Comparison of Survival Outcomes between Early Breast Cancer Patients who Underwent Mastectomy and Patients Treated by Breast Conserving Therapy: A Meta Analysis.

Background: Early stage of breast cancer requires mastectomy or breast conserving therapy. However, there are disagreements regarding the outcome of these two types of therapies in term of overall survivals. Objectives: The first aim of this meta-analysis was to assess the overall survival between patients who underwent mastectomy and those treated by breast conserving therapy. The second was to evaluate the influence of the follow up period on overall survival between the patients who benefited mastectomy and those who under went breast conservative therapy. Methods: We systematically searched on PubMed and Cochrane library all published randomized trials comparing mastectomy with breast conserving therapy and assessing overall survival. Results: Using dichotomous data, there was not a significant difference between mastectomy and BCT (OR:0.99; 95% CI:0.93-1.06; P:0.86). This was the same in subgroup analysis based on period of follow up. Their ORs and CI were (OR:0.97; 95% CI:0.81-1.18; P:0.79), (OR:1.01; 95% CI:0.90-1.13; P:0.87) and (OR:1.04; 95% CI:0.93-1.16; P:0.46) respectively for up to 5 years or less, between 5 and 10 years and more than 10 years of follow up. Using generic inverse variance, there was no significant difference between mastectomy and BCT, (HR:1.01; 95% CI:0.98-1.04; P:0.71). In subgroup analysis based on period of follow up, there was no significant difference between mastectomy and BCT. Their HRs, CI and P-value were (HR:1.01; 95% CI:0.951-1.07; P:0.79), (HR:0.98; 95% CI:0.92-1.04; P:0.51) and (HR:1.02; 95% CI:0.97-1.07; P:0.40) respectively for up to 5 years or less, between 5 and 10 years and more than 10 years of follow up. Conclusion: This meta-analysis demonstrated that there was no significant difference between patients with early stage breast cancer when they are treated by mastectomy or breast consevative therapy in term of overall survival. Additionnally, the follow up period had no any influence on the both types of surgery in term of overall survival. Therefore, we suggest that breast conservative therapy or mastectomy should be discussed between the care team and the patient, taking into account the financial means available to the patient, especially in low-income countries, the benefits of the surgery and the patient's choices.

Aloe and its Effects on Cancer: A Narrative Literature Review.

Many years ago, Aloe Vera was cited to have a lot of therapeutic properties including; anti-microbial, anti-viral, anti-cancer, anti-oxidant, anti-inflammatory, skin protection, wound healing, and regulation of blood glucose and cholesterol. However, Aloe could present some side effects. This review focused on the latest discoveries regarding the therapeutic role of Aloe plant or its compounds on the acquired biological capabilities for tumour growth and progression namely; evading growth suppressor, avoiding immune destruction, enabling replicative immortality, tumour promoting inflammation, activating invasion and metastasis, inducing angiogenesis, genome instability and mutation, resisting cell death, deregulating cellular energetics and sustaining proliferating signalling. It clarified the anti-cancer activities it exerts on different types of cancer and also highlighted some pro-oncogenic pathways that can be disrupted by different compounds of Aloe.

Cancer in Patients Referred Abroad For Health Care and Related Foreign Currency Expenses.

BACKGROUND: There is limited access to health services in Burundi, as most of the services such as cancer care are unavailable. Burundian citizen who can afford the costs involved in seeking treatment elsewhere are referred abroad. The purpose of this study was to assess the proportion of patients suffering from cancer among patients referred abroad for healthcare and to evaluate the costs incurred by those patients in relation to what the country would save by establishing cancer healthcare facilities. METHODOLOGY: The study was performed retrospectively from January 2016 to December 2018. With approval of Ministry of Public Health and AIDS control, the data was collected from medical reports at the general management of health facilities and AIDS control office. All patients with medical reports containing the reason for referral were included in the study. Medical reports assessing occupational disability were excluded. Data analysis was performed using Statistical Package for the Social Sciences (SPSS). RESULTS: Male, female and unclear was 45.3%, 39.9% and 14.8% respectively. Average age was 31,82. The main reason for referral was MRI (21.7%). Cancer patients represented 18% of all patients referred abroad for healthcare and the most common type of cancer found was breast (26.5%), genitourinary (15.7%) and digestive (14,2%). If all patients from 2016-2018 were referred to Kenya, Uganda, Rwanda, India or Europe for 30 years, the country would spend in foreign currency US$3,858,229; US$638,342.80; US$21,288,592; US$10,410,192.90; US$54,718,329.70 respectively. Also, if all patients estimated by Globocan in 2018 were to be referred to these countries, the cost of foreign currencies would be US$52,455,122.60; US$38,264,740.88; US$129,272,590.40; US$81,330,325.94; US$276,601,008.02 respectively. CONCLUSION: There is a good number of cancer patients among patients referred abroad for health care. The estimated costs incurred by patients referred abroad for cancer care are far greater than funds needed to setup modern cancer care centres in Burundi.

Efficacy and Safety of Fentanyl Compared With Morphine among Adult Patients with Cancer: A Meta-Analysis.

BACKGROUND: Cancer pain is experienced by numerous patients; thus, the main pain-relieving opioid analgesics, fentanyl and morphine, are of great importance. However, their analgesic efficacy and safety are different among individuals and are still controversial. The aim of this study was to compare the safety and efficacy of fentanyl and morphine among patients with cancer. METHODS: We performed a meta-analysis by searching PubMed and the Cochrane Library up to 01 April 2019. The search terms were fentanyl, morphine, opioids and cancer pain. All randomised controlled trials comparing fentanyl and morphine were included in the analysis. RESULTS: Overall, the initial search identified 2970 published studies; among them, 9 studies were included in the efficacy analysis and 8 studies were included in the safety analysis. The oral morphine versus oral transmucosal fentanyl subgroup analysis showed a mean difference(MD)=0.47[Confidence interval(CI):0.35-0.58] with an overall effect, Z=8.10, P<.00001. The outcome of the oral morphine versus nasal/transdermal fentanyl subgroup indicated a MD=0.20[CI:0.3-0.37] with an overall effect, Z=2.24 and P=.02.For the oral morphine versus buccal/sublingual fentanyl subgroup, the analysis revealed a MD=1.80[CI:1.35-2.25] with an overall effect, Z=7.87 and P<.00001.The oral morphine versus other forms of fentanyl subgroup showed a MD=0.70[95%CI:0.34-1.06] with the test for the overall effect, Z=3.81 and P=.0001.Constipation, drowsiness, confusion and dry mouth were more common in the morphine group than in the fentanyl group, with a risk ratio=0.60[CI:0.37-0.97]; 0.93[CI:0.69-1.25]; 0.85[CI:0.23-3.13] and 0.54[CI:0.05-6.43], respectively. CONCLUSIONS: Compared with oral morphine, fentanyl is safer and more effective. Moreover, fentanyl presents fewer side effects than morphine, especially constipation, drowsiness, confusion and dry mouth.

Lymphoedema After Breast Cancer Treatment is Associated With Higher Body Mass Index: A Systematic Review and Meta-Analysis.

BACKGROUND: Excess body weight has been identified as an important risk factor for lymphoedema following breast cancer treatment, however it remains unclear how much risk increases as weight increases. We conducted a meta-analysis to assess the relationship between body mass index (BMI) and risk of lymphoedema in breast cancer patients, and to estimate the level of risk by BMI category. METHODS: We conducted a systematic search of all articles published through May 2018 in PubMed and the Cochrane library. Studies that included data on BMI and lymphoedema in breast cancer patients were included in the meta-analysis. We compared risk of lymphoedema in BMI groups as: BMI<25 versus BMI≥25, BMI<25 versus BMI≥30, BMI≥25 to <30 versus BMI≥30, BMI<30 versus BMI≥30, BMI<25 versus BMI≥25 to BMI<30. RESULTS: After exclusion of ineligible studies, 57 studies were included in the meta-analysis. The mean difference in BMI between patients with lymphoedema compared to those without lymphoedema was 1.7 (95% CI, 1.3-2.2). Compared to patients with a BMI<25, risk of lymphoedema was higher in those with a BMI >25 to <30 (odds ratio [OR] 1.3; 95% CI, 1.2 to 1.5), a BMI≥25 (OR 1.7; 95% CI, 1.5 to 1.9), or a BMI≥30 (OR 1.9; 95% CI, 1.6 to 2.4). Compared to patients with a BMI of >25 to <30, risk of lymphoedema was higher in patients with a BMI>30 (OR 1.5; 95% CI,1.4 to 1.8). CONCLUSION: Excess body weight is a risk factor for lymphoedema following treatment of breast cancer, with the magnitude of risk increasing across higher categories of BMI.