Real-world Treatment Patterns and Outcomes in Stage III Non-small Cell Lung Cancer: Middle East and Africa - KINDLE Study.

INTRODUCTION: The Middle East and Africa (MEA)-KINDLE, as part of a real-world global study, evaluated treatment patterns and survival outcomes in stage III non-small cell lung cancer (NSCLC) in the MEA. MATERIALS AND METHODS: Retrospective data were analyzed from 33 centers for patients diagnosed between January 01, 2013, and December 31, 2017. Descriptive analyses included clinical-demographics and treatment patterns; inferential statistics evaluated an association of first-line treatment with progression-free survival (PFS) and overall survival (OS). RESULTS: Of 1,046 patients enrolled, the median (range) age was 61.0 years (24.0-89.0); 83.2% were men, 80.8% were current or past smokers, 58.9% had stage IIIA disease, 47.8% had adenocarcinoma and 20.0% of tested (35/175) had epidermal growth factor receptor mutations. Of 86.0% of patients receiving an initial therapy, about 16% underwent surgical resection. Concurrent chemoradiotherapy (cCRT) (32.3%) was the most frequent treatment modality followed by chemotherapy (CT) alone (19.6%) and sequential CRT (12.1%). Median PFS and OS (months, 95% CI) were 11.8 (10.6, 12.4) and 22.9 (21.2, 26.3), respectively for the overall MEA subset. OS (months) was highest with surgery-based therapies for stage IIIA (IIIA: 37.3, IIIB: 24.1) followed by cCRT (IIIA: 28.9, IIIB: 24.4). Female gender, adenocarcinoma, and cCRT or Sx+CRT in first-line were associated with higher OS (P < .05). CONCLUSIONS: The data reveal an unmet need in stage III NSCLC with worse PFS and OS in the MEA subset than in the global cohort. Better access to newer therapies and quality care will be crucial in improving patient outcomes in the MEA.

Phase II trial of thalidomide, irinotecan and gemcitabine in chemonaive patients with advanced non-small cell lung cancer.

This study aim was to determine the efficacy and safety of the combination of Gemcitabine 1000 mg/m(2) day 1 & 8 and Irinotecan 100 mg/m(2) day 1 & 8 with escalating dose of thalidomide in chemonaive patients with advanced non-small cell lung cancer. Among the 20 patients who met eligibility criteria and received treatment, two patients (10%) experienced partial response and 14 (70%) experienced stable disease. The median time to disease progression was 4 months (95% CI: 2.8-6.6). The 1 year and 2 year survival rates were 36% and 27%, respectively. This combination is active in advanced NSCLC with manageable toxicity profile.

Hematologic complications of alternative remedies.

The use of alternative therapies increased dramatically over the last decade with a wide variety of methods and interventions. Dietary supplements are a very common form of alternative therapy used by healthy people as well as patients with serious health problems. The use of these untested, unregulated therapies may carry inherent risks. Hematologic complications are known side effects of these remedies and may present potentially life-threatening events. This manuscript discusses the clinical manifestations and mechanisms of action of these remedies and provides recommendations for patients' evaluation and counseling.

Prognostic factors in patients with surgically resected stages I and II non-small cell lung cancer.

BACKGROUND: About one-third to one-half of patients with early stages of non-small cell lung cancer (NSCLC) succumb to their disease. In this study, we attempted to identify prognostic factors that predict outcome in patients with stages I and II NSCLC. METHODS: A retrospective evaluation of 454 patients with surgically resected stages I and II NSCLC was performed to determine the impact of various clinical, laboratory, and pathological factors on patient outcome such as overall survival (OS) and event-free survival (EFS). RESULTS: Patients older than 65 years had shorter EFS and OS than younger patients (p = 0.002). Patients with preoperative hemoglobin less than or equal to 10 g% had shorter EFS and OS compared to patients with a hemoglobin greater than 10 g% (p = 0.001). Expectedly, OS and EFS were shorter in patients with stage II as compared to stage I patients (p < 0.001). In a multivariate analysis, age, hemoglobin level, and stage remain significant predictors for EFS and OS. CONCLUSIONS: Older age, anemia, and higher stage are important prognostic factors in patients with surgically resected stage I and II NSCLC.

The reality of mammography utilization in the state of Arkansas.

The Arkansas Mammography Data Collection Project, funded by the Arkansas Department of Health, aimed to determine the mammography screening patterns throughout the state of Arkansas. Data were obtained from 92 mammoraphy centers out of 112 centers (82%). A total of 157,976 mammography data sets were obtained for 148,586 women. Mammography rate was 22.7% for women 40 years and older and 24.1% for women 50 years and older. Mammography rates per county varied from 0.3% to 42.6%. The overall low rate of mammography utilization reflects the need to intensify public health interventions and continuous evaluations of these interventions.

Mammography utilization pattern throughout the state of Arkansas: a challenge for the future.

The Mammography Data Collection Project (MDCP) was aimed at determining the 1997 mammography rate and screening practice patterns throughout the state of Arkansas. The MDCP conducted a comprehensive survey of mammography centers to collect individual patient demographic data, and mammography data. Data elements pertinent to patients' age, race, insurance, type of mammogram, date of mammogram, and the zip code were obtained from participating centers. Analysis was performed to determine the mammography rate by age group and areas of residence. Of the 112 eligible mammography centers contacted, 92 centers (82%) participated. A total of 157,976 mammography data sets were obtained. The total number of women imaged was 148,586 with 90% of them over the age of 40 years. The mammography rate was 24.1% for women 50 years of age and older and 19.4% for women 40-49 years of age. Most of the women imaged had private insurance (52%). This study revealed that only a small fraction of women ages 40 years and older obtained annual mammograms in 1997, thus highlighting the need for intensifying efforts to increase the utilization of this lifesaving test.

Case report of sideroblastic anemia caused by ingestion of coins.

This is a report of a 54-year-old schizophrenic patient with a 15-year history of ingesting metal objects (pica). He presented with severe anemia (hemoglobin of 3 g/dl and hematocrit of 8.3%) and leukopenia (white blood count of 1,300/mm3). Work-up revealed copper deficiency (copper level of <0.05 microg/ml) and elevated zinc levels (280 microg/ml). The zinc toxicity was produced by the zinc content in the coins ingested by the patient over a period of many years. He was initially treated with -acetylcysteine and sodium bicarbonate followed by intravenous copper sulfate. He was also placed on Adolph's meat tenderizer and pancreatin thrice a day orally to loosen the massive amount of metallic objects including coins in his bowel and allow them to pass out in his feces. He was also continued on oral copper sulfate. His copper levels began to rise and reached a maximum of 0.72 microg/ml, and his zinc level fell to 153 microg/ml. However, as he refused surgery to remove the metal objects from his bowel and continued to ingest more coins, there was continued absorption of zinc, which later overcame the efforts to reduce the zinc level and increase copper levels in his blood. He finally succumbed to sepsis and multiorgan failure. Autopsy revealed a coin mass in the stomach weighing 1,870 grams in addition to a sigmoid volvulus caused by another coin bezoar in the colon.

Development of a patient information packet for veterans with cancer receiving chemotherapy.

BACKGROUND: Patient education is an important part of caring for cancer patients. Providing educational materials suitable to the particular patient population is crucial. Veterans with cancer represent a population that requires special educational materials. METHODS: A patient information packet (PIP) was developed for veteran cancer patients receiving chemotherapy. The PIP contains information about chemotherapy side effects, when to call for help, available resources, and information about support groups. RESULTS: The PIP was distributed by the oncology pharmacist to 96 newly diagnosed cancer patients. One-month evaluation of 85 patients revealed that 83 had utilized the materials. Thirty-four patients had read the PIP once; 32, twice; ten, three times; and six, four or more times. The PIP had helped 13 patients decide to call the VA Hospital and had helped 16 patients decide whom to call. CONCLUSION: The PIP, developed to meet the specific needs of this patient population, was well received and utilized.

Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature.

The significant increase in the use of alternative medicine in general and the herbal and dietary supplement in particular represents a challenge to the health care professionals. Because of their unregulated use, physicians are encountering increasing numbers of toxicities and untoward events. We report a case of severe intraoperative haemorrhage in a patient who was taking the herb Saw Palmetto. His bleeding time which was prolonged, normalized few days after he stopped the herb. This case should increase the awareness of physicians to such possible complications and encourage them to enquire thoroughly about the use of any dietary supplement in all their patients.

Severe hemorrhagic complication due to acquired factor V inhibitor after single exposure to bovine thrombin product.

Hemorrhagic complications have been reported after repeated exposures to bovine thrombin products due to development of factor V inhibitors. Our patient underwent emergency repair of acute aortic dissection and coronary artery bypass grafting. The patient developed leg wound infection at the saphenous vein harvest site, which was debrided and left open. Attempt to reclose the leg wound 1 month later was complicated by a life-threatening hemorrhage with markedly elevated activated partial thromboplastin time. There was no evidence of infection or disseminated intravascular coagulation, and further study identified low factor V level with positive factor V inhibitor. Treatment with plasmapheresis and steroid successfully reversed the coagulopathy. Detailed case review failed to reveal exposure to any thrombin products other than the one used for the aortic dissection repair. This case was unusual because only a single exposure to this product resulted in severe hemorrhagic complication 1 month after surgery.

The impact of a cancer education program on the knowledge base of participating students.

BACKGROUND: Partners in Research is a ten-week summer elective designed to provide cancer-related educational activities. This study was undertaken to evaluate the impact of the program on the general cancer knowledge of medical students, pharmacy students, and undergraduate biology majors. METHODS: The 24 students enrolled in 1999 were evaluated using a pretest and post-test with 75 multiple-choice questions. RESULTS: The mean test score increased significantly from 46.6% to 53.0% (p = 0.001). Improvements were significant for general cancer knowledge and three specific disease categories (breast, gastrointestinal, and skin cancers). CONCLUSIONS: The results indicate that the program does increase the cancer-related knowledge of students.