Impact of COVID-19 on Management and Outcomes of Oncology Patients: Results of MENA COVID-19 and Cancer Registry (MCCR).

Introduction: Despite extensive studies of the impact of COVID-19 on patients with cancer, there is a dearth of information from the Middle East and North Africa (MENA) region. Our study aimed to report pertinent MENA COVID-19 and Cancer Registry (MCCR) findings on patient management and outcomes. Methods: MCCR was adapted from the American Society of Clinical Oncology COVID-19 Registry to collect data specifically from patients with cancer and SARS-CoV-2 infection from 12 centers in eight countries including Saudi Arabia, Jordan, Lebanon, Turkey, Egypt, Algeria, United Arab Emirates, and Morocco. The Registry included data on patients and disease characteristics, treatment, and patient outcomes. Logistic regression was used to assess associations with mortality. Results: Between November 29, 2020, and June 8, 2021, data were captured on 2008 patients diagnosed with COVID-19 from the beginning of the pandemic. Median age was 56 years (16-98), 56.4% were females, and 26% were current or ex-smokers. Breast cancer (28.5%) was the leading diagnosis and 50.5% had metastatic disease. Delays of planned treatment (>14 days) occurred in 80.3% for surgery, 48.8% for radiation therapy, and 32.9% for systemic therapy. Significant reduction in the delays of all three treatment modalities occurred after June 1, 2020. All-cause mortality rates at 30 and 90 days were 17.1% and 23.4%, respectively. All-cause mortality rates at 30 days did not change significantly after June 1, 2020; however, 90-day mortality increased from 33.4% to 42.9% before and after that date (p = 0.015). Multivariable regression analysis showed the following predictors of higher 30- and 90-day mortality: age older than 70 years, having metastatic disease, disease progression, and being off chemotherapy. Conclusion: Patients with cancer in the MENA region experienced similar risks and outcome of COVID-19 as reported in other populations. Although there were fewer treatment delays after June 1, 2020, 90-day mortality increased, which may be attributed to other risk factors such as disease progression or new patients who presented with more advanced disease.

Corrigendum: Factors influencing participation in COVID-19 clinical trials: a multinational study.

[This corrects the article DOI: 10.3389/fmed.2021.608959.].

Interpretation of P16 expression as a marker of HPV in colorectal cancer.

BACKGROUND: Colorectal cancer is one of the most prevalent types of tumors worldwide. P16ᴵᴺᴷ4ᵃ is a widely used immunohistochemical marker for high-risk HPV infection. The purpose of this study is to explore the relationship between P16 expression as an indicator of HPV infection and colorectal cancer in Egyptian patients, as well as its association with histopathological characteristics. MATERIAL AND METHODS: The study was performed on 59 cases of colorectal carcinoma cases and 30 specimens of normal colonic mucosa. RESULTS: p16 protein was detected in 22% (13 of 59) of patients with colorectal carcinoma. No evidence of P16 expression in all 30 cases of non-neoplastic colonic mucosa was found. More frequent expression of P16 was seen in distal carcinomas. CONCLUSION: our study demonstrated that P16 protein is expressed in a reasonable percent of colorectal carcinoma cases, suggesting a role of HPV in colorectal carcinogenesis. The present study highlights the role of p16 protein expression which is important in the pathogenesis in colorectal carcinoma, especially regarding distal tumors.

Virtual educational meetings and activities during the COVID-19 pandemic and beyond: Egyptian oncologists' experience.

The COVID-19 pandemic has had ramifications for most healthcare activities, including medical education and communication aspects. Virtual educational meetings and activities (VEMAs) have been utilised tremendously in the pandemic era, reflecting a transition to new horizons of cyberspace. This creates the need to explore possible challenges for the implementation of such services in the rapidly evolving field of oncology. The aim of our study is to explore the impact of the COVID-19 pandemic on VEMAs in the oncology community in Egypt. It focused on the evaluation of current attitudes, satisfaction and expectations of Egyptian oncologists during and beyond the COVID-19 era. The study is a cross-sectional study using a survey that was distributed through social media. It targeted Egyptian oncologists during the months of May and June 2020. A total of 118 participants completed the survey and most of them were younger than 35 years (71%). Most participants (93.2%) agreed that COVID-19 affected the stream of live medical educational meetings. About three-quarters of them attended VEMAs during the COVID-19 period compared to 50% prior to the pandemic. The majority reported that evening hours after 8 PM was the best time to attend VEMAs and 1 hour is the optimal duration for a virtual meeting. Although the COVID-19 pandemic appeared as an unprecedented challenge for medical education, it can be a catalyst for VEMAs, especially in a rapidly evolving field such as oncology. Further research is needed to assess whether learners are ready and willing to make greater use of online educational platforms and investigate the possible barriers and strategies to enhance their use.

Predictors of poor precautionary practices towards COVID-19 among cancer patients.

Objective: Our study goal was to evaluate the behavioral response and practices of cancer patients to the coronavirus disease 2019 (COVID-19) pandemic in the Middle East and north Africa. Methods: A cross-sectional study was conducted using a validated anonymous 45-question survey administered via SurveyMonkey® to cancer patients in 13 centers in Algeria, Egypt, Jordan, Kuwait, Morocco and Saudi Arabia. Results: During the study period (from 21 April to 30 May 2020), 3642 patients participated in the study. The majority of patients (84.81%) were worried about contracting the infection. The reported strict adherence to precautions included avoiding the following actions: hand-shaking (77.40%), hugging and kissing (82.89%), social gathering (90.09%), meeting friends (84.68%) and visiting markets (75.65%). In a multivariate analysis, patients with poor precautionary practices were about twice as likely to cancel their medical appointment or a treatment session. Conclusion: Improving cancer patients' knowledge of and adherence to precautionary measures is needed not just to reduce the risk of acquiring infection but also to minimize the interruption of their medical care.

Lay abstract COVID-19 poses a higher risk for patients with cancer than other patients; therefore, it is prudent that they adhere to precautionary measures to protect themselves from the infection. We conducted a study to evaluate the behaviors and practices of these patients in response to the COVID-19 pandemic in the Middle, East and North Africa. We developed a survey of 45 questions that was distributed in 13 centers in Algeria, Egypt, Jordan, Kuwait, Morocco and Saudi Arabia between 21 April and 30 May 2020. About 85% of the 3642 patients who participated in the study were worried about contracting the infection. A substantial percentage of them (10­30%) were not adhering to various precautions and social distancing rules. On the other hand, 16% of them canceled medical appointments and 12% canceled treatment sessions. Our study showed the need for better adherence of patients with cancer to the infection precautions and most importantly, the need to have a better compliance with their treatment plans, such as keeping their scheduled appointments, to avoid harms from treatment delays.

Factors Influencing Participation in COVID-19 Clinical Trials: A Multi-National Study.

In 2020, the World Health Organization has characterized COVID-19, a disease caused by infection with the SARS-CoV-2 virus, as a pandemic. Although a few vaccines and drugs have been approved to, respectively, prevent or treat the disease, several clinical trials are still ongoing to test new vaccines or drugs to mitigate the burden of the pandemic. Few studies have shown the role of host genetics in disease prognosis and drug response highlighting the importance of diverse participation in COVID-19 clinical trials. The goal of this study is to assess public attitudes in Egypt, Saudi Arabia, and Jordan toward participating in COVID-19 clinical trials and to identify the factors that may influence their attitude. An online questionnaire was developed and distributed among the target group through social media platforms. The number of responses was 1,576. Three quarters (74.9%) of participants heard about clinical trials before, 57.6% of them had a positive attitude toward participation in COVID-19 clinical trials. The conduct of clinical trials in accordance with the scientific, research, and ethical guidelines was a strong predictor of willingness to participate in clinical trials. Other positive factors also included protection of family from COVID-19 and contributing to the return to normal community life as well as receiving additional healthcare benefit was the fourth significant predictor. On the other hand, the thought that clinical trials can have a negative impact on the health of participants strongly predicted the unwillingness of individuals to participate in such trials. This was followed by having limited information about the novel coronavirus and COVID-19 and the lack of trust in physicians and hospitals. In general, Arab citizens are accepting the concept and have a positive attitude toward COVID-19 clinical trials. Increasing awareness of COVID-19 and clinical trials, enforcing the concept of altruism, and placing clear policies in conducting clinical trials are needed to increase participation in clinical trials among Arabs.

Clinico-pathological relationship between androgen receptor and tumour infiltrating lymphocytes in triple negative breast cancer.

BACKGROUND: Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with ill-defined therapeutic targets. Androgen receptor (AR) and tumour-infiltrating lymphocytes (TILs) had a prognostic and predictive value in TNBC. The relationship between AR, TILs and clinical behaviour is still not fully understood. METHODS: Thirty-six TNBC patients were evaluated for AR (positive if ≥1% expression), CD3, CD4, CD8 and CD20 by immunohistochemistry. Stromal TILs were quantified following TILs Working Group recommendations. Lymphocyte-predominant breast cancer (LPBC) was defined as stromal TILs ≥ 50%, whereas lymphocyte-deficient breast cancer (LDBC) was defined as <50%. RESULTS: The mean age was 52.5 years and 27.8% were ≥60 years. Seven patients (21.2%) were AR+. All AR+ cases were postmenopausal (≥50 years old). LPBC was 32.2% of the whole cohort. Median TILs were 37.5% and 10% (p = 0.1) and median CD20 was 20% and 7.5% (p = 0.008) in AR- and AR+, respectively. Mean CD3 was 80.7% and 93.3% (p = 0.007) and CD8 was 75% and 80.8% (p= 0.41) in AR- and AR+, respectively. All patients who were ≥60 years old expressed CD20. LDBC was found to be significantly higher in N+ versus N- patients (p = 0.03) with median TILs of 20% versus 50% in N+ versus N-, respectively (p = 0.03). LDBC was associated with higher risk of lymph node (LN) involvement (odds ratio = 6; 95% CI = 1.05-34.21; p = 0.04). CONCLUSIONS: AR expression was evident in older age (≥50 years). Median CD20 was higher in AR- TNBC, while mean CD3 was higher in AR+ tumours. LDBC was associated with higher risk of LN involvement. Larger studies are needed to focus on the clinical impact of the relation between AR and TILs in TNBC.

Prevalence, Associated Factors, and Consequences of Burnout Among Egyptian Physicians During COVID-19 Pandemic.

Objectives: COVID-19 has been recognized as a pandemic by the World Health Organization, and physicians are at the frontline to confront the disease. Burnout syndrome (BOS) is a syndrome resulting from chronic workplace stress that has not been successfully managed. The objective of this study is to evaluate the frequency and associated risk factors of BOS among a sample of Egyptian physicians during the COVID-19 pandemic. Methods: Using Maslach Burnout Inventory Human Services Survey, a cross-sectional electronic survey was conducted to assess BOS among the target group. Results: Two hundred and twenty physicians participated in the study. The frequency of BOS among the research group was 36.36%. The possibility of development of BOS increased two times with the need to buy personal protective equipment (PPE) from participants' own money, with harassment by patients' families, and was less likely to develop in doctors with older age. While male gender was a predictor of depersonalization (DP), female gender showed a significant association with higher emotional exhaustion (EE). Infection or death from COVID-19 among colleagues or relatives showed significant association with elevated EE and lowered personal achievement (PA), respectively. Conclusion: COVID-19 pandemic added new factors to the development of BOS in our research group. Several measures should be taken to support physicians at this stage. These measures include psychological support, organizing work hours, adjusting salaries, and providing personal protective equipment and training on safety measures.

Pleural empyema due to Salmonella in a patient with bronchogenic carcinoma: the first case report from a cancer hospital in Egypt.

BACKGROUND: Salmonella species are motile, Gram-negative facultative anaerobic bacilli, which belong to the family Enterobacteriaceae . The most common clinical presentations of Salmonella infection are gastroenteritis and enteric fever. Detection of Salmonella organisms in empyema is very rare. CASE PRESENTATION: We report the case of a 66-year-old female patient with bronchogenic carcinoma who developed empyema, and Salmonella was identified from the culture of pleural fluid. After antimicrobial therapy and other therapeutic measures, including the insertion of an intercostal tube, oxygen supplementation, frequent suction of respiratory secretions, and chest physiotherapy, the patient's condition improved. To the best of our knowledge, this is the first case to be reported in Egypt. CONCLUSIONS: Our case sheds light on the role of Salmonella in immunocompromised patients in general and cancer patients in specific. We recommend further study of this role, since it may lead to a better understanding of the pathogenicity of this organism in these patients.

Social Stigma: The Hidden Threat of COVID-19.

COVID-19 infection has been recognized as a pandemic by the World Health Organization. Efforts to prevent the spread of the disease are threatened by the appearance of disease-associated social stigma in society. In Egypt, a small wave of stigma directed at different groups started to appear. Here we report the features of COVID-19-associated stigma in Egypt and suggest recommendations to overcome this stigma before it grows and have physical and psychological impacts on society.

Implementation of breast cancer continuum of care in low- and middle-income countries during the COVID-19 pandemic.

Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.

Knowledge, Perceptions, and Attitude of Egyptians Towards the Novel Coronavirus Disease (COVID-19).

Coronavirus disease 2019 (COVID-19) has been recognized as a pandemic by the World Health Organization. Global efforts have been exerted to prevent the spreading of the disease through political decisions together with personal behaviors, which depend on awareness of the public. The goal of this study is to assess the knowledge, perceptions and attitude of the Egyptian public towards the COVID-19 disease. We conducted a cross-sectional survey about these points, which was distributed among adult Egyptians. Five hundred and fifty nine persons completed the survey. The mean knowledge score was 16.39 out of 23, gained mainly though social media (66.9%), and the internet (58.3%). Knowledge was significantly lower among older, less educated, lower income participants, and rural residents. Most participants (86.9%) were concerned about the risk of infection. While 37.6% thought that their salary will be continued if they become isolated, 68.5% believed that it should be continued during this period. About 73.0% were looking forward to get the vaccine when available. In general, participants had a good knowledge about the disease and a positive attitude towards protective measures. This knowledge is gained mainly through novel media channels, which have pros and cons. Although the government has taken major steps to educate the public and limit the spread of the disease, more effort is needed to educate and support the lower economic strata. If a vaccine or a treatment is approved, we recommend a government control over its use to preserve the rights of the vulnerable and needy groups.

Application of the American society of clinical oncology frameworks to compare tyrosine kinase inhibitors used in first line treatment of metastatic renal cell carcinoma: had we solved the mystery?

INTRODUCTION: The approval of multiple biological therapies as a first line treatment for metastatic renal cell carcinoma (mRCC) in the last decade have made the selection of the best treatment between these drugs, especially tyrosine kinase inhibitors (TKIs), a great challenge to oncologists and patients. The four TKIs recommended by the National Comprehensive Cancer Network guidelines in this setting have a relatively similar mechanism of action and analogical adverse events. Areas covered: In this article, the two published American Society of Clinical Oncology frameworks are applied to calculate the net health benefits of the four TKIs used as the first line in mRCC and this was balanced against their monthly cost. The available clinical data that is present for each drug has been displayed and compared to the use of the ASCO frameworks. Expert commentary: There is an urgent need to develop a comprehensive model incorporating all relevant aspects of each drug together. Oncologists should consider all data available for the drugs in order to give the patients an informed opportunity to select the best drug fitting for them.

Early Stage Non-Small-Cell Lung Cancer in Octogenarian and Older Patients: A SEER Database Analysis.

BACKGROUND: The median age at diagnosis of lung cancer is 70 years. However, the evidence guiding the management of octogenarians and older patients with non-small-cell lung cancer (NSCLC), is based on data derived from younger patients and may not be appropriate. METHODS: Patients ≥ 80 years diagnosed with clinical stages I and II NSCLC, between 1988 and 2007, were identified from the SEER database. Patients were classified according to treatments received: no treatment, surgery only, radiation only, and surgery + radiation. Factors associated with survival were assessed using the Cox proportional hazards model. RESULTS: There were 1338 cases of early stage NSCLC in octogenarians. Surgery was the most common treatment modality. The median overall survival was 3.8 years for patients who had surgery, compared with 1.6 years, 1.6 years, and 0.9 years for those who received surgery + radiation, radiation alone, and no treatment, respectively (P < .0001). Factors significantly associated with worse overall survival following surgery included increasing age (hazard ratio [HR], 1.08; P = .0005), male gender (HR, 1.33; P = .01), stage II (HR, 2.21; P < .0001), and squamous histology (HR, 1.36; P = .01). CONCLUSION: Surgical resection is associated with long-term survival outcomes in a substantial proportion of octogenarian and older patients with early stage lung cancer and should not be withheld on the basis of age alone.

EGFR monoclonal antibodies in locally advanced head and neck squamous cell carcinoma: What is their current role?

Treatment options for locally advanced squamous cell carcinoma of the head and neck (SCCHN) include either surgical resection followed by radiation or chemoradiation, or definitive chemoradiation for which single-agent cisplatin is the best studied and established. The increasing understanding of the molecular biology of SCCHN has led to an interest in the development of targeted therapies. The epidermal growth factor receptor (EGFR) is over-expressed in nearly 80-90% of cases of SCCHN and correlates with poor prognosis and resistance to radiation. Preclinical evidence showed that blocking EGFR restores radiation sensitivity and enhances cytotoxicity. This finding led to clinical trials evaluating this class of agents and the approval of cetuximab in combination with radiation for the treatment of locally advanced SCCHN. This review is focused on the anti-EGFR monoclonal antibodies and their role either with radiotherapy or chemoradiation in unresectable LA SCCHN.

Use of angiotensin-converting enzyme inhibitors in the prophylaxis of anthracycline or trastuzumab-related cardiac dysfunction: preclinical and clinical considerations.

Cardiac toxicity is one of the most important long-term toxicities experienced by cancer survivors so that survival rate due to anticancer therapy may be negatively affected due to cardiac complications. Thus, the search for novel methods to lower the incidence of treatment-related cardiotoxicity is a priority for all cancer-related disciplines. In this review, we provide an overview of the available preclinical and clinical data evaluating the role of angiotensin-converting enzyme inhibitors in the prophylaxis of cardiac dysfunction secondary to anthracyclines and trastuzumab use. The available clinical data suggest some degree of protective utility for the use of some angiotensin-converting enzyme inhibitors against anthracycline-related cardiotoxicity while the data are scarce with regard to a similar role for patients receiving trastuzumab.