Current Issue: Vol.14, No1 - July 2015
A Retrospective Study of Patients with Chemotherapy-induced Febrile Neutropenia in Jeddah Cancer Center - King Abdullah Medical City, Kingdom of Saudi Arabia.
Introduction: Febrile neutropenia is an oncologic emergency. Delayed antibiotic administration in patients with febrile neutropenia may result in adverse outcomes. Febrile neutropenia (FN) has high mortality and requires prompt antibiotic therapy. There is a high risk for morbidity and mortality in immunocompromised patients with fever if antibiotics are not received in a timely manner. Aim Of Study: The aim of this study was to determine and analyze retrospectively the number of patients admitted with chemotherapy induced febrile neutropenia and to determine the time taken from triage to administration of first dose of antibiotic in Jeddah Cancer Center - King Abdullah Medical City over a period of one year. Patients And Methods: This is a retrospective study of patients with solid tumor and hematological malignancy admitted to Jeddah Cancer Center - King Abdullah Medical City in the period between December 2013 to December 2014 who were treated with chemotherapy and as a result became neutropenic. Ethical approval was obtained from the institutional review board prior to the initiation of data collection. Results: A total of 459 patients starting chemotherapy were analyzed. 10 patients were admitted with postchemotherapy febrile neutropenia. Discussion: Prompt administration of antibiotics within one hour of admission is imperative for patients with cancer who have febrile neutropenia, a potentially life threatening complication. Patients with neutropenic fever have an increased risk to develop the same problem during subsequent therapy, secondary prophylactic G-CSF should be strongly considered for the support of subsequent treatment cycle.
Disclosure Preferences Towards Terminally Ill Patients in Singapore: Are We Ready to Confront the “Elephant in the Room”?
The disclosure preferences of dying patients, family members, palliative care professionals and members of the public in Singapore and the actual disclosure practices of palliative care professionals were investigated with 115 participants. Discrepancies between patient and family member preferences were evident. Family members tended to want to know the patients’ diagnosis and prognosis more than the patients themselves wished for the family to be informed. Family members also wanted patients to be informed of their diagnosis and prognosis even though they believed that the patients sometimes preferred otherwise. In the situation where family members were asked about their own disclosure preferences should they have a terminal illness, more preferred full disclosure of prognosis to self than to their family. The finding that people imagining a terminal illness reported wanting to know their own (hypothetical) diagnosis and prognosis more frequently than actual patients do is a salient reminder about the danger of making assumptions about patient preferences. Concerns reported by palliative care professionals showed that they are careful about the potential impact their disclosure may have on patients. Palliative care professionals nonetheless did tend to respect family member wishes over those of the patients. They perceived their lack of communication skills in delivering bad news as the main barrier to open communication. The allied healthcare participants in this study appeared to be more confident in communicating bad news than the doctors and nurses, but their expertise did not seem to be fully utilised. Thus, there may be some potential for closer collaboration and cross training amongst the professions to increase self-efficacy in delivering bad news.
The breast cancer stem cells hypothesis is a new paradigm which has major impact on the treatment by suggesting a new target for cancer therapy. Failure of the long term clinical remission, by advance hormonal receptor therapy, targeting cancer stem cell would be the powerful way to beat cancer in future. Currently <5 cancer stem cells in 7.5 ml blood is used as prognostic marker in metastatic and recurrent breast cancer. CD44+/ CD24- or low phenotype have been identified to the key cell surface marker of promising target. Thus future therapy will need to effectively target the breast cancer stem cell (BCSC) to induce clinically significant remission of diseases.
Aims & Objective: To study the histopathological patterns of ovarian tumors in different age groups and find out commonest type and subtypes of Ovarian tumors as per WHO classification in Northern Pakistan. Place and duration of study: The study was carried out at Histopathology Department, Armed Forces Institute of Pathology over a period of 10 years (2004-2013). Patients and Methods: A total of 2146 cases of ovarian tumors diagnosed on histopathology, as benign, borderline and malignant, from 1st Jan 2004 to 31st Dec 2013 were included in the study. The age of patients ranges from 1-80 years. Results: Ovarian tumors were divided into Surface epithelial tumors (59.6%), Germ cell tumors (25.5%), Sex cord stromal tumors (10.4%), Metastatic tumors (3.3%) and miscellaneous tumors (1.2%). Out of all OTs studied 1437(67%) were benign, 55(2.6%) were borderline and 652(30.4%) were malignant. Benign tumors were most common in 3rd decade of life (38.4%). Malignant tumors were most common in 5th and 6th decades constituting (26.5%) and (22.39%) among malignant tumors respectively. SETs were most common 1280 cases (59%), followed by GCTs 547 cases (25.5%). Benign surface epithelial tumors comprised 56.3% (811 cases) of all benign tumors whereas their malignant counterpart constituted 63.5% (414 cases) of all malignant tumors. Conclusion: Benign tumors were more common than malignant ones for all age groups. SETs are most common class of tumors in both benign and malignant tumors. Serous cystadenoma is the most common benign ovarian tumor seen overall, whereas serous cystadenocarcinoma is most common malignant tumor. Malignant ovarian tumors are more common above 40 years. Histologic types encountered in our cases can help in documenting trends of ovarian tumors along with their changing patterns in population of Northern Pakistan.
Objective: To analyze hematological changes in patients of oral cancer with history of smoke able and chewable tobacco use, and to compare them with healthy controls. Study Design: Descriptive type of study survey. Setting: This study was conducted at department of Oral and Maxillofacial Surgery, LUMHS, Jamshoro. Study Period: One year July, 2013 to July, 2014. Subject & Methods: Histo-pathologically confirmed hundred cases of oral cancer with history of smoke able and non-smoke able tobacco were selected to analyze the hematological variation. Inclusion Criteria: Histopathologically diagnosed patients of oral squamous cell carcinoma, with history of smoke able and non smoke able tobacco. Exclusion Criteria: Patient with any systemic medically compromising problem, terminally ill patients, radio or chemotherapeutically treated patients, patients with metastasis to lungs or any distant metastasis, patients with history of more than one well defined etiological factor involved. Results: There were 73% patients of oral cancer reported with anemic. Significantly lower values of Hb, Platelet and higher mean values of ESR, TLC and were observed in both groups of oral cancer patients; tobacco smokers and tobacco chewers as compared to non-smokers healthy controls. There was more decline in the level of haemoglobin and incline in the level of ESR observed in tobacco chewer oral cancer patients as compared to tobacco smokers patients, while TLC was more observed in smokers. Conclusion: Oral cancer patients with history of chewable/smoke able tobacco have likely worse hematological profile, which increases the anesthetic and surgical challenges for maxillofacial surgeons, which have significant impact on treatment planning as well.
Evaluation the Dependence of the Electron Beam Characteristics on the Field Shaping and Plan Parameters in Comparison with Different Dosimetry Systems.
Electron beam therapy is widely used in the management of cancers. The rapid dose fall-off and the short range of an electron beam enable the treatment of lesions close to the surface, while sparing the underlying tissues. In an extended source-to-surface (SSD) treatment with irregular field sizes defined by cerrobend cutouts, underdosage of the lateral tissue may occur due to reduced beam flatness and uniformity. To study the changes in the beam characteristics, the depth dose, beam profile, and isodose distributions were measured at different SSDs for regular 6 X 6 cm 2 to 25 X 25 cm 2 cone, and for regular cutouts of field size 3 X 3 cm 2 and 25 X 25cm 2 for beam energies ranging from 6 to 21 MeV. The PDD, beam flatness, symmetry and uniformity index were compared. For lower energy (6 MeV), there was no change in the depth of maximum dose (R100) as SSD increased, but for higher energy (20 MeV), the R100 depth increased from 2 cm to 3 cm as SSD increased. This shows that as SSD increases there is an increase in the depth of the maximum dose for higher energy beams.