The journey of cancer patients and the quest to equity: findings from Morocco.

OBJECTIVES: Rapid diagnostic and assessment pathways for cancer patients provide timely and effective care. This study took place in Morocco, where the majority of patients treated in the public sector are diagnosed at an advanced stage. The aim of this study was to determine the duration of different time intervals along the cancer patient pathway and to highlight problem areas so that strategies can be implemented to make the process more equitable and effective. STUDY DESIGN: Cross-sectional study. METHODS: Recently diagnosed cancer patients were recruited from four major oncology centres in Morocco; namely, Marrakech, Casablanca, Rabat, and Fez. A questionnaire survey was administered, including sociodemographic and medical information and questions on access to the oncology centre, beliefs, and opinions on the medical staff. The dates of symptom recognition, assessment, diagnosis referral, biopsy, and treatment initiation were collected. Different time intervals (patient, diagnosis, biopsy, and treatment) were estimated and their determinants were investigated. RESULTS: A total of 812 patients were interviewed. The majority of participants were breast cancer patients. In total, 60% of participants were at stage III-IV. The main facilitators of cancer diagnosis confirmation and treatment initiation were easy access to diagnosis and treatment facilities, financial resources, personal history of cancer, time availability, late stage at diagnosis, advanced age, and private health insurance. The patient interval (i.e., time from symptom recognition to initial healthcare assessment) had a median duration of 30 days. The biopsy and treatment intervals were within the current international recommendations (7 and 28 days, respectively). However, the diagnosis interval (52 days) was twice as long as the recommended timeframes from the UK, Australia, and the World Health Organization (<28 days). CONCLUSIONS: Interval targets should be defined to encourage health systems to be more equitable and effective and to ensure that cancer patients are treated within a defined timeframe.

[Non-small lung cancer, ECCO/ESMO congres 2017]. / Cancers bronchiques non à petite cellule : congrès de l'ECCO/ESMO 2017.

During the esmo congress that took place from 08 to 12 September 2017 in Madrid, non-small cell lung cancer (NSCLC) was the subject of various communications and posters. We selected the most innovative and most likely to change our daily practice These updates presented concerned both localized and metastatic lung cancers. For completely resected localized stages minimal monitoring by annual CT scan is recommended, in stage III after radio chemotherapy durvalumab treatment provides better progression-free survival (PFS). For metastatic stages, pembroluzumab immunotherapy plus platinum-based chemotherapy in first-line is superior to chemotherapy alone in terms of response rate, second-line treatment with nivolumab provides better overall survival (OS) at 3years, the duration of 1year is characterized by a PFS lower than a continuous treatment. In EGFR mutated NSCLCs, the best choice between 3rd and 1st generation EGFR antigen has generated a lot of debate after the interesting results in terms of progression-free survival (PFS) of osamertinib in 1st metastatic line as well as for NSCLC with ALK rearrangement, alectinib was superior to crizotinib in the first metastatic line even in the presence of brain metastases.

Rare variant of metaplastic carcinoma of the breast: a case report and review of the literature.

BACKGROUND: Metaplastic carcinoma encompasses a group of neoplasms characterized by differentiation of the neoplastic epithelium into squamous cells and/or mesenchymal-looking elements. Spindle cell carcinoma is a rare variant of this special histological type. Its prognosis remains poor, with a high rate of local recurrence and distant metastasis. To date, only a small number of cases have been described. There is no clear agreement on this histological subtype. CASE PRESENTATION: We report a case of a 53-year-old Moroccan woman who consulted our institution following palpation of a nodule of the left breast. Mammography in combination with breast ultrasonography revealed a lesion classified as Breast Imaging Reporting and Data System 4 with microcalcification. The patient was diagnosed with spindle cell carcinoma of the breast. The diagnosis was based primarily on histological and immunohistochemical studies of the breast biopsy and secondarily on the surgical specimen. No local or distant metastasis was found. The treatment used was total surgical excision followed by radiotherapy. CONCLUSIONS: We describe the features (epidemiological, clinical, histological, immunohistochemical, and therapeutic outcomes) of our patient's case and compare them with literature data.

[Complementary medicine in cancer patients under treatment in Marrakech, Morocco: a prospective study]. / Les médecines alternatives et complémentaires chez les patients cancéreux en cours de traitement à Marrakech, Maroc : étude prospective.

Use of complementary and alternative medicine (CAM) is very frequent in cancer patients. The aims of this study were to analyze the frequency, the reasons of use of CAM in patients with a cancer treated in a Moroccan oncology department. We included in this study 400 patients. An anonymous questionnaire was proposed to patients during treatment. Over 384 analyzable questionnaires, 71% of patients were using CAM. The most frequent method was religious therapy (60%). The second one was herbal medicine (36%). The main reason for using CAM was reducing psychic pain in 53%, and boosting the immune system in 32%. Adverse effects were reported in 2% of cases. Only 5% of patients discussed CAM with their doctors. The cost of CAM was less than 100 Euros in 88% of cases. To optimize the patient-physician relationship and to avoid a propensity to unproved treatments, accurate and adequate communication is necessary.

[Dietary risk factors of undifferenced nasopharyngeal carcinoma : a case-control study]. / Les facteurs de risque alimentaires du carcinome indifférencié du nasopharynx : Une étude cas témoin.

BACKGROUND: The incidence of nasopharyngeal carcinoma (NPC) is relatively high in Maghreb countries. This cancer is a model of multifactorial oncogenesis, but the role of food as risk factor in ethiopathogenesis of this tumor is not negligible. AIM: To identify the association between risk of NPC and some dietary factors in Morocco. METHODS: It is a case-control study including all new cases of NPC in our department between December 2009 and May 2010. Frequency consummation of foods was compared between cases and controls matched for age, sex and socio economic level. A high frequency consummation of a food was defined as consumption once or more by a week. Some traditional foods in Moroccan cooking like Harissa (hot red pepper), Qadid (mutton dried and salted), Khlii (dried meat, salted, spiced cooked and preserved in a mixture of oil and rendered beef fat) and Smen (rancid butter) were analyzed in this study. A conditional logistic regression was used to identify the association between dietary factors and the risk of NPC. RESULTS: Cases were more likely to have high frequency consumption of Harissa, Smen and Black Pepper, and less frequency consumption of fruts and vegetables. There was significant association between the risk of NPC and the frequency consumption of Qadid, khlii and cooking with olive oil. CONCLUSIONS: Some of these risk factors (Harissa, Black pepper) were found in 3 North Africain studies. This study indicates the involvement of dietary factors, and thus the lifestyle in the development of NPC and the need of biochemical analysis of food specimens to search for the carcinogenic agents.