Compliance with Oral Hormonal Therapy for Breast Cancer at Oman National Oncology Center; Descriptive Study.

INTRODUCTION: Breast cancer is the commonest cancer amongst females. The incidence of breast cancer is estimated to be around 260K yearly. Oral hormonal medication is an essential part of the management of breast cancer for hormone receptor-positive patients. Adjuvant hormonal medication is recommended to be taken daily for 5-10 years. Adjuvant hormonal medication reduces mortality by 30% and the recurrence rate in receptor-positive patients. PATIENTS AND METHODS: This study's primary goal is to evaluate the rate of nonadherence to Endocrine Therapy for hormone receptor-positive breast cancer patients at Oman National Oncology Center. This study included patients taking hormonal therapy (either with Tamoxifen or Aromatase inhibitor) and presented for regular followup between June 2019 and February 2020 at the National oncology center, Oman. Data was collected using a written questionnaire. Descriptive analysis was done by using SPSS. A cross-sectional descriptive study for patients taking oral hormonal therapy. 131 patients were included. RESULTS: One hundred thirty-one patients were included, Tamoxifen was used by 73 (55.73%). 71 (54%) of breast surgery was "WLE" The majority of patients 95 (72.5%) did not identify a specific reason for non-compliance. The most commonly reported adverse effects were musculoskeletal symptoms by 75 patients (57.3%), with other reported side effects included hot flashes (33.6%), anxiety (30.5%), gynecological toxicity (29.8%), decreased concentration (19.1%), neurological symptoms (16%), and depression (9.9%). DISCUSSION: We reported that patients with hormone receptor-positive breast cancer have a high adherence rate to the medication than developing countries; selfreported non-compliance to oral hormonal medication is 41.22% below the average of non-compliance to chronic disease therapy of developing countries as WHO report. Medical insurance, unemployment, or drug cost is not a cause for non-compliance to medication. CONCLUSION: The self-reported nonadherence to oral hormonal medication is (41,22%). Most of the patients (72.5%) did not report a specific cause for non-adherent to medication. Close follow-up is recommended increasing compliance to medication.

Primary Gastric Chorioadenocarcinoma.

Primary gastric chorioadenocarcinoma (PGC) is a rare and rapidly invasive tumor. Choriocarcinoma is usually known to be of endometrial origin and gestational; however, it has been reported in other extragenital organs, such as the gall bladder, prostate, lung, liver, and the gastrointestinal tract. Human chorionic gonadotropin related neoplasms of the stomach are seldom discussed in the literature. We report a case of PGC in a 56-year-old man treated with a standard non-gestational choriocarcinoma chemotherapy regimen, EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine), with a complete response and good tolerability.

Dermatofibrosarcoma Protuberans: A Rare Malignancy of the Breast.

Dermatofibrosarcoma protuberans (DFSP) of the breast is a rare skin cancer with only a few cases reported in the literature. It corresponds to approximately 1% of all soft tissue sarcomas and to less than 0.1% of all malignancies with annual incidence of 0.8-4.5 cases per million. DFSP usually affects young and middle-aged adults and it can affect any site, but most commonly the trunk and extremities. This tumor arises from the deep dermis and subcutaneous tissues and is usually locally aggressive, but rarely metastasizes. Surgery including wide local excision with free margins remains the main modality of treatment. We report a case in a 28-year-old Omani woman who presented with a right breast lump to a local secondary hospital. She was offered excision biopsy of the lump and the histology came as DFSP with involved margins. The patient was then referred to the Breast Unit at the Royal Hospital where she was reviewed by multidisciplinary team including breast surgeons, oncologists, radiation oncologists, pathologists, and breast radiologists. Her laboratory and radiological investigations did not show any signs of distal metastasis and breast ultrasound did not reveal any residual breast lesions. We performed a wide re-excision of the previous surgical scar with the underlying breast tissues down to the level of the pectoral fascia followed by treatment with radiotherapy. The final histology report showed the presence of a 4×5mm residual tumor, and all resection margins were tumor-free. At six months follow-up, she had no signs of local recurrence. We publish this case report because of its rarity.

Utilization of systemic palliative chemotherapy at the end of life: a local experience.

OBJECTIVE: To evaluate attitude towards using systemic chemotherapy near the end of life for cancer patients. METHODS: This retrospective study comprised data of all patients who died with cancer at the Medical Oncology Department of the National Oncology Centre, Muscat, Oman, from January 2009 to December 2011. The records were retrieved from the electronic patient record system of ALSHIFA, Royal Hospital. Demographic data, chemotherapy at end of life, performance status, 'do not resuscitate' status, hospitalisation, and chemotherapy toxicity were analysed. RESULTS: The mean age of the 261 patients in the study was 52.3 +/- 14.52 years. Ninety-two (35%) patients did not receive chemotherapy in the last 3 months of their lives. Chemotherapy administered at end of life was 169 (65%), 126 (48%), and 75 (29%) in last 3 months, one month and 2 weeks of life. Those who received more than 3 lines of chemotherapy were 66 (36%). CONCLUSIONS: The end-of-life use of chemotherapy should always be carefully discussed. The patient's right to information should be honoured. The transition from active to best supportive care should be carefully guided.

Age at diagnosis of female breast cancer in Oman: Issues and implications.

INTRODUCTION: Female breast cancer (BC) is the most frequent malignancy diagnosed globally, about 23% of the diagnosed cancers. BC incidence varies geographically, highest in Western Europe and lowest in Africa. BC in females is strongly correlated to age, the highest incidence rate amongst older women reinforcing the importance of hormonal status. BC in young females has an aggressive phenotype. There is a shared observation amongst practicing oncologists that BC in Middle East and the developing world presents at an earlier age. AIM AND OBJECTIVE: The aims of this study are to evaluate the age at presentation of female BC in Oman, and to compare our data with international and regional published data. It discusses the impact of young age Breast Cancer. MATERIALS AND METHODS: All diagnosed female BC cases registered from 1996-2010 all over the country, were retrieved from the National Cancer Registry, Ministry of Health. BC cases were analyzed with respect to age at presentation. The data were compared with regional and international data. RESULTS: A total of 14,109 cancer cases were recorded during the period of study. BC was the leading malignancy as 1,294 cases (9.1%). Female BC patients were 1,230; denoting 19.2% of all female cancers. 53.5% of female BC presented below 50 years of age. Male BC constituted 5% of total, with 67% of male BC occurring over 50 years of age. Compared with data from Oman, the highest rates in UK and other Western countries are above 50 years of age. These rates are four to 10 times higher than local in different age groups. Interestingly, these rates increase with increasing age in UK from 40-45 to up to 85+, keep on increasing and go up to four times higher with higher age. This phenomenon, of increasing incidence rates with age, is not observed in our local population. DISCUSSION: BC is significantly correlated to age as reported from Western population. BC is reported at a younger age from developing and Arab World, which need to be further studied and validated. This phenomenon of BC in younger age may have significant implications and effects ranging from screening, diagnosis, management, prognosis, and cost of treatment. CONCLUSION: The impact on young women diagnosed with BC is enormous, ranging from psychosocial to healthcare services and economics. There is a need to study it further in depth in developing World.

Anaplastic large cell lymphoma of scrotal skin.

Cutaneous T cell lymphoma (CTCL) is an uncommon diverse group of lympho-proliferative disorders involving the skin. They vary considerably in clinical presentation, microscopic features and immunophenotyping. The diagnosis is challenging, zealous, and often not easy. CD30+ve anaplastic large cell lymphoma is extremely rare. Its clinical spectrum varies from a solitary unifocal skin lesion of excellent prognosis to a multi focal systemic disease having a poor out come. The diagnosis is quite cumbersome, and often difficult. The differential diagnosis include from benign skin lesions to secondary cutaneous involvement by lymphoma. A correct diagnosis is integral with a complete metastatic/staging work up to avoid over treatment. The treatment options depend on extent of disease involvement and include surgical excision, surveillance, local radiotherapy, and systemic chemotherapy. The prognosis is good with unifocal local disease. We present here a very rare case of CD30+ ALCL of scrotal skin, in a middle aged male patient.