Sociodemographic and treatment-related correlates of fatigue in breast cancer survivors at an oncology clinic in Nigeria.

Background: Breast cancer survivors (BCS) still experience fatigue that may impair their quality of life even after completion of treatment. There is a need to understand the sociodemographic and treatment-related factors associated with this to develop relevant and effective interventions. Aim: To assess the relationship between cancer-related fatigue and sociodemographic and treatment-related factors in BCS. Materials and methods: This is a cross-sectional study involving 80 BCS attending the radiation oncology University College Hospital Ibadan. Their sociodemographic, disease and treatment characteristics were obtained. Fatigue Symptom Inventory was used to assess fatigue. A score of at least 3 on average fatigue severity item was taken as cut-off for clinically meaningful fatigue. Result: The mean age of patients was 51.5 years. The prevalence of fatigue was 22.5%. On univariate analysis, fatigue was significantly associated with younger age (p = 0.022), employment (p = 0.006), stage of the disease(p = 0.014), anthracycline-based chemotherapy (p = 0.026), last chemotherapy less than 1 year (p = 0.001). Using logistic regression analysis, stage (Odds ratio (OR) 5.115, 95% CI 1.029-25.438, p = 0.046), employment status (OR 52.224, 95% CI 3.611-755.899, p = 0.004) and year of last cycle chemotherapy (OR 6.375, 95% CI 1.108-36.680, p = 0.038) were associated with fatigue in BCS. Conclusion: About a quarter of BCS reported fatigue. Advance stage disease, employment status and receiving last course of chemotherapy less than a year are correlates of fatigue.

Evaluation of side effects and compliance to chemotherapy in breast cancer patients at a Nigerian tertiary hospital.

Background: Chemotherapy improves tumour control and survival, but it may be associated with side effects (SEs) which can impair treatment compliance and worsen outcomes. Assessment of patients in routine clinical practice, outside clinical trials, may provide the information on effects of chemotherapy on patients and its impacts on treatment compliance. Aim: To assess the SE and compliance to chemotherapy in breast cancer patients. Methodology: A prospective study involving 120 breast cancer patients receiving chemotherapy was carried out at the oncology clinics of the University College Hospital Ibadan. SEs reported were recorded and graded using Common Toxicity Criteria for Adverse Events version 5. Compliance was defined as a receipt of planned cycles of chemotherapy in the planned doses within the planned duration. The data collected were analysed using the Statistical Package for the Social Sciences software version 25. Results: The patients were all females with a mean age of 51.2 ± 11.8 years. Patients reported between 2 and 13 SE with a median of 8 SE. Forty-two (35.0%) missed at least one course of chemotherapy while 78 (65%) were compliant. The reasons for non-compliance were deranged blood test 17 (14.2%), chemotherapy SE symptoms related 11 (9.1%), financial constraints 10 (8.3%), disease progression 2 (1.7%) and transportation-related 2 (1.7%). Conclusion: Breast cancer patients encounter multiple SEs from chemotherapy which led to non-compliance with the treatment. Early identification and prompt treatment of these SEs will improve compliance with chemotherapy.

EGFR and HER2 expression in cervical cancer patients in Ibadan, Nigeria.

Cervical cancer is a leading cause of cancer-related deaths in developing countries, including Nigeria where it is the second most common female malignancy. Studies from elsewhere have demonstrated the relationship between epidermal growth factor receptor (EGFR) and human epidermal growth factor receptor 2 (HER2) and advanced cervical cancer. However, we are not aware of such studies in Nigerian patients. The main objective of the study was to determine the prevalence of EGFR or HER1 and HER2 protein expression in cervical cancers and to determine their impact on overall survival. Clinical data and formalin-embedded tissue blocks of 124 patients who presented in the Radiation Oncology Department, University College Hospital (UCH), from 2006 to 2015 and had their histological diagnosis at the Pathology Department, UCH were retrieved and analysed for EGFR and HER2 expression using immunohistochemistry. EGFR expression was analysed using the immunoreactivity score by Remmele and Stegner. HER2 was analysed using the Hercep® test kit guidelines. Survival analysis was done using Kaplan-Meier and Cox regression analysis. Missing data were reported as missing, not documented. EGFR (immunoreactivity score > 4) was overexpressed in 26.6% of the 124 cervical tissue samples tested. Most patients whose samples were positive for EGFR were young, had squamous cell carcinoma and advanced diseases. HER2 was overexpressed in two samples (1.6%). The 5-year overall survival rate of the patients was 28.3%. The 5-year survival rate of patients who were EGFR positive was 9.5% and 34.1% for those who were EGFR negative. Screening for EGFR should be considered in cervical cancer patients. HER2 was overexpressed in two cervical tissue samples in this study and may be of poor interest as a potential target in the management of cervical cancer patients. Large prospective multi-institutional studies should be considered to further explore the relationship between EGFR and survival in cervical cancer patients.

Fatigue as a complicating factor in the recovery of breast cancer survivors treated at an oncology clinic in South West Nigeria: a case-control study.

Purpose: Recovering cancer survivors hope to return to their premorbid lifestyle after treatment and be free from the disease. They are, however, faced with some psychosocial issues, including fatigue, which could negatively impact their quality of life. With increasing cancer awareness and improvement in treatment, it is expected that the number of cancer survivors will increase in Nigeria. Little has, however, been done with regard to survivorship care in the country. It is important to explore fatigue in this group of patients with a view to find ways of reducing it to the barest minimum. Aim: To assess the level of fatigue in breast cancer survivors on follow-up visit at a radiation oncology clinic and compare it with age and sex-matched apparently healthy controls. Materials and Methods: Fatigue levels were obtained using the Fatigue Symptom Inventory (FSI). Kruskal-Wallis H test was used to compare the FSI scores in cases and controls. Chi-squared test was used for comparison of proportions. Level of significance was set at 5%. Results: Seventy cancer survivors (cases) and 70 apparently healthy age (±1)-matched controls were recruited. The prevalence of fatigue was higher among cases than controls (24.3% versus 10%; p = 0.025). Breast cancer survivors reported significantly worse fatigue on the day they were most fatigued (p = 0.017), least fatigued (0.047) and fatigued on average (p = 0.006) compared to controls. Fatigue also significantly interferes with the ability to concentrate (p = 0.040) and relate with people (p = 0.002) more in cases compared to controls. While fatigue was more common in the morning and afternoon in breast cancer survivors, fatigue either occurred more in the evening or followed no daily pattern in the controls. Conclusion: Breast cancer survivors reported worse fatigue, suggesting the need to include fatigue screening as part of post-treatment follow-up. There is also a need to investigate the factors responsible for this and explore ways of reducing or eliminating it.

Clinicopathologic Features of Childhood Rhabdomyosarcoma and Treatment Outcomes in Ibadan, Nigeria: A 10-year Review.

The objectives of this study were to describe the clinicopathologic features and treatment outcomes of childhood rhabdomyosarcoma in a resource-constrained setting. All cases of childhood rhabdomyosarcoma seen over a 10-year period (July 2006 to June 2016) at the University College Hospital, Ibadan, Nigeria were reviewed. Data were extracted from the database of the pediatric Hematology/Oncology Unit of the hospital and analyzed. Ethical approval was obtained from the Institutional Ethics Committee. Fifty children were seen comprising 30 men and 20 women with bimodal ages of 4 and 5 years. Median duration of illness was 16 weeks and the most common primary tumor site was the head-and-neck region in 27 (54%) of cases. The histologic subtypes were embryonal in 30 (60%), alveolar in 9 (18%), and not specified in 11 (22%). The Intergroup Rhabdomyosarcoma Study group TNM Pretreatment stages were stage I in 15 (30%), stage III in 17 (34%), and stage IV in 18 (36%). Treatment included chemotherapy, surgery, and radiotherapy and abandoned in 20 (40%) cases. Median survival was 45 weeks (95% confidence interval: 16.4-73.6) and 5 (10%) patients were alive and disease free, 4 years or more after diagnosis. Outcome of childhood rhabdomyosarcoma is poor and early diagnosis and improved access to treatment are recommended.

Pre-Treatment Knowledge and Side-Effects Experienced during Chemotherapy for Breast Cancer in a Nigerian Tertiary Hospital.

Background: Chemotherapy is an important component of treatment for breast cancer as it improves tumour control, overall survival or disease-free survival but is associated with side effects that could affect patients' quality of life. Patients' understanding and expectation of these side effects can improve their coping abilities. Exploring these understanding and expectations before chemotherapy can reduce the burden of chemotherapy side effects and improve compliance to treatment by increasing their physical and psychological preparedness. The study aimed to assess how the knowledge of expected side effects of chemotherapy affected the level of coping with the side effects of chemotherapy. Methodology: This study was carried out at the Radiation Oncology and the Surgical Oncology clinics of the University College hospital Ibadan Nigeria. Patients with breast cancer were randomly selected to participate in the study. Before commencement of 1st-course chemotherapy data on sociodemographic variables, clinical characteristics and patients' knowledge about chemotherapy side effects was collected using a set of questionnaires. While presenting for the second course, patients were asked if they encountered side effects and how long it took them to recover from the side effects. The data collected was analysed using the Statistical Package for the Social Sciences (SPSS) software version 21. Result: A total of 110 women participated in the study. Most of the patients (85%) knew chemotherapy side effects (SE).Most of the respondents, (73.5%), received their information on the side effects of chemotherapy from doctors, followed by nurses (40.9%), internet (32.7%), peers (32.7%) and family members (12.7%). Currently employed and younger patients tended to have more knowledge concerning chemotherapy SE (p = 0.018). Patients who knew SE before treatment recovered faster than those who did not (p=0.01). Conclusion: Majority of the patients were aware of the side effects of chemotherapy. Having knowledge about side effects was associated with faster recovery. Pre-Chemotherapy counselling should be done routinely for patients starting on chemotherapy.

The role of radiation treatment in the management of inflammatory musculoskeletal conditions: a revisit.

Inflammatory musculoskeletal conditions are a common group of diseases among the elderly, worldwide. They are characterized by articular degenerative changes accompanied with often debilitating pain. Treatments often involve life-long analgesic therapy or joint replacement in extreme cases. The aim of this current review is to look at the role of radiation treatment with the hope of further study into the effectiveness of radiation treatment in reducing pain, eliminate or reduce the need for life-long analgesic therapy and thereby avoiding the analgesics' side effects. Extensive literature search was done on PubMed and other available data base and the findings are presented and discussed. Literature showed that many countries in Europe, especially Germany use radiation routinely for the treatment of many degenerative disorders including osteoarthritis with good results and few side effects. A pilot study is therefore recommended with a view to establish the effectiveness or otherwise of this treatment method in patients.

Topical Anaesthesia for Pain Relief during High Dose Rate Brachytherapy for Carcinoma of the Cervix

Purpose: To determine the clinical efficacy of a local anaesthetic spray of 10 xylocaine in reducing pain and discomfort in patients undergoing high dose rate (HDR) brachytherapy. Patients and Method: Ninety two consenting patients diagnosed with cervical cancer and planned for HDR as part of their treatment were enrolled for the study. Each patient had three sessions of brachytherapy following the standard procedures. In the first session all the patients had brachytherapy in the usual manner with conscious Sedation with parenteral diazepam and pentazocine. For the second and third sessions; they had treatment sessions using conscious sedation and 10 xylocaine spray and a control session using conscious sedation and a placebo spray with 0.9 normal saline (NS) respectively. Visual Analogue Scale (VAS) was used in assessing pain during each of the procedure. Results: Only 80 patients completed the study. Their age ranged from 28-70 years with a median age of 54 years. The pre-treatment VAS median scores in the treatment and the control sessions were similar at 0.275 and 0.200. However; the post-procedure median VAS scores were increased to 6.3 in the control group and 3.2 in the xylocaine-treated group (P 0.0001). The haemodynamic status including the blood pressure (BP) and pulse rates (PR) were similar pre and post procedure in both groups. Conclusion: Topical xylocaine spray is efficacious in reducing pain and discomfort in HDR Brachytherapy without any appreciable adverse effect

Histolopathological Patterns of Cervical Carcinoma Seen at A Radiotherapy Centre in Ibadan, Nigeria.

INTRODUCTION: The treatment of cervical carcinoma is dependent on many factors including histological types and degree of differentiation. Degree of differentiation is an important consideration in determining the prognostic outcome. OBJECTIVE: The study is to describe the histological pattern of cervicer cancer seen in our practice with emphasis on tumour differentiation. METHOD: This retrospective study was carried out within Radiotherapy Department of University College Hospital, Ibadan. The records of patients diagnosed of cervical cancer seen between July 2008 and June 2010 were analysed. Data pulled out included age, disease stage at presentation, histological variant and degree of differentiation. RESULTS: 206 patients were seen during the period of which 196 had complete data. Squamous cell carcinoma (SCC) was seen in 178 patients (i.e. 90.8%) while 14 patients (7.1%) had adenocarcinoma. One patient each had adenoid cystic carcinoma, adenosquamous carcinoma, clear cell carcinoma and mucinous carcinoma. Majority of the patients, 99 (50.5%) had poorly differentiated tumours, 64 (32.7%) had well differentiated tumours, while the rest 33 (16.8%) had moderately differentiated tumours. Of the SCC tumours, 95 (53.4%) were poorly differentiated, 58 (32.6%) well differentiated while the remaining 25 (14%) were moderately differentiated. In comparison only 3 of the 14 adenocarcinoma cases (21.4%) were poorly differentiated, 5 cases (35.7%) were well differentiated, while 6 (42.9%) were moderately differentiated. The difference in the degree of differentiation between squamous histology and adenocarcinoma was statistically significant (p value = 0.002). CONCLUSION: Poorly differentiated squamous cell carcinoma remains the leading variants of cervical cancer seen in our environment.

Keloid and hypertrophic scars: a review of recent developments in pathogenesis and management.

AIM: The treatment of keloid and hypertrophic scars remains a challenging clinical problem despite numerous proposed therapies reported in the literature. This is due to the fact that the mechanisms that bring about keloid/hypertrophic scars are not completely understood. This article reviews the pertinent literature regarding the pathophysiology and management of keloid and hypertrophic scars. MATERIAL AND METHODS: A computerized literature search using MEDLINE was conducted for published articles on keloid and hypertrophic scars. The medical subject headings "keloid" or "hypertrophic scar" were combined with "treatment" or "management" or "mechanisms" or "pathophysiology" using the Boolean operator "AND" to narrow the searches. A review of selected relevant literature was undertaken. RESULTS: Numerous advances have been made in understanding the process of formation of wound healing and scar formation. This increased knowledge has led to the introduction of new treatments as well as to a better understanding of how older treatments work. These include surgical excision, intralesional steroid injection, cryotherapy, laser therapy, irradiation, mechanical compression dressing, silicone sheet applications, intralesional interferon injection, or combination of techniques. Many of the treatment modalities have a defined biologic basis while others are based on anecdotal reports. CONCLUSIONS: Presently there is still no single, reliable and effective treatment protocol for keloid and hypertrophic scars. However, surgical excision followed by postoperative intralesional steroid injection seems to provide a reasonable treatment outcome with low recurrence rate.