the early stages (1 and 2) and less than30% were in the advanced stages. The five-year overall survival rate was estimated at72% in women and 60% in men. The stage and number of positive lymph nodessignificantly affected the survival rate. In the Gulf Cooperation Council, ASR of the Kingdom of Saudi Arabia was (12. 9), Bahrain (46. 4), Kuwait (44. 3), Qatar (35. 5), United Arab Emirates (19. 2), and Oman(14. 4) per 100, 000. Conclusion: Our study shows that epidemiology and histopathology of cancer isdifferent with other neighborhood countries and is multi-dimension and needs multicenterinvolvement from government authorities, clinicians and scientists.

Euthanasia has initiated a debate in many countries on whether ending a patient's lifeintentionally who suffers from a terminal stage cancer should be lawful or not. Thistopic has recently gained much attention. This controversial issue was raised becauseof the few existing countries that have passed legislation. This argumentative essaydefends the author's position regarding euthanasia in oncology patients and reviews bothopponents and proponents point of views, taking into consideration the legal andethical perspectives regarding euthanasia. The current authors are against all types ofeuthanasia, and do not support the legislation of euthanasia in Jordan. The authors, intheir defence against legalizing euthanasia, provide four main arguments (religion, slippery slope, reliance, and palliative care) as an opposition stand to persuade readerswith their position. A suggestion has been made throughout several recommendationsin an effort to resolve the furthermost important ethical and legal debates aroundeuthanasia. The authors conclude that there is no agreement on whether euthanasia shouldbe legislated or not. The opposing side has reasoned that it was contrary to religiousjurisprudence and against established basic public taboo. Alternatively, the proponentside reasoned that the patients' autonomy for decision-making had to be respected, whichwould allow euthanasia to give the patients a means to end suffering and pain.