The prevalence and pattern of complementary and alternative medicine use among cancer patients in a tertiary oncology center: a cross-sectional study.

Background: Complementary and alternative medicine (CAM) is widely used nationally and internationally for multiple medical conditions, including different stages of cancer. It is used by the patients for multiple purposes, including to cure diseases or resolve symptoms, as patients have the misconception that natural remedies are safer than radiotherapy and chemotherapy. Objectives: The aim of this research is to investigate the prevalence, pattern, and purpose of CAM use by cancer patients at Princess Noorah Oncology Center (PNOC), King Abdulaziz Medical City, in Jeddah (KAMC-JD). Methods: This was a cross-sectional study that examined 293 patients (selected through random computerized sampling) who were seen at PNOC during the study period. To be eligible for the study, participants had to be cancer patients over the age of 18 who were seen at PNOC. The authors excluded patients who had privacy requests or did not fit our inclusion criteria. Results: Of the sample, 52.9% [95% confidence interval (CI), 47.0-58.7] used CAM. Only 5.8% of patients delayed their medical treatment to use CAM. A significantly higher proportion of females used CAM than males (61.8% vs. 40.0%, P<0.001). The most common types of CAM were Zamzam water (67.7%), Quran recitation (42.6%), water read upon Quran (41.3%), and black seed (Nigella sativa) (41.3%). The most frequently reported reasons for CAM use were to treat cancer (53.5%), increase immunity (34.2%), and religious beliefs (23.9%). Generally, 57.4% of CAM users felt improvement with CAM modalities. Conclusion: In conclusion, more than 50% of our sample used CAM; 5.8% of patients delayed the medical treatment to use CAM. The most common type of CAM was Zamzam water, and the most frequently reported reason for CAM use was to treat cancer. Of CAM users, 57.4% felt improvement with CAM modalities. Further studies that involve qualitative designs and include a more diverse sample are recommended in the Kingdom of Saudi Arabia to understand CAM utilization patterns.

Sarcopenia and associated risk factors in oncology outpatients in specialized cancer centers in Saudi Arabia: a cross-sectional study.

Sarcopenia is a comorbidity associated with cancer, which takes advantage of a patient's deteriorating state and decreases the survival rate. Thus, early detection of sarcopenia could improve oncology outpatient prognosis, treatment, and general quality of life. Objective: To measure the prevalence of probable sarcopenia and the associated risk factors in patients with cancer. Methods: This is a cross-sectional study. A total of 324 cancer patients were screened for sarcopenia using a simple questionnaire to rapidly diagnose sarcopenia [SARC-F (strength, assistance with walking, rising from a chair, climbing stairs, and falls)] and a hand grip dynamometer tool. The study was conducted from 1 January 2021 till 28 February 2021, in the outpatient department of Princess Noorah Oncology Center. Results: Among 324 cancer patients receiving active chemotherapy treatment, 28.4% screened positive for sarcopenia (SARC-F score ≥4). Moreover, 23.45% were identified as probable cases [SARC-F score ≥4 and a low hand grip strength (HGS)] of sarcopenia, according to the European Working Group on Sarcopenia in Older People consensus 2 (EWGSOP2) case-finding algorithm, which is sufficient to initiate a management plan. Conclusions: One-quarter of the cancer patients had probable sarcopenia at our institution. Sarcopenia risk was independently associated with patient age, and the risk of sarcopenia was low among patients with higher albumin concentrations. Screening cancer patients for sarcopenia using the SARC-F questionnaire and HGS may offer a useful strategy to mitigate the risk of unfavorable consequences that may occur during cancer treatment.

Opioid-induced respiratory depression and risk factors in a tertiary hospital: A retrospective study.

Background: Opioids are potent analgesics used for the treatment of moderate to severe acute and chronic cancer and non-cancer pain. However, opioid usage may be limited by negative side effects, such as potentially life-threatening respiratory depression. Objectives: The aim of our study is to investigate the prevalence of opioid-induced respiratory depression (OIRD) and its predictors at King Abdulaziz Medical City in Jeddah (KAMC-JD). Method: This is a retrospective cross-sectional (chart review) study conducted from January 1, 2016, to December 31, 2020. Results: A total of 15,753 patients received opioids during admission to KAMC-JD, and only 144 (0.915%) of them received naloxone from January 1, 2016 to December 31, 2020. Only 91 patients (0.57%) developed opioid-induced respiratory depression (OIRD), which was more frequently reported among young and middle-aged adults. OIRD was significantly associated with receiving a daily morphine milligram equivalent (MME) dose of ≥150 MME and with having a low urea concentration at the baseline and at admission under surgery. Also, fentanyl use remained a significant risk factor for OIRD. Conclusion: In conclusion, monitoring patient receiving opioids with a daily MME dose of ≥150 MME, prescribed Fentanyl, low urea concentration at the baseline, and patients' admissions to the surgery department may mitigate the risk of developing OIRD.

Tele-clinics in palliative care during the COVID-19 outbreak: Tertiary care cancer center experience.

OBJECTIVES: To investigate the effect of tele-clinics on palliative care patients during the COVID-19 pandemic. METHODS: This is a retrospective cross-sectional study (chart review) carried out from March 17, 2020, to September 16, 2020, included all patients who were booked into the palliative care clinic. Patients were assessed by the palliative nurse specialist for COVID-19 symptoms using the acute respiratory illness screening form and Edmonton Symptoms Assessment System, also identifies the needs of the patient. Data were analyzed to investigate the effect of tele-clinics on the patients regarding ER visits and admission. RESULTS: A total of 167 individuals were analyzed and the results showed that 234 of 447 visits were virtual, supporting the increasing value of telemedicine. The number of virtual patients' visits dropped slightly at the beginning of the pandemic (46.4% in March to 39.8% in July). Subsequently, it increased steadily to 72.2% in September. The choice of virtual/non-virtual visits for individuals with cancer diagnosis significantly depends on other factors. Code status, palliative patients or follow-up service, and the frequency of oncology center visits, admissions, or ER visits were crucial in explaining the means of receiving treatment. CONCLUSION: Virtual visits in palliative care are efficient means of decreasing the threat of COVID-19 contagion. It is recommended to increase the palliative care patients' awareness of tele-clinics and their positive outcomes, particularly during the pandemic.

The Practice of Pain Assessment and Management in a Tertiary Oncology Center.

Background Pain is one of the common and devastating symptoms that affects millions of cancer patients globally. Despite published guidelines and education on the assessment and management of cancer-related pain, underestimated or undertreated pain continues to be a considerable worldwide public health concern among cancer patients. In this study, we aimed to assess physicians' adherence to the World Health Organization (WHO) guidelines in the management and assessment of pain in oncology patients based on the available score of pain in the Princess Noorah Oncology Center (PNOC) at the King Abdulaziz Medical City in Jeddah. Methodology This cross-sectional, retrospective chart review study studied 451 patients (selected through computerized random sampling) who were admitted to the PNOC during the study period. Results The pain was assessed using the Brief Pain Inventory in almost all patients (n = 450, 99.8%). The pain was categorized as mild in 386 (85.6%) patients, moderate in 46 (10.2%) patients, and severe in 19 (4.2%) patients. Opioid prescriptions were significantly higher among patients with moderate (76.1%) and severe pain (89.5%) compared to those with mild pain (39.1%; p < 0.0001). Conclusions The practice of pain documentation for cancer patients was adequate as indicated by reporting the pain scores of 99.8% of inpatients. Patients with moderate and severe pain were more likely to receive opioids and a combination of opioids plus non-opioid analgesics, whereas the prescription of analgesics was predicted by experiencing moderate cancer pain.

Opioid-Induced Constipation in Advanced Cancer Patients.

The present study discusses opioid-induced constipation (OIC) in advanced cancer patients, focusing on the OIC definition, pathophysiology, and treatment. OIC is any change from baseline defecation patterns and bowel habits that developed after starting opioid therapy. The condition is characterized by bowel frequency reduction, worsening or development of straining, a sensation of incomplete defecation, or distress associated with bowel habits. OIC is common in advanced cancer patients, with a prevalence of approximately 51%-87% in patients taking opioids for pain management. Patients are likely to experience severe distress, work productivity reduction, poor quality of life, and increased healthcare utilization. OIC has a complex pathophysiology that involves propulsive and peristalsis impairment, intestinal mucosal secretion inhibition, intestinal fluid absorption enhancement, and anal sphincters function impairment. The Rome III criteria are used to assess and diagnose clinical OIC and can also be diagnosed through the Patient Assessment of Constipation (PAC) measures, including the symptom survey (PAC-SYM) and quality of life survey (PAC-QOL). Non-pharmacological treatment of OIC involves lifestyle habits and dietary adjustments, although these interventions might be insufficient to manage the condition. Pharmacological treatments involve the use of traditional laxatives and newer agents like peripherally acting mu-opioid receptor agonists (PAMORAs), including naldemedine, naloxegol, and methylnaltrexone. More novel treatments for OIC that target the pathophysiology are still needed and should be studied carefully for safety and efficacy.

Effectiveness and Safety of Hypodermoclysis Patients With Cancer: A Single-Center Experience From Saudi Arabia.

INTRODUCTION: Decreased intake of food or fluid causes dehydration in hospitalized adult patients. This has led to a negative impact on patients and increased the morbidity and mortality rate at the Princess Noorah Oncology Center, where patients with advanced cancer who suffer from dehydration have been treated with parenteral fluids until the date of discharge from the hospital. OBJECTIVE: The objective of this pilot study is to assess the effectiveness and safety of hypodermoclysis (HDC) to close the gap of treatment for home-based palliative patients with cancer. METHOD: During home visits, the home health care (HHC) nurse assessed these patients through history and physical examination for dehydration. Our team also incorporated the Edmonton Symptom Assessment System revised (ESAS-r) Scale in the assessment of these patients' symptoms. Informed consent has been obtained from the patient and the caregiver. The trained nurses initiated the subcutaneous infusion. The caregivers monitored it and disconnected it when completed. The study population consists of palliative patients with advanced cancer under the services of palliative care. Effectiveness and safety have been assessed using the ESAS-r scale. RESULTS: A total of 25 (92.6%) HDC treatments were successfully completed for nine patients (seven males and two females). One female patient had only one session because her health had deteriorated for reasons other than dehydration and was transferred to the hospital. No serious side effects were observed. One (3.6%) patient developed redness at the site of cannula insertion. The mean duration of the infusions was 8.44 hours. The median age was 70 years. CONCLUSION: This study has concluded that HDC is effective, safe, and can enhance the patient's comfort level without the need for hospitalization. The fact that HDC can be administered at home with minimum equipment and technical support makes it an ideal option in several countries with varied income settings.

Referral Time of Advance Cancer Patients to Palliative Care Services and Its Predictors in Specialized Cancer Center.

Background and aim Globally, there is a discrepancy in whether terminal cancer patients are early referred to palliative care service (PCS) or not. A late referral can lead to a delay in treating and palliating those patients in need. The aim of this study is to investigate the referral time patterns of advanced cancer patients to PCS in Princess Noorah Oncology Center (PNOC) at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia. In addition, this study evaluates the factors that influence referral time to the palliative care unit (PCU), along with the overall survival rate. Methods This was a retrospective cross-sectional study (chart review) conducted at the inpatient unit in PNOC and included all patients referred to PCS between January 1st, 2016, and December 31, 2016. In total, 153 patients met the inclusion criteria, and their data were collected and analyzed. Results The median length of stay (LOS) was five days (95% CI: 3.85-6.15). Among the 153 patients, 22 (14.4%) died within 24 hours of enrollment to PCU. Patients who were referred to the PCU with non-metastasis disease had a median LOS of nine days, which is significantly longer than the median LOS in patients with metastatic disease (95% CI: 0.35-0.82, p=0.004), which indicates that they referred relatively earlier to PCU. The hazard ratio for death in patients with non-metastatic cancer stage was 0.54 (95% CI: 0.35-0.82, p=0.004). Conclusion Referral of advanced cancer patients to palliative care services occurs late in their disease course in our institution, like other institutions, with variation in LOS, which shorten their stay at palliative, as well as, affects their quality of life (QOL) and ability to plan or make a decision regarding their care. Education of the public and, most importantly, the medical community is needed.