Quit Smoking for Life—Social Marketing Strategy for Youth: A Case for Pakistan

Smoking is the single most avoidable risk factor for cancers. Majority of smokers know about this fact but it is difficult for them to give it up mainly in the face of widespread smoking advertisements by the tobacco industries. To reduce the prevalence of smoking and its associated cancers, immediate actions are required by public health authorities. Social marketing is an effective strategy to promote healthy attitudes and influence people to make real, sustained health behavior change by transiting through different stages which include precontemplation, contemplation, preparation, action, and maintenance. Social marketing can influence smokers to voluntarily accept, reject, modify, or abandon their smoking behavior. In Pakistan, the smoking prevalence has been increasing, necessitating effective measures. The trend of its usage has been going upwards and, according to the World Health Organization, in Pakistan, the usage of cigarette smoking is increased by 30% compared to 1998 figures. The Pakistan Pediatrics Association has estimated 1,000 to 1,200 school-going children between the ages of 6 and 16 years take up smoking every day. In Pakistan, ex-smokers in the low socioeconomic group reported spending 25% of the total household income on this habit. This paper focuses on the antismoking social marketing strategy in Pakistan with an aim to reduce smoking prevalence, especially among the youth.     

Markov’s Modeling for Screening Strategies for Colorectal Cancer

Economic decision models are being increasingly used to assess medical interventions. Advances in this fieldare mainly due to enhanced processing capacity of computers, availability of specific software to perform thenecessary tasks, and refined mathematical techniques. We here estimated the incremental cost-effectiveness often strategies for colon cancer screening, as well as no screening, incorporating quality of life, noncomplianceand data on the costs and profit of chemotherapy in Iran. We used a Markov model to measure the costs andquality-adjusted life expectancy of a 50-year-old average-risk Iranian without screening and with screening byeach test. In this paper, we tested the model with data from the Ministry of Health and published literature. Weconsidered costs from the perspective of a health insurance organization, with inflation to 2011, the Iranian Rialbeing converted into US dollars. We focused on three tests for the 10 strategies considered currently being usedfor population screening in some Iranians provinces (Kerman, Golestan Mazandaran, Ardabil, and Tehran):low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performedannually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectalcancer by 39%, 60% and 76%, and mortality by 50%, 69% and 78%, respectively, compared with no screening.These approaches generated ICER (incremental cost-effectiveness ratios) of $9067, $654 and $8700 per QALY(quality-adjusted life year), respectively. Sensitivity analyses were conducted to assess the influence of variousscales on the economic evaluation of screening. The results were sensitive to probabilistic sensitivity analysis.Colonoscopy every ten years yielded the greatest net health value. Screening for colon cancer is economical andcost-effective over conventional levels of WTP8.     

Intensity-modulated radiation therapy for breast: is it for everyone?

Intensity-modulated radiation therapy (IMRT) became available to the radiation oncology community in the late 1990s, and its initial applications were to increase conformality of dose to the target, allowing for both dose escalation and decreased radiation to adjacent normal organs. In most disease sites, these continue to be the goals of IMRT. However, for breast cancer, IMRT has emerged with a different endpoint, namely improving dose homogeneity throughout the targeted breast. In 2 recent prospective randomized trials comparing IMRT with "standard" planning, IMRT was associated with a significant decrease in both acute side effects and late fibrosis, which was related directly to dose homogeneity. Better conformality can also be achieved with IMRT; yet because of the unique location of the breast tissue external to the thoracic contents, attempts at "inverse planning" with multiple fields were largely not perceived as "better" plans when treating the breast alone. Research is underway to determine if the use of IMRT for breast or chest wall along with regional lymphatics may improve outcomes over "standard" treatment planning. Additionally, special anatomic situations, such as pectus excavatum, have been shown to benefit from IMRT.     

Mistletoe for cancer?

Mistletoe extracts are widely used in the treatment of cancer. The results of clinical trials are however highly inconsistent. We therefore conducted a systematic review of all randomised clinical trials of this unconventional therapy. Eight databases were searched to identify all studies that met our inclusion/exclusion criteria. Data were independently validated and extracted by 2 authors and checked by the 3rd according to predefined criteria. Statistical pooling was not possible because of the heterogeneity of the primary studies. Therefore a narrative systematic review was conducted. Ten trials could be included. Most of the studies had considerable weaknesses in terms of study design, reporting or both. Some of the weaker studies implied benefits of mistletoe extracts, particularly in terms of quality of life. None of the methodologically stronger trials exhibited efficacy in terms of quality of life, survival or other outcome measures. Rigorous trials of mistletoe extracts fail to demonstrate efficacy of this therapy.     

Laparoscopic Hepatectomy for Colorectal Metastases: Ready for Prime Time?

Colorectal metastases represent the most common hepatic malignancy, and experience has shown that surgical resection may offer long-term cure in select patients. Advances in operative technique and adjuvant therapy have increased 5-year survival rates to more than 50%. During the last decade, the introduction of laparoscopic liver resection has progressed from a novelty to a viable surgical option. With the growing enthusiasm for laparoscopic hepatectomy, multiple centers are utilizing a minimally invasive approach to hepatic colorectal metastases. As with any new surgical procedure, several concerns have arisen with laparoscopic hepatectomy. These include the safety of this procedure as well as its oncologic integrity. Despite these concerns, recent series have demonstrated the equivalence of laparoscopic and open hepatectomy for colorectal metastases, resulting in many of these fears being put to rest. Given these promising results, centers that have developed the necessary expertise to safely perform laparoscopic hepatectomy should begin to apply this approach to hepatic colorectal metastases.     

Contents for Volume 14,2002

(Vol. 14 No. 1, March 2002) Articles THE EFFECT OF PHENYLACETATE ON THE EXPANSION AND CYTOTOXIC ACTIVITY OF ADHERENT LAK CELLS FROM PATIENTS WITH HEPATOCELLULAR CARCINOMA Zheng Ning, Ye Sheng-long, Sun Rui-xia, et al. 1 GENE EXPRESSION PROFILING IN MULTIDRUG RESISTANT KB CELLS USING CDNA MICROARRAYS Wang…     

Radiation Therapy for Liver Tumors: Ready for Inclusion in Guidelines?

Despite the historically limited role of radiotherapy in the management of primary hepatic malignancies, modern advances in treatment design and delivery have renewed enthusiasm for radiation as a potentially curative treatment modality. Surgical resection and/or liver transplantation are traditionally regarded as the most effective forms of therapy, although the majority of patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma present with locally advanced or unresectable disease on the basis of local vascular invasion or inadequate baseline hepatobiliary function. In this context, many efforts have focused on nonoperative treatment approaches including novel systemic therapies, transarterial chemoembolization, ethanol ablation, radiofrequency ablation, and stereotactic body radiation therapy (SBRT). This review aims to summarize modern advances in radiotherapy, particularly SBRT, in the treatment of primary hepatic malignancies.     

Metastasectomy for stage IV melanoma: for whom and how much?

Although the conventional paradigm for treating metastatic melanoma relies on systemic therapies, a surgical approach should be strongly considered in selected patients. A surgical approach may not be appropriate for all patients, but it can offer a rapid clearance of disease without the toxicity of systemic therapy. Patient selection is of paramount importance for surgery to be effective. The rationale for surgical intervention in the management of metastatic melanoma, selection factors to be considered, published results, and future directions are discussed in this article.     

Allogeneic stem cell transplantation for myelodysplastic syndromes: critical for cure?

Allogeneic stem cell transplantation (SCT) is the treatment of choice for young patients (age ≤ 55 years) with myelodysplastic syndromes (MDS) characterized by poor-risk or intermediate-risk cytogenetics, who have a histocompatible related or unrelated donor. For patients who lack an human leukocyte antigen-compatible donor, autologous SCT, or chemotherapy may be good alternatives for those with MDS and with good-risk cytogenetic characteristics. Iron toxicity is an underestimated cause of hematopoietic stem cell transplantation (HSCT) treatment-related mortality. The pathogenesis, diagnosis, and monitoring of iron-induced organ damage are currently topics of investigation. Prospective studies on the prevention or treatment of iron toxicity before HSCT and/or after HSCT are necessary.     

Radiotherapy for gynecologic cancerin nonagenarian patients：a framework for new paradigmsCSCD

No consensus exists regarding the role of radiotherapy in the management of gynecologic cancer in nonagenarian patients.We retrospectively reviewed the outcomes of 19 consecutive nonagenarian patients with gynecologic cancer(6 endometrial cancers,6 cervical cancers,4 vulvar cancers,and 3 vaginal cancers) who were treated with radiotherapy.Radiotherapy was performed mainly in a palliative setting(n = 12;63.2%),with a median dose of 45 Gy(range,6-76 Gy).Infrequent major acute or late toxicities were reported.Among 19 patients,9(47.4%) experienced tumor progression,5(26.3%) experienced complete response,2(10.5%) experienced stable disease and/or partial response.At last follow-up,12 patients(63.2%) had died;most deaths(n = 9) occurred because of the cancer.These results suggest that radiotherapy is feasible in the treatment of nonagenarian patients with gynecologic cancer.     

Stereotactic Body Radiotherapy for Kidney Cancer: Ready for Prime Time?

The standard treatment for renal cell carcinoma (RCC) is surgery. However, a number of patients will not be candidates for surgical treatment or will reject this therapeutic approach. Therefore, alternative approaches are required. Historically, radiotherapy has been considered an ineffective treatment for RCC due to the radioresistance of renal tumour cells to conventional fractionation and the increased rate of toxicity. Stereotactic body radiotherapy (SBRT) is a radiotherapy technique that provides a non-invasive ablative treatment with remarkable rates of local control in both primary tumours and metastases in several locations, with a low associated morbidity due to the highly conformal dose and the use of image-guided techniques. Current evidence shows that a higher dose per fraction, achieving a higher biological effective dose, can overcome the radioresistance of RCC cells. Therefore, SBRT, as well as the combination of SBRT and new emerging immune therapies, has a potential role in the local treatment of primary RCC and oligometastatic RCC patients.