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Background: Time toxicity refers to the considerable time investment required by patients undergoing cancer treatment, including travel, waiting periods and treatment duration. It is increasingly recognised not only as a logistical burden but also as a psychological stressor, significantly affecting patient well-being.

Objectives: This study surveyed oncologists across Pakistan to assess their understanding of time toxicity and its impact on both patients and clinical practice.

Methods: From August to October 2023, we conducted a cross-sectional study targeting a diverse group of cancer care professionals including medical oncologists, clinical hematologists, radiation oncologists and palliative care physicians - across various healthcare centers in Pakistan. An online questionnaire was used to gather insights into their perspectives on time toxicity.

Results: Over 54% of oncologists had a basic understanding of time toxicity, with 83.6% recognising its importance in cancer care. However, 69% noted that patients were poorly informed and often did not consider time burden in decision-making. About 45% of patients spent more than 10 hours per week on care-related activities. Key factors influencing time toxicity included cancer type, stage and logistical challenges. Notably, 85% of oncologists reported modifying treatment plans to reduce this burden. Strategies included offering chemotherapy services closer to patients' homes, using telemedicine for consultations and proactively managing side effects. The psychological toll of time-consuming schedules was also acknowledged by respondents.

Conclusion: Time toxicity poses a substantial burden in cancer treatment, both practically and psychologically. Enhancing healthcare providers' awareness, improving access to care and adopting patient-centered approaches can significantly improve patient outcomes and quality of life.

Chemotherapy-related cognitive impairment (CRCI) refers to a decline in cognitive function in patients during and after cancer treatment and is mainly associated with the use of cytotoxic chemotherapy (CT). As CT is still an essential component in the treatment of many cancers and taking into account the fact that cancer survival rates are increasing, CRCI may negatively impact the quality of life and working capacity of a growing number of individuals, especially those treated with curative intent in conditions such as breast cancer. There is still a need to address several issues related to CRCI, namely: the improved identification of risk factors, earlier diagnosis, more effective treatment strategies and prevention. Currently, the diagnosis relies on a multidisciplinary evaluation using neuropsychological tests, and rehabilitation remains the only treatment option available. A better understanding of the pathophysiological basis of CRCI is essential to improve the daily care and long-term outcomes of these patients.

Introduction: Thyroid cancer (TC) is the most pervasive endocrine cancer worldwide. We examined the region-wise pattern of TC in India according to demographic, clinicopathological treatment and waiting-time distribution from diagnosis to treatment.

Methods: TC cases in India from 96 hospital-based cancer registries (HBCRs) (North 28, East 8, West 7, South 40, Central 4 and North-East 9) reported for 2012-2019 were included. Among the 31,678 newly diagnosed cases, those treated only at the respective HBCR's (n = 10,521) were included in the detailed analysis. Statistical significance by region was obtained using the chi-square test for categorical variables, the t-test for continuous variables and Marascuilo procedure to compare multiple proportions.

Results: Among the 10,521 cases, 58% were from the South, the majority (68%) were females, with female-to-male ratio of 4.3:1, 3.8:1 and 3.5:1 in the north-east, central and southern regions, respectively, in the youngest (<35 years) age group (p < 0.001). The most familiar histological type was papillary carcinoma (69.0%). The female-to-male ratio for follicular carcinoma was 5:1 among <35 years, while the same for papillary carcinoma was 2.9:1. Distant metastasis at diagnosis was highest in the western region (19.0%), lowest in the South (13.4%). Radical intent-to-treat was highest in the South (92%) and lowest in the East (68.5%) (p < 0.001). Surgery alone or combined with other treatments was highest in the West (91.2%) compared to 48.9% in Central India. The waiting time from diagnosis to treatment was <7 days in 36% of cases from the North and the lowest proportion (19.0%) in both East and North-East regions (p < 0.001).

Conclusion: We observed considerable heterogeneity in demographic, clinic-pathological, treatment and waiting time from diagnosis to treatment for TC across the regions in India; this kind of region-wise hospital-based analysis would help to improve national and local cancer care programmes.

Background: Due to fundamental biological differences, de-novo metastatic breast cancer (MBC) generally exhibits a more favourable prognosis compared to recurrent MBC. There is a notable absence of databases documenting de-novo MBC patients from North-East India.

Materials and methods: A retrospective analysis of 195 patients was performed from 1 January 2020 to 31 December 2022, covering a span of 3 years. Clinical, pathological and radiological data were extracted from medical records.

Results: The median age at diagnosis was 50 years. The median duration of symptoms was 5 months, with 66% of patients being postmenopausal. The predominant histological type was infiltrating ductal carcinoma. Baseline receptor status indicated that 108 patients (55.38%) were hormone receptor (HR) positive, 97 patients (49%) were positive for human epidermal growth factor receptor and 34 patients (16.4%) had triple-negative breast cancer. The most frequent sites of metastasis included bone (28.7%), lung (27%) and liver (17.4%), followed by non-regional lymph nodes (11.8%) and brain (5.6%). Among the 195 patients, 136 (70%) received treatment. Seventy-three patients (37.4%) underwent single-agent chemotherapy with taxanes, 48 patients (24.2%) received poly-chemotherapy and 12 patients (6.15%) were treated with up-front hormone therapy. Of the 110 patients who were HR positive, 57.2% received endocrine therapy (15 patients (13.6%) on tamoxifen and 48 patients (43.6%) on aromatase inhibitors). Among the 97 patients who were Her2-neu positive, 63 patients (65%) received trastuzumab-based therapy. The study reported a 3-year overall survival rate of 24%. Multivariate analysis indicated that the presence of oligo-metastasis, along with Her2-positive and HR-positive status, correlated with improved patient outcomes.In conclusion, our findings suggest that patients with Her2-positive, HR-positive and oligometastatic disease experience significantly enhanced outcomes. Enhancing access to novel therapeutic options for our patient population is likely to result in improved prognoses.

Metastatic castration-resistant prostate cancer (mCRPC) remains a formidable clinical challenge despite advancements in therapy. This narrative review explores the role of artificial intelligence (AI), machine learning and deep learning in addressing therapeutic resistance in mCRPC. AI-driven approaches leverage integrated datasets encompassing genomics, proteomics and clinical parameters to uncover molecular mechanisms, predict treatment responses and identify biomarkers of resistance. These methodologies promise personalised treatment strategies tailored to individual patient profiles. However, data heterogeneity and regulatory considerations are challenges that hinder the translation of AI insights into clinical practice. By synthesising current literature, this review examines the progress, potential and limitations of AI applications in combating therapeutic resistance in mCRPC, highlighting implications for future research and clinical implementation.

Background: Metastatic breast cancer (MBC) is a significant cause of cancer-related mortality worldwide, with unique challenges in resource-limited settings. Radiotherapy centers play a critical role in the management of MBC, but there is limited data on the clinical and pathological profiles as well as treatment patterns in these settings.

Aim: To describe the socio-demographic characteristics, clinico-pathological features, molecular profiles and treatment patterns of patients with MBC at a major radiotherapy centre in sub-Saharan Africa.

Methods: This was a quantitative retrospective cross-sectional study involving patients with MBC managed between 2016 and 2020. Data were extracted from patients' medical records and analysed with STATA software (version 16). Descriptive statistics were used to summarise the data.

Results: The study involved 154 MBC patients with a median age of 48 years (IQR 19) ranging from 26 to 79 years. Young adults (< 39 years) comprised 29.9% whereas patients ≥60 years accounted for 12.9%. Triple-negative breast cancers comprised 28.6% whereas human epidermal growth factor receptor-2/Neu - enriched tumours constituted 18.8%. Only 29.9% were diagnosed with de novo metastasis. A considerable majority (85.1%) were treated with palliative intent whereas 14.9% received best supportive care only, with none receiving curative treatment. The sites of first occurrence of distant metastasis were bone tissue (38.3%), lung (34.4%), liver (14.9%) and the brain (12.4%). Overall, 63% had solitary metastatic sites whereas 27.9% and 7.8% had double and triple metastatic sites, respectively. About a quarter (24.7%) presented to the radiotherapy center within 6 months of the onset of symptoms, whereas the majority (84.5%) sought care within 24 months.

Conclusion: Bone, lung, liver and brain were the primary metastatic sites, with complex combinations involving these organs, reflecting the heterogeneity of the disease. Context-specific strategies are needed to address the high burden of advanced-stage disease and improve oncological care for patients with MBC in limited-resource settings.

Background: Acute leukaemias (AL) are a group of heterogeneous malignancies characterised by clonal hematopoietic progenitor cell proliferation. Despite advances in the therapy of acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML) in developed countries, outcomes in developing countries like Armenia are thought to be substantially worse.

Aims: The aim of this article is to understand how the limitations in diagnostic and treatment modalities in Armenia impact the clinical outcomes of AL patients and by presenting it to health authorities contribute to the development of evidence-based policies and regulatory improvements to enhance patient care.

Methods: We interrogated data from 431 adults representing all cases of adult AL in Armenia at the Hematology Centre of Armenia from 1 January 2016, to 31 December 2020. Death data were obtained from the United Information System of Electronic Healthcare in the Republic of Armenia. There were some limitations with data collection due to the absence of a unified electronic database and detailed paper records.

Results: Over the 5 years a total of 431 patients were diagnosed with AL at the Hematology Centre of Armenia of which 310 (72%) died. Male patients' number was 131 (54%). Median age was 59 years (Interquartile Range = 50, 18-85 years). A morphological complete remission before death was reached in 82 (34%) patients, including 24 dying without relapse. Additionally, 50 subjects (20%) died during induction chemotherapy including 9 with ALL, 37 with AML and 1 with mixed-lineage leukaemia. Causes of death included no response to treatment (N = 29) or therapy-related complications including septic shock (N = 5), acute heart failure (N = 5), brain hemorrhage (N = 2) and acute respiratory failure (N = 1). Causes of death were unclear in eight patients. Thirty subjects failed induction therapy and declined further treatment before starting the induction. In 24 subjects' remission, state and death causes were unclear. Before starting chemotherapy 58 subjects died, 26 of whom refused therapy and 24 had leukaemia progression. A 5-year survival was 22% including 26% for ALL and 21% for AML.

Conclusion: The results of AL therapy in Armenia are worse than those reported in developed countries, where overall survival is about 60%. The major reasons are leukaemia progression and treatment-related complications.

Background: Lung cancer is the leading cause of cancer death worldwide, with an estimated 1.8 million deaths in 2020. Despite the advancement of new treatment strategies that have emerged over time, surgery remains a very important aspect of cancer treatment. This study aims to highlight the long-term outcomes of surgery as well as the healthcare gaps in the diagnosis and treatment of Lung cancer in Africa by providing a comprehensive systematic review and meta-analysis.

Methods: This systematic review was conducted using database searches from PubMed and Google Scholar to identify published data reporting on the surgical outcomes of lung cancer in Africa from inception till August 2024. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to conduct this study. The primary outcomes of interest were overall mortality, 1- and 5-year survival rates, metastasis, morbidity and recurrence. Data were pooled together and analysed using a random-effect model for meta-analysis with R software. Out of a total of 381 articles identified, only eight papers met our inclusion criteria following deduplication and screening. The five countries with published research on our topic include Egypt, Kenya, Tunisia, Nigeria and Morocco, with a total sample size of 2150 patients.

Results: The meta-analysis of the reported outcomes produced an overall mortality rate of 27%, a 1-year survival rate of 56%, a 5-year survival rate of 13%, metastases of 76.9%, morbidity of 7.7% and recurrence of 11.4%.

Conclusion: The burden of lung cancer is relatively high across the African continent, with surgical treatment significantly underutilised due to several factors, including an inadequate number of skilled healthcare workers, limited cardiothoracic surgical services and the advanced stage at which most patients present. Nevertheless, there is room for improvement by addressing these gaps through targeted investments in cardiothoracic surgical training, research and infrastructure, alongside increased awareness of lung cancer and the benefits of screening services across Africa. These measures, combined with joint international and governmental funding efforts, could significantly improve survival outcomes.

Background: The rising cancer burden in low- and middle-income countries (LMICs) has been accompanied by an increase in clinical trials. However, there is a paucity of research from LMICs on patient preferences for trial participation.

Methods: We undertook a cross-sectional qualitative study using in-depth interviewing to explore the views of Indian cancer patients (n = 11), caregivers(n = 10) and public (n = 10), regarding clinical trials. Clinical researchers (n = 10) were also interviewed. Data were analysed using the framework of qualitative content analysis.

Results: Five themes were identified regarding clinical trials: a) Perception: Only a minority had a prior understanding; when explained, most were willing to be randomised and attend additional monitoring visits. b) Recruitment: Consensus that trial discussions should be with the patient, with caregivers and family included where appropriate, variability in when a patient should be first approached. c) Patient information: Need for both written and audio-visual information material using simple local language. d) Benefits/adverse effects : Discussion of all pros and cons, including the possibility of dying was preferred. There were divided views regarding disclosure of all versus common risks. Challenges in understanding quantitative risks/benefits were voiced. e) Consent: Honesty and transparency, imbalance of power/trust between trialists and participants and financial vulnerability of patients were voiced by participants.

Conclusion: Cancer clinical trials in LMICs can be enriched by patient and public involvement during planning research and conduct of the clinical trial. The financial vulnerability of patients and the power imbalance between them and researchers need to be addressed, especially in international multiregional clinical trials.

Background: Advanced laryngeal carcinoma (LC) has a poor prognosis with limited treatment options. Managing oligometastasis is challenging, and there are currently no standard recommendations.

Methods: We reported a case of a 64-year-old male with locally advanced LC who developed oligometastatic disease in the bones and liver 21 months after concurrent cisplatin-based chemoradiotherapy. Initially, due to negative PD-L1 expression, the patient was treated docetaxel, cisplatin and cetuximab combination. Chemotherapy after 10 months, new hepatic progression was confirmed by biopsy. Given the asymptomatic, single-site progression in a cirrhotic liver, microwave ablation was performed. Isolated bone progressions were treated with stereotactic body radiation therapy at 2 and 4 months, and nivolumab replaced cetuximab.

Results: The patient has shown no evidence of disease progression for 22 months, with excellent tolerance.

Conclusion: The synergy between nivolumab and local therapies appears promising for managing oligometastasis in laryngeal cancer.