Breast cancer survivorship needs: a qualitative study.

BACKGROUND: Breast cancer rates and the number of breast cancer survivors have been increasing among women in Iran. Effective responses from healthcare depend on appropriately identifying survivors' needs. This study investigated the experience and needs of breast cancer survivors in different dimensions. METHODS: In this qualitative content analysis, semi-structured in-depth interviews were conducted from April 2023 to July 2023. Data saturation was achieved after interviewing 16 breast cancer survivors (BCSs) and four oncologists using purposive sampling. Survivors were asked to narrate their experiences about their needs during the survivorship. Data were analyzed with an inductive approach in order to extract the themes. RESULTS: Twenty interviews were conducted. The analysis focused on four central themes: (1) financial toxicity (healthcare costs, unplanned retirement, and insurance coverage of services); (2) family support (emotional support, Physical support); (3) informational needs (management of side effects, management of uncertainty, and balanced diet); and (4) psychological and physical issues (pain, fatigue, hot flashes, and fear of cancer recurrence). CONCLUSIONS: This study provides valuable information for designing survivorship care plans. Identifying the survivorship needs of breast cancer survivors is the first and most important step, leading to optimal healthcare delivery and improving quality of life. It is recommended to check the financial capability of patients and take necessary measures for patients with financial problems. Additionally, support sources should be assessed and appropriate. Psychological interventions should be considered for patients without a support source. Consultation groups can be used to meet the information needs of patients. For patients with physical problems, self-care recommendations may also be useful in addition to doctors' orders.

Survival Benefit of Induction Chemotherapy with Paclitaxel and Carboplatin Followed by Chemoradiation Versus Postoperative Treatment in Locally Advanced Gastric Cancer: A Retrospective Cohort Study.

BACKGROUND: Gastric cancer remains a prevalent worldwide illness that lacks a definitive cure. Recently, induction chemotherapy followed by concurrent chemoradiation has shown promising results in achieving a significant pathological response in locally advanced gastric cancer and improving survival rates. However, the optimal regimen for this approach continues to be a subject of discussion. METHODS: This retrospective cohort study was conducted on treatment-naïve patients with locally advanced gastric cancer who were referred to Imam Hossain General Hospital in Tehran, Iran, between April 2016 and March 2019. Eligible patients met the criteria of clinical T3-4 or nodal-positive stage, or both, and had non-metastatic resectable tumors. The patients were categorized into two groups: (a) the neoadjuvant group, which received induction chemotherapy (carboplatin AUC 2 and paclitaxel 50 mg/m2 weekly for 12 cycles) followed by concurrent neoadjuvant chemoradiation (radiotherapy 45-50 Gy/1.8 Gy per fraction concurrent with capecitabine 500 mg/m2 BID and oxaliplatin 40 mg/m2 weekly), and (b) the adjuvant group, which was treated with standard chemoradiation or chemotherapy regimens. The two groups were compared regarding the 3-year recurrence rate and 3-year overall survival. RESULTS: A total of 102 patients were included in the study (63.7% male, mean age ± standard deviation 56 ± 13 years). Among these, 45 patients received neoadjuvant treatment, and 57 received adjuvant treatment. The neoadjuvant group had a higher proportion of patients with advanced disease (stage III: 91.1% vs. 57.9%, P = 0.001). In the neoadjuvant group, 20 patients (44.4%) achieved a complete pathologic response, and all underwent curative surgery. The neoadjuvant group exhibited a lower 3-year recurrence rate (13 [28.9%] vs. 33 [57.9%], P = 0.003) and a higher 3-year overall survival rate (36 [80%] vs. 32 [56.1%], P = 0.003). CONCLUSIONS: Patients receiving induction chemotherapy with paclitaxel and carboplatin followed by chemoradiation demonstrated enhanced disease control and survival compared to standard adjuvant regimens. In addition, patients treated with the applied preoperative regimen in this study showed higher pathologic response and overall survival rates than in previous studies.

Breast cancer survivors-supportive care needs: systematic review.

OBJECTIVES: To achieve optimal survival care outcomes, all healthcare services must be tailored to patients' specific needs, preferences and concerns throughout the survival period. This study aimed to identify supportive care needs from the point of view of breast cancer survivors. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews, a comprehensive search of PubMed, Web of Science and Scopus was performed. The inclusion criteria were studies published from inception to the end of January 2022, covering all stages of breast cancer. The exclusion criteria were mixed-type studies relating to cancer, such as case reports, commentaries, editorials and systematic reviews, as well as studies that assessed patients' needs during cancer treatment. Two quality assessment tools were used for the qualitative and quantitative studies. RESULTS: Of the 13 095 records retrieved, 40 studies, including 20 qualitative and 20 quantitative studies, were retained for this review. Survivors' supportive care needs were classified into 10 dimensions and 40 subdimensions. The most frequently mentioned supportive care needs of survivors were psychological/emotional needs (N=32), health system/informational needs (N=30), physical and daily activities (N=19), and interpersonal/intimacy needs (N=19). CONCLUSIONS: This systematic review highlights several essential needs for breast cancer survivors. Supportive programmes should be designed in order to take into consideration all aspects of these needs, particularly psychological, emotional and informational needs.

The Impact of COVID-19 on Cancer Recurrence: A Narrative Review.

Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) continues to be a worldwide healthcare problem. While our knowledge of the interaction of cancer and its management with COVID-19 mortality is gradually evolving, there are still many unanswered questions regarding the impact of COVID-19 on cancer and its prognosis. Several factors activated during COVID-19 have been implicated in tumorigenesis and the development of metastasis. Inflammation, hypoxia, reduced levels of angiotensin converting enzyme 2, elevated levels of Interleukin 6 and some other cytokines that are hallmarks of COVID-19 are capable of inducing tumor relapse and metastasis. On the other hand, there are reports that COVID-19 has been associated with cancer cure. Understanding the interaction between COVID-19 and tumor cells is essential for evaluating the potential long-term risks of COVID-19 in cancer patients, and for scheduling necessary preventive and therapeutic interventions. In this review, we briefly overview the potential impacts that COVID-19 might have on tumorigenesis and cancer relapse, as well as the role that COVID-19 might play in cancer remission and cure.

Routine COVID-19 testing may not be necessary for most cancer patients.

Cancer patients are at risk for severe complications or death from COVID-19 infection. Therefore, the need for routine COVID-19 testing in this population was evaluated. Between 1st August and 30th October 2020, 150 cancer patients were included. Symptoms of COVID-19 infection were evaluated. All eligible individuals went through RT-PCR and serological tests for COVID-19. At the same time, 920 non-cancer patients were recruited from a random sample of individuals who were subject to routine molecular and anti-body screening tests. Of 150 cancer patients, 7 (4.7%) were RT-PCR positive. Comorbidity made a significant difference in the RT-PCR positivity of cancer patients, 71.4% positive versus 25.8% negative (P-value = 0.02). The average age for negative and positive groups was 53.3 and 58.2 respectively (P-value = 0.01). No significant difference was observed between cancer and non-cancer patients regarding COVID-19 antibody tests. However, cancer patients were 3 times less likely to have a positive RT-PCR test result OR = 0.33 (CI: 0.15-0.73). The probability of cancer patients having a positive routine test was significantly lower than non-cancer patients, and the concept that all cancer patients should be routinely tested for COVID-19 may be incorrect. Nevertheless, there may be a subgroup of patients with comorbidities or older age who may benefit from routine COVID-19 testing. Importantly, these results could not be subjected to multivariate analysis.

Generating pseudo-computerized tomography (P-CT) scan images from magnetic resonance imaging (MRI) images using machine learning algorithms based on fuzzy theory for radiotherapy treatment planning.

PURPOSE: The substitution of computerized tomography (CT) with magnetic resonance imaging (MRI) has been investigated for external radiotherapy treatment planning. The present study aims to use pseudo-CT (P-CT) images created by MRI images to calculate the dose distribution for facilitating the treatment planning process. METHODS: In this work, following image segmentation with a fuzzy clustering algorithm, an adaptive neuro-fuzzy algorithm was utilized to design the Hounsfield unit (HU) conversion model based on the features vector of MRI images. The model was generated on the set of extracted features from the gray-level co-occurrence matrices and the gray-level run-length matrices for 14 arbitrarily selected patients with brain malady. The performance of the algorithm was investigated on blind datasets through dose-volume histogram and isodose curve evaluations, using the RayPlan treatment planning system (TPS), along with the gamma analysis and statistical indices. RESULTS: In the proposed approach, the mean absolute error within the range of 45.4 HU was found among the test data. Also, the relative dose difference between the planning target volume region of the CT and the P-CT was 0.5%, and the best gamma pass rate for 3%/3 mm was 97.2%. CONCLUSION: The proposed method provides a satisfactory average error rate for the generation of P-CT data in the different parts of the brain region from a collection of MRI series. Also, dosimetric parameters evaluation shows good agreement between reference CT and related P-CT images.

The Outcome of Induction Chemotherapy, Followed by Neoadjuvant Chemoradiotherapy and Surgery, in Locally Advanced Rectal Cancer.

BACKGROUND & OBJECTIVE: Currently, neoadjuvant chemoradiotherapy, followed by surgery, is the standard treatment for locally advanced rectal cancer. The use of induction chemotherapy for this tumor is controversial. In this study, the benefits and side effects of induction chemotherapy in locally advanced rectal cancer are evaluated. METHODS: Twenty-nine patients with locally advanced rectal cancer in 2018-2019 were enrolled in this study. Initially, they underwent induction chemotherapy (oxaliplatin 130 mg/m2 every 3 weeks and capecitabine 1000 mg/m2 twice a day for 14 days every 3 weeks for 2 courses). Then, neoadjuvant chemoradiotherapy (radiotherapy 50.4 Gy/28 for 5 days a week concomitant with weekly oxaliplatin 50 mg/m2, as well as capecitabine 825 mg/m2/bid on the days of radiotherapy) was administered. After 4 weeks, computed tomography (CT) scan of thorax, pelvis, and abdomen with and without contrast was performed. Total mesorectal surgery was performed 6-8 weeks after the end of radiotherapy. Four courses of adjuvant chemotherapy were applied. Pathologic complete response (pCR), margin, sphincter preservation, and adverse effects were assessed. RESULTS: In this study, pCR was present in 6 (20.7%) patients. R0 resection was done in 96.05%. Sphincter was preserved in 44.4% of lower rectal tumors. Two patients (6.9%) did not complete adjuvant treatment. Grade 3 adverse effects were documented in 13.7% of cases during induction chemotherapy and 17.2% of cases during neoadjuvant chemoradiation. Mortality was not reported. CONCLUSION: Induction chemotherapy, followed by neoadjuvant chemoradiotherapy and surgery, would be an effective and safe modality in locally advanced rectal cancer.

COVID19 Prevention & Care; A Cancer Specific Guideline.

On March 11th 2020, the coronavirus outbreak was declared a pandemic by the WHO. One of the groups that is considered high risk in this pandemic are cancer patients as they are treated with a variety of immune system suppressor treatment modalities and this puts them in a great risk for infectious disease (including COVID-19). Therefore, cancer patients require higher level measures for preventing and treating infectious diseases. furthermore, cancer patients may bear additional risk due to the restriction of access to the routine diagnostic and therapeutic services during such epidemic. Since most of the attention of health systems is towards patients affected with COVID-19, the need for structured and unified approaches to COVID-19 prevention and care specific to cancer patients and cancer centers is felt more than ever. This article provides the recommendations and possible actions that should be considered by patients, their caregivers and families, physician, nurses, managers and staff of medical centers involved in cancer diagnosis and treatment. We pursued two major goals in our recommendations: first, limiting the exposure of cancer patients to medical environments and second, modifying the treatment modalities in a manner that reduces the probability of myelosuppression such as delaying elective diagnostic and therapeutic services, shortening the treatment course, or prolonging the interval between treatment courses.

Capecitabine induced fingerprint changes.

WHAT IS KNOWN AND OBJECTIVE: Fingerprinting is recognized as an easily accessible means of personal identification; however, fingerprints can be damaged after administration of some chemotherapy agents that result in hand and foot syndrome (HFS). Fingerprint loss may also be due to reasons unrelated to HFS. This study evaluated the incidence of fingerprint changes in patients treated with capecitabine-containing chemotherapy regimens and its relations to various grades of HFS. METHODS: Seventy-one patients who received chemotherapy with or without capecitabine as part of their regimen were enrolled in the study. Fingerprints were collected once before the initiation of chemotherapy and once after the third course of chemotherapy. The fingerprints were examined by the Iranian Society of Forensic Physicians, for probable changes in the post-chemotherapy states. RESULTS AND DISCUSSION: Thirty-seven patients were enrolled in the capecitabine group and 34 in a comparison group. Fingerprint changes were observed in 25 (67.6%) of the 37 patients in the capecitabine group and none in the comparison group. There was no correlation between the occurrence or severity of HFS and fingerprint changes (P = 0.880). In capecitabine group, the total dose and course numbers of capecitabine were not significant in patients with and without fingerprint changes. WHAT IS NEW AND CONCLUSION: Based on our findings, we recommend notifying patients who are considered for capecitabine therapy about the risk of fingerprint changes before the initiation of treatment, as this may have legal implications.

Comparison of Capecitabine (Xeloda) vs. Combination of Capecitabine and Oxaliplatin (XELOX) as Neoadjuvant CRT for Locally Advanced Rectal Cancer.

We decided to compare pathologic complete response (pCR) and disease-free survival (DFS) in rectal adenocarcinoma patients who received neoadjuvant chemoradiotherapy (CRT) with capecitabine plus oxaliplatin (XELOX) or capecitabine (Xeloda). In this study, patients with non-metastatic locally advanced rectal cancer (tumor stages of T2, T3, or T4) with or without lymph node involvement were retrospectively included. Patients received concomitant radiation (50.4-54 Gy external beam radiation in 28 to 30 fractions) and neoadjuvant therapy as either Xeloda (capecitabine, 2500 mg/m2 concomitantly with radiation therapy) (42patients) or XELOX [(oxaliplatin (50 mg/m2 intravenously once a week for five weeks) and capecitabine)] (72 patients). Surgery was done eight weeks after CRT. The endpoints were pCR (defined as no evidence of viable tumoral cells) and DFS (the interval from the initial treatment to the first tumor recurrence). Rectal sphincter preservation via low-anterior resection (LAR) was achieved in 73.8% of Xeloda group which was similar to XELOX group (70.8%), P = 0.61. pCR was documented in 11 (26.9%) of Xeloda group and 26 patients (36.1%) of XELOX group (P = 0.27). Tumor recurrence was recorded in 97 patients (85.1%). Mean (±SD) DFS was 52.13 (±31.92) months (median = 48 months). Mean (95% CI) DFS was 129.42 (110.19 to 148.64) in Xeloda group vs. 122.77 (110.72 to 134.83) in XELOX group (P = 0.74). Addition of oxaliplatin to capecitabine as neoadjuvant CRT for locally advanced rectal cancer did not result in improved pCR or better DFS.

Cutaneous Verrucous Carcinoma Superimposed on Chronically Inflamed Ileostomy Site Skin: A Case Report.

Verrucous carcinoma (VC) is a rare variant of well differentiated squamous cell carcinoma (SCC) which is usually found in oral cavity mucosa. Cutaneous verrucous carcinoma is a rare entity and in this paper we report a 43 years old man with VCsuperimposed on chronically inflamed skin of ileostomy site. Previously, he was operated to treat rectal adenocarcinoma and has had ileostomy for six months. The skin lesion was resected totally during surgical operation for ileostomy closure. Histopathologic examination confirmed the diagnosis of cutaneous verrucous carcinoma. Post-operative follow up shows no evidence of recurrence after six months. We suggest patient's training for follow up visits in order to early detection of osteomy site complications including neoplastic changes.

Von Hippel-Lindau Disease With Multi-Organ Involvement: A Case Report and 8-Year Clinical Course With Follow-Up.

BACKGROUND Von Hippel-Lindau (VHL) disease is a rare autosomal dominant syndrome manifested by a spectrum of benign and malignant tumors.  CASE REPORT The patient presented here was a 31-year-old female with unremarkable family history who presented initially complaining of intermittent abdominal pain. Abdominal CT scan revealed an inhomogeneous solid mass (13×9×7 cm) originating from the tail of the pancreas with splenic and gastric invasion as well as several pancreatic cysts. A nucleotide scan showed left adrenal involvement. The patient underwent tumor resection, splenectomy, partial gastrectomy, and left adrenalectomy. Histopathologic examination reported well-differentiated neuroendocrine carcinoma with low malignant potential of the tumor with splenic and adrenal involvement. Pancreatic cysts had benign component.  Three years later, follow-up abdominal CT showed heterogeneously-enhanced solid nodules in both kidneys found to be renal cell carcinoma (RCC) on biopsy. At the same time, brain MRI showed cerebellar hemangioblastomas. Partial nephrectomy was done. Molecular genetic testing for demonstrated NM_000551.3:c.481C > T (p.R161* CGA>TGA), which has been reported previously in VHL disease. The next year, she developed peritonitis, which found to be the result of a perforated gastric ulcer. Histopathologic examination of the ulcer revealed neuroendocrine carcinoma. Then, the next year, a brain MRI revealed 4 solid and enhanced nodules in the cerebellum, suggesting multiple hemangioblastomas. Octreotide (Sandostatin® LAR) and everolimus (Afinitor®) were started for the patient. At the last visit, the patient was asymptomatic with acceptable condition.    CONCLUSIONS Here, we present a young patient with pancreatic neuroendocrine tumor as the first presentation of VHL without a remarkable family history for VHL disease. The patient developed RCC, renal cysts, cardiomegaly, and brain hemangioblastomas during the 8-year follow-up. Regular follow-up with imaging (ultrasound, CT, MRI) are necessary to follow the previous lesions and detect any newly-developed VHL-associate tumors.

Fingerprint changes among cancer patients treated with paclitaxel.

BACKGROUND: Fingerprints have long been used for personal identification; however, some case reports suggested that some chemotherapy agents such as paclitaxel lead to fingerprints loss due to hand-and-foot syndrome (HFS). METHODS: This case-control study was performed on 65 patients who received chemotherapy regimens with/without paclitaxel. Patients with the history of receiving any drugs with significant HFS adverse effect or patients with any conditions that affect fingerprints were excluded. Baseline and post-chemotherapy images of fingerprint examples were referred to the Iranian Society of Legal Medicine to compare changes in the fingerprints. RESULTS: Thirty-one patients entered in the paclitaxel and 34 subjects in the control groups. Seventeen patients (54.8%) in the paclitaxel group experienced fingerprint changes, whereas no patient had fingerprint changes in the control group. By physical examination, no patients in the two groups experienced HFS. After adjusting for age, sex, occupation, and cancer type, there was a significant difference between the two groups regarding fingerprint changes (P = 0.002, OR 13.69, 95% CI 2.05 to infinite). CONCLUSIONS: Considering that fingerprint recognition has been utilized in both government and civilian investigation, patients taking paclitaxel and centers necessitating fingerprint identification should be informed about possible fingerprint changes by paclitaxel.

Solitary Psoas Muscle Metastasis of Gastroesphageal Junction Adenocarcinoma.

Metastasis of gastroesphageal junction (GEJ) adenocarcinoma in skeletal muscle is rare and primary sites for skeletal muscle metastases are usually lung, renal and colorectal cancer. We have encountered with the first case report of solitary psoas muscle metastasis of GEJ adenocarcinoma. Here we describe a 65 years old man was diagnosed with GEJ adenocarcinoma in Gastroenterology Department, Imam Hussein Hospital, Tehran, Iran in February 2014. We were not able to use PET techniques due to lack of access. Staging CT scans demonstrated a small mass lateral to right psoas muscle. A CT-guided core needle biopsy of right psoas muscle was performed that supported a diagnosis of adenocarcinoma consistent with primary adenocarcinoma of the GEJ. Distant metastasis to skeletal muscle rarely occurs in patients with GEJ adenocarcinoma, but heightened awareness to these soft tissue lesions is warranted. CT or MR imaging could show findings suggestive of metastatic disease, although PET is preferable modality.

Jaw Pain as a First Presentation in the Diagnosis of Breast Cancer.

The oral cavity is uncommon site for metastatic disease usually discovered secondary to malignancy. We encountered with a rare case in which metastasis to mandibular bone was the first clinical sign in the diagnosis of breast cancer without any radiographic findings. A 49-yr-old premenopausal woman, was referred to the Department of Medical Oncology of Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran in 2014, presented with pain and tenderness in the left mandibular and temporal bone and paresthesia of the lower left lip and chin. CT scan of mandible showed no significant finding. Four months later, she was referred with complaints left breast pain for 4 wk and worsening swelling, pain and paresthesia. Breast examination revealed a 2 cm firm nodule on the left breast. Based on her medical history and histopathological study, metastatic carcinoma of the breast was suspected. She has received chemoradiotherapy that led to complete relief of her symptoms and remission of the disease. In the presence of an ambiguous sign in oral cavity such as jaw pain or paresthesia, diagnostic examination of malignancy is recommended.

Cetuximab Plus Various Chemotherapy Regimens for Patients with KRAS Wild-Type Metastatic Colorectal Cancer.

BACKGROUND: The aim of this study was to compare the efficacy and hematologic toxicity of cetuximab combined with various types of chemotherapy regimens in patients with KRAS wild-type metastatic colorectal cancer (mCRC). METHODS: The response rate, progression-free survival (PFS) and overall survival of the patients were analyzed. RESULTS: In total, 45 patients were included in the study. The overall response rate for the combination of cetuximab and FOLFOX, FOLFIRI and CAPOX was 20, 46 and 30%, respectively, but the differences were not statistically significant. The median PFS for the three groups were 8, 6 and 3.5 months, respectively, but again these differences were not significant. All-grade leukopenia and anemia for the cetuximab plus FOLFOX group were significantly higher than for the other chemotherapy regimens. CONCLUSION: Our findings suggest that the combination of cetuximab and the three standard chemotherapy regimens resulted in the same outcomes in our patient population of mCRC, with higher hematologic toxicities among the FOLFOX subgroup.

Attitude of cancer patients toward diagnosis disclosure and their preference for clinical decision-making: a national survey.

OBJECTIVES: There is still contradictory evidence on disclosure preferences regarding cancer diagnosis. The aim of this study was to evaluate the preference of cancer patients for knowing the truth about their disease, as well as the factors that might have an impact on these preferences. METHOD: This study was conducted in 11 cancer centers in Iran. A questionnaire was used to collect data, and all patients above 15 years of age who were willing to participate were included in the study. The patients were asked if they were aware of the malignant nature of their disease, and if they came to know about their disease at the time of initial diagnosis, or later. The patients were then asked about the way they looked upon their disease. In the final part of the questionnaire, the participants were asked the level of involvement they prefer to have in making treatment decisions. RESULTS: In total, 1226 patients were enrolled in this study, only 565 (46.7%) of whom were aware of their disease at the time of diagnosis, and 878 (72.7%) at the time of interview, while 980 (85.2%) were willing to receive information about their disease. Patients' awareness was significantly associated with age under 50 years, female gender, having breast, skin or head and neck cancer, and having medical care in Shiraz or Hamadan while it was not associated with the stage or accompanying illness. CONCLUSION: While the majority of Iranian cancer patients prefer to be aware of the nature of their disease and have an active role in treatment decision making, they do not receive this information.