Exploring Integrative Approaches: Insights Into Complementary Medicine Practices Among Breast Cancer Survivors in Saudi Arabia.

OBJECTIVES: Complementary and integrative medicine (CAM) is a prevalent approach often used with conventional medical practices The study aims to understand the factors influencing breast cancer (BC) survivors' decisions regarding CAM therapy and the drivers behind their use. SETTING: This research was conducted at an academic hospital in Saudi Arabia. The study used cross-sectional research with a questionnaire. Participants were enrolled in the study through BC survivors' groups on WhatsApp. Individuals who were actively following up at the clinic were also interviewed. Informed consent was obtained. RESULTS: The study surveyed 211 BC survivors, aged 34-49 (50.2%), who had undergone surgery (93.4%), hormonal therapy (66.4%), and chemotherapy (87.7%). Less than half (44.5%) had chronic conditions such as diabetes and hypertension. CAM users were 43.6%. The most used CAM modalities were Zamzam water, honey, and water read-upon Quran. A significant motivator for CAM use was to boost the immune system. More than half of patients used less than 100 SAR per month on CAM modalities. Exactly 80.4% of CAM users perceived benefits from CAM use. Predictors of CAM use included higher family monthly income, radiation therapy, and being diagnosed from 1 to 5 years. BC survivors without medical conditions after diagnosis were less likely to use CAM. CONCLUSION: The study highlights the prevalence, predictive factors, motivations, and perceived benefits of CAM use among BC survivors in Saudi Arabia, emphasizing the need for understanding and integration into cancer care plans and the need for further research on CAM safety and efficacy.

Knowledge- and Experience-Based Perceptions of Radiation Therapists during the COVID-19 Outbreak.

Objective: To assess the perceived risks and impact of the COVID-19 outbreak on radiation therapists in Saudi Arabia. Methods: A questionnaire was distributed to all radiation therapists in the country. The questionnaire contained questions about demographic characteristics, the extent of the pandemic's impact on hospital resources, risk perception, work-life, leadership, and immediate supervision. The questionnaire's reliability was assessed using Cronbach's alpha; >0.7 was considered adequate. Results: Out of the 127 registered radiation therapists, 77 (60.6%) responded; 49 (63.6%) females; and 28 (36.4%) males. The mean age was 36.8 ± 12.5 years. Nine (12%) of the participants had a past experience with pandemics or epidemics. Further, 46 (59.7%) respondents correctly identified the mode of transmission of COVID-19. Approximately, 69% of the respondents perceived COVID-19 as more than a minor risk to their families and 63% to themselves. COVID-19 had an overall negative impact on work at the personal and organizational levels. However, there was a positive attitude toward organizational management during the pandemic in general; positive responses ranged from 66.2% to 82.4%. Ninety-two percent considered protective resources and 70% considered the availability of supportive staff to be adequate. Demographic characteristics were not significantly associated with the perceived risk. Conclusions: Despite the high perception of risk and negative impact on their work, radiation therapists conveyed a positive overall perception regarding resource availability, supervision, and leadership. Efforts should be made to improve their knowledge and appreciate their efforts.

Effect of Body Mass Factors on Setup Displacement in Gynecologic Tumors and Subsequent Effect on PTV Margins.

Purpose: This study aimed to analyze the effect of body mass factors (BMFs) on setup errors in gynecologic tumors, and whether the planned tumor volumes (PTVs) are adequate for obese patients. Methods: This was a retrospective study of 46 consecutive female patients with gynecologic tumors who were treated with volumetric modulated arc therapy. Setup accuracy was verified using daily cone beam computed tomography. Accuracy was determined for each fraction by testing 2 different PTVs (cutoff I = ≤0.7 cm; cutoff II = ≤1.0 cm). A pooled analysis was conducted to test the association between accuracy levels (within vs beyond PTV) and the mean and variance of body mass index (BMI), umbilical (UC), and hip circumference (HC). A receiver operating characteristics curve analysis was carried out to test the sensitivity of BMI, UC, and HC in predicting inaccurate setup. Results: A significant association between BMFs and level of accuracy was observed in the lateral and vertical directions, but not in the longitudinal direction. In the lateral direction, inaccurate setups were associated with a greater BMI (mean difference: ∼3.50 kg/m2; P = .001), UC (∼10 cm), and HC (∼8 cm) compared with accurate setups (P < .001). With respect to the vertical direction, inaccurate setups (>0.7 cm margin [cutoff I]) were associated with a greater BMI (mean difference = 7.4 kg/m2; P = .001), UC (5.3 cm; P < .001), and HC (16.0 cm; P < .001) with reference to accurate setups. The receiver operating characteristics curve analysis showed that a BMI >31.4 kg/m2 was predictive for inaccurate setup in the vertical direction with 90.0% sensitivity with respect to cutoff I. Furthermore, a BMI >30.3 kg/m2 was predictive for inaccurate setup in the lateral direction with 92.5% sensitivity with respect to cutoff II. Conclusions: The accuracy of radiation therapy setups for gynecologic tumors is highly sensitive to patients' BMI, notably in the lateral and vertical directions. We suggest that daily cone beam computed tomography should be applied on patients with a BMI >30.3 kg/m2, using customized protocols that are lower in dose and comparable in image quality.

Morbidity and mortality among patients with breast cancer receiving anticancer treatment before and during the COVID-19 pandemic: A single tertiary center experience.

Breast cancer is the most common cancer type in women in Saudi Arabia (SA). Globally, cancer treatment has been affected by the recent COVID-19 pandemic. The present retrospective study reviews the 30-day morbidity and mortality rates of patients with breast cancer receiving anticancer systemic treatment before (group1) and during the peak of the COVID-19 (group 2) pandemic at a tertiary center, King Abdulaziz University Hospital (Jeddah, SA). There were no differences between the two groups regarding sex, age, breast cancer stage distribution, intention to treat or class of anticancer treatment received. Patients treated during the peak pandemic period received delayed treatment. No statistically significant difference was observed in the 30-day morbidity or mortality rates, although there was a trend towards higher rates of morbidity among patients treated during the peak of the pandemic period. In group 2, only 2.3% of the patients tested positive for COVID-19, and there was no significant difference in the 30-day morbidity and mortality rates between COVID-positive and COVID-negative patients receiving anticancer treatment. Individuals with breast cancer are a vulnerable group of patients that should be treated with special care during pandemics or other crises that affect the health care system.

Locally Advanced Breast Cancer: Treatment Patterns and Predictors of Survival in a Saudi Tertiary Center.

Background  Breast cancer (BC) is the most common cancer in the Kingdom of Saudi Arabia (KSA) and the second leading cause of cancer-related mortality. About 40% of BC in KSA is locally advanced BC (LABC), which has been associated with poorer survival compared with early diagnosed BC. Objective To review the presentation and outcomes of LABC, including the characteristics of the disease, different treatment modalities, overall survival (OS), disease-free survival (DFS), and local recurrence in relation to different radiotherapy (RT) techniques. Methods  We retrospectively reviewed the medical records of 153 female patients with pathologically proven LABC diagnosed at King Abdulaziz University Hospital, Jeddah, KSA, between 2009 and 2017. We obtained data on patient demographics, stage of cancer at diagnosis, tumor characteristics (subtype and receptor status), type of surgery, systemic treatments received (hormonal, targeted therapy, and chemotherapy), RT variables, and recurrence and death dates. Data were analyzed to assess OS and DFS by using Kaplan-Meier analyses and the log-rank test. Univariate and multivariate Cox proportional hazard regression analyses were used to explore and identify factors associated with survival. Results  The median survival time in the study population was 9.16 years. Older age (65+ years) was associated with worse OS and DFS than was younger age (<65 years) (hazard ratio (HR) 3.20, 95% CI 1.48-6.90, P = 0.003 and HR 2.21, 95% CI 1.12-4.36, P = 0.022, respectively). Regarding the type of surgery, having a mastectomy was associated with worse OS and DFS than was having a lumpectomy (HR 2.44, 95% CI 0.97-6.12, P = 0.05 and HR 2.41, 95% CI 1.13-5.14, P = 0.023, respectively). Positive estrogen and progesterone receptor status was associated with better OS and DFS than was a negative estrogen or progesterone receptor status (HR 0.13, 95% CI 0.05-0.30, P < 0.001 and HR 0.21, 95% CI 0.11-0.41, P < 0.001, respectively). Patients who received RT had a lower risk of recurrence than did those who did not receive RT (P = 0.011). Moreover, three-dimensional conformal RT was associated with lower local recurrence than intensity-modulated RT or volumetric-modulated arc therapy (P = 0.003). Conclusion  Multiple factors can affect the OS and DFS in LABC. Younger patients, having hormone-positive disease, and undergoing lumpectomy were associated with better outcomes. Adjuvant RT may improve local control and the use of three-dimensional conformal RT was superior for local control. Prospective studies with larger sample sizes are needed to further highlight these findings and to assess the role of chemotherapy and targeted therapy in patients with LABC.

Adenocarcinoma in a Recurrent Retrorectal Cyst: A Case Report.

I present a case of an adenocarcinoma in a retrorectal cyst in a 63-year-old female with a prior history of a congenital cyst excised as a newborn. The patient had a resection with positive margins, followed by chemotherapy and radiotherapy at progression. Her disease did not respond to chemotherapy or radiotherapy and she died with systemic manifestations related to her disease 28 months after diagnosis.

Patterns of breast cancer radiotherapy practices among Saudi radiation oncologists.

OBJECTIVES: To identify practice patterns among radiation oncologists in Saudi Arabia. METHODS: A questionnaire comprising 27 scientific questions and 6 demographic questions was created in 2019 by a faculty member at King Abdulaziz University, Jeddah, Saudi Arabia, and distributed among radiation oncologists in Saudi Arabia between February and April 2019. RESULTS: Twenty-four responses were received. Regarding chest wall treatment after mastectomy, 100% of the respondents offered postmastectomy radiotherapy (PMRT) for tumor stage 3 node 1 (T3N1) or T4 disease, while 87.5% offered PMRT for T2N1, and 83.3% offered PMRT for T3N0 disease. In contrast, there was a lack of consensus regarding treatment planning and coverage criteria for internal mammary lymph nodes and contouring. CONCLUSION: Variations in breast radiotherapy practices in Saudi Arabia exist due to the lack of clinical evidence and national guidelines, as well as potential variations in health resources allocation. Resource allocations and the establishment of national guidelines are recommended to decrease this variation and allow for data exchange and the development of national research collaborations.

Technique adaptation, strategic replanning, and team learning during implementation of MR-guided brachytherapy for cervical cancer.

PURPOSE: MR-guided brachytherapy (MRgBT) with interstitial needles is associated with improved outcomes in cervical cancer patients. However, there are implementation barriers, including magnetic resonance (MR) access, practitioner familiarity/comfort, and efficiency. This study explores a graded MRgBT implementation strategy that included the adaptive use of needles, strategic use of MR imaging/planning, and team learning. METHODS AND MATERIALS: Twenty patients with cervical cancer were treated with high-dose-rate MRgBT (28 Gy in four fractions, two insertions, daily MR imaging/planning). A tandem/ring applicator alone was used for the first insertion in most patients. Needles were added for the second insertion based on evaluation of the initial dosimetry. An interdisciplinary expert team reviewed and discussed the MR images and treatment plans. RESULTS: Dosimetry-trigger technique adaptation with the addition of needles for the second insertion improved target coverage in all patients with suboptimal dosimetry initially without compromising organ-at-risk (OAR) sparing. Target and OAR planning objectives were achieved in most patients. There were small or no systematic differences in tumor or OAR dosimetry between imaging/planning once per insertion vs. daily and only small random variations. Peer review and discussion of images, contours, and plans promoted learning and process development. CONCLUSIONS: Technique adaptation based on the initial dosimetry is an efficient approach to implementing MRgBT while gaining comfort with the use of needles. MR imaging and planning once per insertion is safe in most patients as long as applicator shifts, and large anatomical changes are excluded. Team learning is essential to building individual and programmatic competencies.

Intermediate dose-volume parameters and the development of late rectal toxicity after MRI-guided brachytherapy for locally advanced cervix cancer.

PURPOSE: The dose delivered to the most exposed 2 cm3 [Formula: see text] of the rectum and bladder is predictive of late rectal and bladder toxicity in cervix cancer patients. We investigated the predictive value of intermediate doses to the rectum and bladder for late rectal/bladder toxicity after MRI-guided brachytherapy for patients with locally advanced cervix cancer. METHODS AND MATERIALS: Toxicity was prospectively graded using Common Toxicity Criteria for Adverse Events v4.0 and retrospectively verified for women with Stage IB-IVA cervix cancer treated consecutively with MRI-guided brachytherapy between 2008 and 2013. The minimum equivalent dose in 2 Gy fractions delivered to 0.1, 1, 2, 5, and 10 cm3 of the rectum and bladder and the absolute volume of the rectum receiving 55, 60, 65, 70, and 75 Gy3 (V55-75) were collected. The association between dose-volume parameters and Grade 2+ rectal/bladder toxicity was examined using logistic regression. RESULTS: With a median followup of 44 months, cumulative incidences of Grade 2+ rectal and bladder toxicity among the 106 patients were 29% and 15% at 3 years, respectively. All the dose-volume parameters were significantly associated with late Grade 2+ rectal and bladder toxicity (p < 0.05), except for bladder [Formula: see text] . On multivariable logistic regression, both [Formula: see text]  > 70 Gy3 and V55 > 11 cm3 (p < 0.05) were predictive of late Grade 2+ rectal toxicity, with improved model fitting and higher area under the curve compared with the model with [Formula: see text]  > 70 Gy3 alone. CONCLUSIONS: In this study, V55 was predictive of late Grade 2+ rectal toxicity. Adding V55 to  [Formula: see text] improved prediction accuracy.