Diagnosis and Predictive Molecular Analysis of Non–Small-Cell Lung Cancer in the Africa-Middle East Region: Challenges and Strategies for Improvement

The identification of tumor biomarkers provides information on the prognosis and guides the implementation of appropriate treatment in patients with many different cancer types. In non–small cell lung cancer (NSCLC), targeted treatment plans based on biomarker identification have already been used in the clinic. However, such predictive molecular testing is not currently a universally used practice. This is the case, in particular, in developing countries where lung cancer is increasingly prevalent. In September 2012 and November 2013, a committee of 16 lung cancer experts from Africa and the Middle East met to discuss key issues related to diagnosis and biomarker testing in NSCLC and the implementation of personalized medicine in the region. The committee identified current challenges for effective diagnosis and predictive analysis in Africa and the Middle East. Moreover, strategies to encourage the implementation of biomarker testing were discussed. A practical approach for the effective diagnosis and predictive molecular testing of NSCLC in these regions was derived. We present the key issues and recommendations arising from the meetings.     

Erythrocyte Catalase and Carbonic Anhydrase Activities in Lung Cancer

Aim: To study the relationship between the pathogenesis of lung cancer and antioxidant status and acidicmedia by measuring the activities of erythrocyte catalase (CAT) and carbonic anhydrase (CA). Methods: A totalof 26 patients with lung cancer and 15 healthy individuals were included in the study. The CAT and CA activitiesof erythrocytes were defined. The catalase (CAT) activity of erythrocytes was measured using Aebi`s method.Carbonic anhydrase (CA) activity was analyzed by CO2 hydration. Results: It was found that erythrocyte CAand CAT activities were significantly lower in patients with lung cancer compared to controls (p<0.05). Of the 26patients with lung cancer, seven (26.9%) had metastasis, and the CA and CAT levels in patients with metastasiswere significantly decreased (p=0,0001). Conclusions: Development of oxidative stress due to lung cancer maybe related to the balance between prooxidant and antioxidant reactions. Catalase may have a preventive effectfor malignant lung cancers and the gene of the antioxidant enzymes may be one of the anti-oncogenes, andinactivation of one of these genes in the process of carcinogenesis may lead to tumor development. This maybe an explanation for the very low levels of antioxidant CAT in patients with lung cancer compared to healthyindividuals. Carbonic anhydrase (CA) in tumor cells may be an indicator of the acid-base balance in lung cancer.Decreased levels of CA in patients with lung cancer may provide a convenient media for tumor development,growth and metastasis by creating an acidic media.     

Some Mineral,trace Element and Heavy Metal Concentrations in Lung Cancer

Objective: We aimed to determine the relationship between some mineral, trace element and heavy metallevels in the patients of lung cancer by measuring serum levels of copper (Cu), lead (Pb), zinc (Zn), iron (Fe),cobalt (Co), cadmium (Cd), manganese (Mn), magnesium (Mg). Methods: A total of 50 lung cancer and humanhealth (30 lung cancer and 20 healthy human) were included in the study. Venous blood samples of each lungcancer were obtained, and serum Cu, Pb, Zn, Fe, Cd, Co, Mn, Mg levels were analysed by Atomic AbsorptionSpectrophotometer measurements. Results: Mg value measured in lung cancer group were lower than the controlgroup and this was statistically significant (P<0.01). Serum Cu level was significantly lower with lung cancercompared to healthy human (P<0.01). Pb level was significantly higher than those of controls (P<0.01). Theserum Zn level was significantly lower in serum of lung cancer group than controls (P<0.01). Serum Mn and Colevels were found increased in lung cancer group than controls (P<0.01). Cd value was higher in lung cancer butit was not statistically significant (p>0.01). The mean concentration of Fe in the serum of lung cancer patientswas higher than in the controls, but the difference was not significant (p>0.01). There was a positive correlationbetween Cd and Pb level, and between Mn and Fe levels in lung cancer. There was a negative correlation betweenCo and Zn levels of healthy human. There was a negative correlation between Co and Mg levels of lung cancer.Conclusions: Serum Cu, Pb, Zn, Fe, Mg, Co, Mn and Cd might be play a role in the patients of lung cancers.Zn may protective as potent lung cancer. In addition, it is suggested that low levels of zinc can induce thepathogenesis of lung cancer.     

Public Knowledge on Cancer and its Determinants among Saudis in the Riyadh Region of Saudi Arabia

Background: Earlier studies on cancer knowledge/awareness from Saudi Arabia have been few and mostlylimited to knowledge of and attitude towards breast cancer. The objectives of the present cross sectional studywere to determine the levels of knowledge concerning cancer and to identify associated factors. Methods: Thisstudy was carried out among 1,407 Saudis who were either patients or their escorts, attending selected hospitalsin Riyadh region and aged 15 years or more. Required information was obtained by interview using a pilotedArabic questionnaire. Associations between different variables and respondents knowledge were evaluated byChi square test. Multiple logistic regression analyses were performed to examine the potential impact of thevariables. Results: This study population consisted of 688 males and 719 females. Approximately two thirds ofparticipants (67.6%) had never heard of any cancer warning signals, but 80.7% believed some cancers can becured if detected early, 27.1% believed cancer means end of life and 74.2% believed cancer will appear overnight.The majority of the respondents (65.1%) received information about cancer from television/radio. Although 1,159had high level knowledge (scored 50.0% and more), only 233 individuals scored 75.0% and more. Significantdifferences in the knowledge level across age groups, educational levels and marital status were observed.Females had higher level knowledge than males. Odds of having high level knowledge about cancer was 5.27times higher among those who had undergone any of the tests (breast self examination, mammography, occultblood, Papanicolau smear) compared to those who had none of those tests (95% CI: 1.87-14.84). Those who hadheard about any cancer warning signal were more knowledgeable (OR=1.55; 95% CI: 1.10-2.19) than thosewho hadn’t. The other most important determinants of knowledge level included age, and attending a primaryhealth care centre. Conclusions: Our results suggest that the knowledge of cancer is poor among the public andgreater attempts should be made to increase public awareness.     

Multidisciplinary Clinics in Lung Cancer Care: A Systematic Review

Multidisciplinary cancer clinics (MDCCs) are recognized in cancer care as an alternate model of care for lung cancer patients. However, the precise MDCC characteristics that could potentially improve the quality of care in lung cancer care have not been clearly defined. We performed a systematic review of the data regarding MDCCs in the treatment of patients with lung cancer to summarize and evaluate the available evidence and to determine valuable clinic characteristics and projected outcomes. We searched Embase, Cochrane, Medline, PubMed, and Web of Science through April 2017 for studies that included ≥ 2 physician specialties in a MDCC for lung cancer. A total of 2374 unique articles were identified, of which 13 met the inclusion criteria. All the studies were either retrospective or qualitative, with many having small sample sizes. The most commonly reported quantitative outcome for MDCCs was a decreased time from diagnosis to treatment; however, this was only statistically significant in 2 studies. Evidence was conflicting regarding improved patient survival. Several studies of MDCCs reported improved qualitative outcomes, including increased patient satisfaction, increased collaboration, and cohesive communication among care providers, although the sample sizes were small. The few studies of MDCCs that included a care coordinator, in addition to physicians from multiple specialties, reported improvements in patient satisfaction. Overall, our review of the reported data revealed a paucity of evidence regarding the value of MDCCs for lung cancer patients, highlighting the need for further studies to understand the optimal medical model to deliver care.     

Advanced Non–Small-Cell Lung Cancer in the Elderly

Systemic chemotherapy provides improvement in both survival and quality of life for patients with advanced non–small-cell lung cancer (NSCLC). Elderly patients have more comorbidities and tend to tolerate more poorly aggressive chemotherapy and radiation therapy than younger individuals. Our purpose in this article is to summarize recent studies of single-agent chemotherapy and combination regimens with cytotoxic or targeted therapies in the management of elderly patients with advanced NSCLC. We have reviewed the available evidence in the literature to gauge the results of therapy for elderly patients with lung cancer. We found that single-agent chemotherapy remains the standard of care for nonselected elderly patients. Retrospective analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with increased but acceptable toxicity for elderly patients. Therefore, the outcomes in the fit elderly mirror results observed in younger patients, although toxicity is generally greater.     

The Care and Outcomes of Older Persons with Lung Cancer in England and the United States, 2008–2012

Introduction

Although prior research has demonstrated lower lung cancer survival in England than in the United States, more detailed comparisons are needed. We conducted a population-based analysis to compare diagnostic, treatment, and survival patterns.

Chinese Medicine in Cancer Treatment – How is it Practised in the East and the West?

Chinese medicine therapies in cancer treatment are very common in the East. Although it is usually classified as a form of complementary and alternative therapy in the West, Chinese medicine is an independent medical profession in Hong Kong and mainland China. It has a different perspective in understanding health and diseases compared with Western medicine. In oncology practice, whereas Western medicine focuses on direct tumour eradication by surgery, radiation therapy and systemic therapies, Chinese medicine focuses on restoring body balance and enhancing the body's defences (immunity), in addition to some cytotoxic herbal therapies. Most often patients, especially those in the East, receive both treatments. Chinese medicine is also commonly used to reduce side-effects from chemotherapy or radiation therapy, to aid recovery after an operation, to palliate symptoms and to address survivorship issues. However, this raises concerns of drug–herb interactions and toxicity in combination therapies. Commonly used Chinese medicine treatment modalities include acupuncture, moxibustion, diet therapy, prescribed Chinese medicine herbal decoction, single Chinese medicine herbs or supplements and tai chi. Although there is an increasing trend of Chinese medicine use in cancer patients in both the East and the West, the scientific evidence of safety and efficacy is often questioned by oncologists. This article reviews the current evidence in different Chinese medicine therapies in cancer management in both the East and the West.     

Causes of Treatment Abandonment of Pediatric Cancer Patients– Experience in a Regional Cancer Centre in North East India

Introduction: Refusal and abandonment of treatment is often considered as an important reason for poor survival ofpediatric cancer patients in developing and underdeveloped countries. In this study we analyze the factors responsiblefor treatment abandonment and refusal in a Regional Cancer Centre (RCC) in North East India. Material and Methods:All histopathologically or cytologically confirmed cases of childhood cancer from below 15 years of age registered from1st April, 2010 to 31st March, 2017 were included in this study. Parents or caregivers were interviewed thoroughly anda questionnaire was filled up for analysis of demographic and socio-economic factors. Modified Kuppuswamy scalewas used to measure socioeconomic status. Results: Of 592 patients 161 (27.1%) abandoned therapy and 23 (3.9%)refused treatment. Factors associated with abandonment of treatment included: lower risk if residing in urban areas(Odds ratio [OR] = 0.8333, 95% CI 0.565-1.228; P=0.36) and higher risk with maternal education less than secondaryschool (OR = 1.357; 95%CI: 0.553-3.326; P=0.505). Low socioeconomic status and age >5yrs were also associatedwith abandonment of treatment. In a binary logistic regression analysis, male sex [Odds Ratio (OR) = 0.701; 95% CI0.48-1.01; P=0.062] have lowest risk of abandoning treatment with trend to statistical significance. Conclusion: Thereis a need for proper definition of the problem of childhood cancer patients so that appropriate policy can be introducedto improve survival by improving treatment compliance.