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Introduction: Despite extensive studies of the impact of COVID-19 on patients with cancer, there is a dearth of information from the Middle East and North Africa (MENA) region. Our study aimed to report pertinent MENA COVID-19 and Cancer Registry (MCCR) findings on patient management and outcomes. Methods: MCCR was adapted from the American Society of Clinical Oncology COVID-19 Registry to collect data specifically from patients with cancer and SARS-CoV-2 infection from 12 centers in eight countries including Saudi Arabia, Jordan, Lebanon, Turkey, Egypt, Algeria, United Arab Emirates, and Morocco. The Registry included data on patients and disease characteristics, treatment, and patient outcomes. Logistic regression was used to assess associations with mortality. Results: Between November 29, 2020, and June 8, 2021, data were captured on 2008 patients diagnosed with COVID-19 from the beginning of the pandemic. Median age was 56 years (16–98), 56.4% were females, and 26% were current or ex-smokers. Breast cancer (28.5%) was the leading diagnosis and 50.5% had metastatic disease. Delays of planned treatment (.14 days) occurred in 80.3% for surgery, 48.8% for radiation therapy, and 32.9% for systemic therapy. Significant reduction in the delays of all three treatment modalities occurred after June 1, 2020. All-cause mortality rates at 30 and 90 days were 17.1% and 23.4%, respectively. All-cause mortality rates at 30 days did not change significantly after June 1, 2020; however, 90-day mortality increased from 33.4% to 42.9% before and after that date (p ¼ 0.015). Multivariable regression analysis showed the following predictors of higher 30- and 90-day mortality: age older than 70 years, having metastatic disease, disease progression, and being off chemotherapy. Conclusion: Patients with cancer in the MENA region experienced similar risks and outcome of COVID-19 as reported in other populations. Although there were fewer treatment delays after June 1, 2020, 90-day mortality increased, which may be attributed to other risk factors such as disease progression or new patients who presented with more advanced disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lung cancer management is getting more complex due to the rapid advances in all aspects of diagnostic and therapeutic options. Developing guidelines is critical to help practitioners provide standard of care. METHODS: The Saudi Lung Cancer Guidelines Committee (SLCGC) multidisciplinary members from different specialties and from various regions and healthcare sectors of the country reviewed and updated all lung cancer guidelines with appropriate labeling of level of evidence. Supporting documents to help healthcare professionals were developed. RESULTS: Detailed lung cancer management guidelines were finalized with appropriate resources for systemic therapy and short reviews highlighting important issues. Stage based disease management recommendation were included. A summary explanation for complex topics were included in addition to tables of approved systemic therapy. CONCLUSION: A multidisciplinary lung cancer guidelines was developed and will be disseminated across the country. [ABSTRACT FROM AUTHOR]

The aim of the present study was to determine the prevalence of epidermal growth factor receptor mutations (EGFRmut) in the Gulf region (GR) and its correlation with demographic and clinical characteristics. A multisite retrospective study was conducted, including institutions from Saudi Arabia, the United Arab Emirates and Qatar. All consecutive patients with non-small-cell lung cancer tested for EGFRmut were eligible. Data collected included demographic information, disease characteristics and EGFR test results. Data on 230 patients were obtained. The median age of the patients was 61 years (range, 26-87 years); 169 patients (69.83%) were male and 204 (88.7%) were Arab. The histological subtype was adenocarcinoma in 191 (83.4%) and squamous cell carcinoma in 21 cases (9.17%). Overall, EGFRmut were detected in 66 patients (28.7%), with a prevalence of 32.46% in adenocarcinoma. No squamous cell carcinomas were found to harbor EGFRmut. The univariate and multivariate analyses revealed that female gender, non-smoking status and adenocarcinoma subtype were significant predictors for EGFRmut. There was no difference between Arabs and non-Arabs. In conclusion, to the best of our knowledge, this is the first multisite study to report the prevalence of EGFRmut in the GR population, which was found to be higher compared with that in Western, but lower compared with that in Far Eastern populations. Studies evaluating the efficacy of targeted therapy in this population are underway. [ABSTRACT FROM AUTHOR]

Background: The use of complementary and alternative medicine (CAM) is common among patients with cancer. However, the issue is not well-studied among the Saudi patient population. Our study aimed at determining the patterns of CAM use among patients with cancer in Saudi Arabia. Methods: A cross-sectional study using interview-administered questionnaire was conducted in patients with cancer in the Oncology Department of King Abdulaziz Medical City for National Guards, Riyadh, Kingdom of Saudi Arabia. Patients were asked about CAM use including dietary supplement (DS) and non-DS remedies. Univariate and multivariate analyses were conducted to identify predicting factors for CAM use. Results: A total of 453 adult patients were enrolled in the study, with a median age of 53.5 years (14.7-94.6), and the ratio of females to males was 271/182 (59.8%/40.2%). Of those, 410 patients (90.5%) used some type of CAM remedy. Non-DS remedies were used by 399 patients (88%) and were mainly of a religious nature including reciting the Quran (74.8%), prayer (16%), supplication (13%), and others (3.7%). However, 386 patients (85.2%) used DS including: Zamzam water (59.8%), honey (54.3%), black seed (35.1%), water with the Quran recited over it (29.8%), and other remedies. The majority of patients (90%) used CAM as a cancer treatment and the rest used it for various reasons, such as symptom control or supportive treatment. Only 18% of the patients discussed CAM use with their physicians, compared to 68% discussing it with religious clergypeople (Sheikhs).The univariate analysis revealed that only female gender is a predictor of CAM use, which remained significant in a multivariate analysis, in addition to current employment. Conclusions: The use of complementary therapies among Saudi patients with cancer is highly prevalent, with a predominance of interventions of religious background, indicating the strong influence of religion on peoples' lives, especially when people are faced with life-threatening illnesses. [ABSTRACT FROM AUTHOR]

Lung cancer patients are afflicted with a plethora of symptoms and complications of their disease. This manuscript will review two specific entities, namely superior vena cava syndrome and skeletal complication of lung cancer. [ABSTRACT FROM AUTHOR]

Patients with lung cancer suffer from multiple symptoms that are distressing and impact the quality of life or can even be life-threatening. Palliative care is an evolving field that focuses on alleviating the suffering of cancer patients. This manuscript describes some of the approaches to alleviate the suffering of lung cancer patients. [ABSTRACT FROM AUTHOR]

The systemic treatment of lung cancer evolved rapidly over the last two decades. Systemic therapy became standard of care for advanced lung cancer up to the third line. The addition of antiangiogenesis agents to chemotherapy proved to be beneficial in the first-line setting. Furthermore, systemic therapy was proven effective in the adjuvant setting in early-stage lung cancer. The use of maintenance therapy was also evaluated recently, adding more treatment options for this fatal disease. Finally, the variation in treatment benefits based on the histological subtypes emerged as an important factor in the treatment decision. [ABSTRACT FROM AUTHOR]

Lung cancer patients have a plethora of symptoms and complications. This manuscript will review two specific entities, namely, superior vena cava syndrome and the skeletal complications of lung cancer. [ABSTRACT FROM AUTHOR]

Small-cell lung cancer (SCLC) accounts for 13-20% of all lung cancers. Strongly associated with smoking and initially responsive to treatment, it results in death within 2-4 months without treatment. Limited-stage disease is treated with curative intent with chemotherapy and radiation therapy, with approximately 20% of patients achieving a cure. Extensive-stage disease is primarily treated with chemotherapy and has a high initial response rate of 60-70% but the median survival is only 10 months. All patients achieving a complete remission should be offered prophylactic cranial irradiation. Relapsed or refractory SCLC has a uniformly poor prognosis. [ABSTRACT FROM AUTHOR]

The thoracic oncology multidisciplinary teams are playing an increasing role in the management of thoracic malignancies. These teams have a great potential to improve the patient care and the health care system, however, they are faced by many challenges. To realize the full potential of these teams, a better understanding of their functions, roles, benefits and challenges from all involved including teams members and leadership is crucial. [ABSTRACT FROM AUTHOR]

Esophagitis is a dose-limiting toxicity of combined chemoradiation therapy in patients with locally advanced lung cancer. Our study aimed at minimizing this complication by using glutamine in an attempt to escalate the dose of chemotherapy. This was a Phase I trial of escalating the dose of weekly paclitaxel and carboplatin with concurrent radiation therapy. Fifteen patients were enrolled, with median age 62 years (58-78), 13 males and 12 Caucasians. Due to multiple severe toxicities including hematological toxicities and esophagitis, the combination was deemed not feasible. In conclusion, the addition of glutamine does not prevent serious toxities of this concurrent chemoradiotherapy regimen. [ABSTRACT FROM AUTHOR]

Objective: To study the patterns of dietary supplement use in veterans with cancer. Design: Using a detailed questionnaire, a cross-sectional study was conducted to determine the patterns of dietary supplement use by patients with cancer. Setting/location: The study was conducted at the Hematology! Oncology Clinic at the VA Hospital in Cincinnati, OH. Subjects: Patients with malignancy who were attending the above clinic and willing to participate and sign a consent form were enrolled in the study. Outcomes/measures: The use of dietary supplements, the type, frequency, and reason for use was captured, along with the source of dietary supplements and perceived benefits. Results: Two hundred (200) veterans were surveyed, with a median age of 68 years (36-82). The type of malignancy included cancer of the genitourinary system (39.5%), lung (19.5%), gastrointestinal tract (14.5%), hematology system (16%), skin/head/neck (6.5%), and other (4%). One hundred and twenty-two patients (122) used dietary supplements (61%). Multi vitamins were the most commonly used dietary supplement reported by 98 patients (80.3%), followed by mineral use by 52 patients (40.6%). Ten (10) patients used herbal supplements. Patients who were employed and patients with higher education were more likely to use dietary supplements. Different reasons were given for dietary supplement use and 74% of the users reported perceived benefits, such as improved overall health and energy. While 38% of the patients did not disclose dietary supplement use to their physicians, 37.8% of them learned about dietary supplements from their physicians and 25% obtained their dietary supplements from the VA hospital. Conclusion: The use of dietary supplements is common among veterans with cancer. Health care professionals should inquire about them in a systematic fashion and he prepared to provide counseling to their patients about them. [ABSTRACT FROM AUTHOR]

Background. This study compared mammography rates in Arkansas, based on race and age, to identify any disparities in obtaining mammography. Methods. The Arkansas Mammography Data Collection Project contained data on 133,549 women, 87,680 of them aged 40 to 64 and 45,869 aged 65 years or older. Race data were available on 64,526 women. Mammography rates were compared by patient age and race. Results. Women aged 65 years and older were less likely to obtain mammograms than younger women: 21.67% versus 23.30%. Mammograms were more likely to be classified as diagnostic in older women and as screening in younger women. Older African American women were less likely to obtain mammograms than younger women of the same race (7.23% vs 8.02%), while older white women were more likely to obtain mammograms than younger white women (11.64% vs 11.31%). African Americans were less likely to obtain mammograms in both age groups. Conclusions. Older African American women are less likely to obtain mammograms than white and younger women. The reasons for this disparity warrant further evaluation. [ABSTRACT FROM AUTHOR]

Determines the mammography rate and screening practice patterns in Arkansas. Estimation of women with breast cancer; Efforts of public health providers to increase the number of women obtaining mammogram; Increase in utilization of lifesaving test.

Management of stage III non- small cell lung cancer (NSCLC) is very challenging due to being a group of widely heterogeneous diseases that require multidisciplinary approaches with timely and coordinated care. The standards of care had significant changes over the last couple of years because of the introduction of consolidation therapy with checkpoint inhibitor following concurrent chemo-radiotherapy and the evolving new role of tyrosine kinase inhibitors in the adjuvant setting. The manuscript presents evidence-based recommendations for the workup, staging, treatment and follow up of the various subtypes of stage III NSCLC. The guidelines were developed by experts in various fields of thoracic oncology and guidelines development. The guidelines consider the sequence of interventions and the role of each discipline in the management of the disease taking into account the recent development and included required resources to help physicians provide better care. [ABSTRACT FROM AUTHOR]

Management of Lung Cancer is evolving rapidly with the availability of more therapeutic options. The 2009 Lung Cancer Guidelines are updated version from the 2008 Guidelines(1) and incorporated more recent evidence as well as the 7th version of the Lung Cancer Staging systems. [ABSTRACT FROM AUTHOR]

The systemic treatment of lung cancer has evolved rapidly over the last two decades. Systemic therapy has become the standard of care for advanced lung cancer up to the third line. The addition of antiangiogenesis agents to chemotherapy has proved to be beneficial in the first-line setting. Finally, systemic therapy has proven effective in the adjuvant setting in early-stage lung cancer. [ABSTRACT FROM AUTHOR]

Lung cancer ranks first in the world in incidence and mortality. Multiple risk factors have been identified and the majority of lung cancer cases are preventable. This manuscript presents a summary of the epidemiology of lung cancer and the risk factors. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic continues to disrupt many health- care settings worldwide including cancer care. COVID-19 has been associated with worse outcomes amongst cancer patients. Saudi Arabia has experienced several Middle East respiratory syndrome coronavirus (MERS-CoV) outbreaks that affected the continuity of cancer care. In this paper, we describe how Saudi Arabia responded to COVID-19, how cancer care was re-restructured during this pandemic and how the recent MERS- CoV experience may have improved the Saudi response to COVID-19. [ABSTRACT FROM AUTHOR]

Delineating the process of guidelines is the fundamental step that should be agreed upon prior to working on the details of the guidelines. The Lung Cancer Guideline Committee agreed on the process described below in order to develop framework of the Committee. Experiences of other organizations in developing guidelines have been taken into consideration. [ABSTRACT FROM AUTHOR]

A letter to the editor on a patient suffering from myeloid metaplasia of the skin and mouth is presented.

Thymoma is an epithelial tumor originating from the thymus that grows relatively slowly and generally responds to surgical resection, chemotherapy and radiotherapy. Surgery remains the cornerstone of therapy and complete resection should be considered the "gold standard," because debulking has been reported to offer no survival advantage over simple biopsy. There is a role for debulking in advanced disease with chemo- and radiotherapy. Chemotherapy, earlier believed to be of scanty value, was revived and proved to be effective in advanced and metastatic thymic tumors. Therefore, the management approach became more and more trimodality treatments (surgery, radiotherapy, and chemotherapy) with reasonable results. For patients with stage I or II thymoma, primary resection is recommended. For patients with stage III or IV thymoma, multimodality treatment, including chemotherapy, radiotherapy and resection is often applied for cure. [ABSTRACT FROM AUTHOR]

Small cell lung cancer (SCLC) accounts for 13-20% of all lung cancers. Highly smoking related and initially responsive to treatment, it leads to rapid death in 2-4 months without treatment. Limited-stage disease is treated with curative intent with chemotherapy and radiation therapy, with approximately 20% of patients achieving a cure. Extensive-stage disease is primarily treated with chemotherapy, with a high initial response rate of 60-70%, but with a median survival of 10 months. All patients achieving a complete remission should be offered prophylactic cranial irradiation. Relapsed or refractory SCLC has a uniformly poor prognosis . [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the most diagnosed cancer among males and third among females in Saudi Arabia, with up to two-third diagnosed at advanced stage. The objective of our study was to estimate CRC survival and determine prognostic factors.Methods: Ministry of National Guard- Health Affairs (MNG-HA) registry data was utilized to identify patients diagnosed with CRC between 2009 and 2017. Cases were followed until December 30th, 2017 to assess their one-, three-, and five-year CRC-specific survivals. Kaplan-Meier method and Cox proportional hazard models were used to assess survival from CRC.Results: A total of 1012 CRC patients were diagnosed during 2009-2017. Nearly, one-fourth of the patients presented with rectal tumor, 42.89% with left colon and 33.41% of the cases were diagnosed at distant metastasis stage. The overall one-, three-, and five-year survival were 83, 65 and 52.0%, respectively. The five-year survival was 79.85% for localized stage, 63.25% for regional stage and 20.31% for distant metastasis. Multivariate analyses showed that age, diagnosis period, stage, nationality, basis of diagnosis, morphology and location of tumor were associated with survival.Conclusions: Findings reveal poor survival compared to Surveillance, Epidemiology, and End Results (SEER) population. Diagnoses at late stage and no surgical and/or perioperative chemotherapy were associated with increased risk of death. Population-based screening in this population should be considered. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has had ramifications for most healthcare activities, including medical education and communication aspects. Virtual educational meetings and activities (VEMAs) have been utilised tremendously in the pandemic era, reflecting a transition to new horizons of cyberspace. This creates the need to explore possible challenges for the implementation of such services in the rapidly evolving field of oncology. The aim of our study is to explore the impact of the COVID-19 pandemic on VEMAs in the oncology community in Egypt. It focused on the evaluation of current attitudes, satisfaction and expectations of Egyptian oncologists during and beyond the COVID-19 era. The study is a cross-sectional study using a survey that was distributed through social media. It targeted Egyptian oncologists during the months of May and June 2020. A total of 118 participants completed the survey and most of them were younger than 35 years (71%). Most participants (93.2%) agreed that COVID-19 affected the stream of live medical educational meetings. About three-quarters of them attended VEMAs during the COVID-19 period compared to 50% prior to the pandemic. The majority reported that evening hours after 8 PM was the best time to attend VEMAs and 1 hour is the optimal duration for a virtual meeting. Although the COVID-19 pandemic appeared as an unprecedented challenge for medical education, it can be a catalyst for VEMAs, especially in a rapidly evolving field such as oncology. Further research is needed to assess whether learners are ready and willing to make greater use of online educational platforms and investigate the possible barriers and strategies to enhance their use. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is the most common cancer in males and third in females in Saudi Arabia, with the majority (66%) diagnosed at a late stage. We evaluated the effect of marital status on stage at diagnosis and CRC survival. We hypothesized that married patients would be more likely to present at an early stage and have higher survival than unmarried patients. The Ministry of National Guard-Health Affairs (MNG-HA) cancer registry was used to identify patients diagnosed with CRC from 2009 to 2017. A competing risk analysis was performed to assess the 5-year CRC-specific survival, adjusting for potential confounders. The Kaplan–Meier method and the Cox regressions were used to assess survival. Two-thirds (76.50%) of the 936 CRC patients were married, 11.64% were unmarried, and 11.86% had an unknown marital status. With multiple imputation-based analysis, the multivariate analysis indicated that unmarried patients were 52% more likely to present at an advanced stage [adjusted odds ratio (aOR) 1.52; 95% CI 1.33–1.73], and had a 30% higher risk of death due to CRC compared to the married patients (aHR 1.30; CI 1.17, 1.44). Future CRC screening and survivorship programs should assess the needs of the vulnerable unmarried population. Interventions supporting the early detection of CRC in this population may be beneficial in the long term and lead to improved cancer outcomes. [ABSTRACT FROM AUTHOR]

Background:The COVID-19 pandemic has a tangible impact on the health care systems globally and is represented by interruption of the usual services in many health facilities and exposing vulnerable patients to significant risks.Objectives:We aimed to evaluate this pandemic’s impact on Iraq’s cancer care.Materials and methods:We conducted an exploratory study using a validated web-based questionnaire of 51 items. The questionnaire collected information on the capacity and services offered at the Iraqi cancer centers, the magnitude of care disruption, reasons for the disruption,challenges faced, patient harm estimation, and the interventions implemented during the pandemic.Results:18 cancer centers from 11 Iraqi governorates took part between 21stApril and 8thMay2020. These centers were serving around 18,867 new patients per year. Most of them (72.2%)were facing challenges in delivering their care during the pandemic. Although 44.4% of the centers reduced their services as part of a pre-emptive strategy, other reported reasons included lack of personal protective equipment (22.2%), an overwhelmed system (11.1%), and a restricted approach to medications (11.1%). Missing at least one therapy cycle by>10% of the patients was reported in 38.9% of the centers. Participants have reported that their patients were exposed to potential harm from interruption of cancer-specific care (44.4%) and non-cancer-related care (33.3%). Conclusion:The negative impact of the COVID-19 pandemic on cancer care in Iraq is evident.Additional research to estimate such an effect at the patients’ level and the required measures to counteract this problem is vital. [ABSTRACT FROM AUTHOR]

Background: During curfew, patients are self-isolated at home and worried. Patient–doctor interactions may be disrupted and therefore need to be replaced by alternative effective communication methods. Purpose: To describe the preferences of cancer patients with respect to communication methods and the use of patient-accessible electronic health records (PAEHRs). To record the impact on cancer patients during the COVID-19 pandemic and the knowledge and attitude of the patients towards it. Patients and Methods: We created a self-administered electronic survey that was piloted and evaluated for its clinical relevance. Using convenient sampling methods, we surveyed the cancer patients in our Oncology Center. Results: We received 385 responses between April 15 and April 30, 2020. The preferred method for communication was a phone call with a 92% response rate followed by the electronic patient portal, mobile application, telemedicine and text message in 75%, 76%, 73%, and 72%, respectively. The majority (97%) preferred the use of PAEHRs for appointments, 95% for drug delivery and to view laboratory tests, and 92% in requesting medical reports. In our survey, 22% of patients with cancer reported that their medical cancer care had not been affected by COVID-19. They reported that trusted sources of information during COVID-19 included the Ministry of Health with 98% and doctors with 94%. Sixty-one percent know that they are more susceptible to COVID-19 infection and 91% of respondents supported the notion of digital transformation in the caring of cancer patients. Conclusion: Our study revealed a general acceptance of patients to telecommunication as substitute to in-person interaction with their physicians. Interaction between cancer patients and health care providers should not be disrupted but should be augmented with more effective platforms to improve health care outcomes. [ABSTRACT FROM AUTHOR]

Purpose: As the burden of cancer on the population and the health care system continues to increase with more complicated treatment options, the need for multidisciplinary teams to be as efficient as possible becomes more vital. Our study aimed to evaluate the consistency of GI Tumor Board (GI TB) recommendations with international guidelines, the adherence of physicians involved in patient care to TB recommendations, and the impact on the management of patients. Methods: A prospective cohort study was conducted from January to June 2016 at our institution, which is a major tertiary hospital that provides comprehensive cancer care. All cases presented at the GI TB during this period were included. Data regarding adherence to National Comprehensive Cancer Network guidelines, adherence to TB recommendations, and changes made to the management of patients were collected weekly from the GI TB in a data collection form. Results: Of the 104 patients included, 57 (55%) were males and the median age was 58 (16 to 85) years. Colorectal cancer was the most common diagnosis, in 65 patients (63%). Nearly one-half of cases (45%) were stage IV cancers. Starting new treatment was recommended for 72 patients (69%). Further investigations were requested for 15 patients (14%). For imaging, 24 recommendations (23%) were made. Adherence to National Comprehensive Cancer Network guidelines was observed in 97% of total recommendations. New findings were found in pathology (11%), radiology (13%), and staging (4%). Management plans were changed in 37 cases (36%). Over a 3-month period after presentation to the GI TB, most of the recommendations (87%) were performed. Conclusion: A multidisciplinary tumor board enhances the adherence to guidelines and has an impact on patient management in approximately one-third of patients. Among physicians, adherence to recommendations of the TB was high. [ABSTRACT FROM AUTHOR]

Background: There is a lack of research concerning health-related quality of life (HRQoL) in Saudi patients with sickle cell disease (SCD), particularly among adult populations. The aim of the current study was to describe the characteristics of SCD patients and their impact on their quality of life (QoL).Methods: Six hundred twenty-nine adult SCD patients who attended King Fahad Hospital in Hofuf and King Fahad Central Hospital in Jazan were included in the analysis. Demographic/clinical data were collected and an Arabic version of the Medical Outcomes 36-Item Short-Form Health Survey (SF-36) questionnaire was used to assess QoL.Results: SCD patients who hold a university degree reported positive impacts on the following domains of SF-36: physical role function, vitality, emotional well being, social function, pain reduction, and general health (P = .002, P = .001, P = .001, P = .003, P = .004, and P = .001, respectively). In general, patients with fever, skin redness, swelling, or history of blood transfusion tended to impair the health status of the SF-36. A multivariate analysis revealed that patients with a university degree tended to report high scores of physical role functions, emotional role function, and vitality. Patients with regular exercise tend to increase vitality, social function, general health, and reduce pain. Unemployment tends to lessen vitality and worsen pain. On average, pain, social function, and physical function scores tended to worsen in patients with swelling or history of blood transfusion.Conclusions: This study highlighted that poor education, fever, skin redness, and swelling were negatively associated with specific components of SF-36. SCD patients with a history of blood transfusion found their QoL poorer, whereas regular exercise tended to improve QoL. [ABSTRACT FROM AUTHOR]

Malignant pleural mesothelioma (MPM) is often treated with combination chemotherapy with a platin compound and a folate antagonist being the recommended treatment of patients with advance disease. Patients with potentially operable MPM can be offered the benefit of a more radical multimodality approach including neo-adjuvant chemotherapy and extrapleural pneumonectomy (EPP) without major long-term impairment of their quality of life and survival. [ABSTRACT FROM AUTHOR]

Patients with advanced non small cell lung cancer who progress after first-line chemotherapy have poor prognosis with limited treatment options. Eighteen patients with advanced non-small cell lung cancer that became progressive after prior chemotherapy received prolonged administration of temozolomide for maximum of six cycles. One patient had partial remission; three patients had stable disease, while the rest had progressive disease. Toxicity included thrombocytopenia and gastrointestinal complications. Temozolomide had a limited efficacy, with ease of administration and acceptable toxicity. Different approaches for temozolomide evaluation in NSCLC are warranted. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate response rates, progression-free survival (PFS), overall survival (OS), and toxicity of two high-dose chemotherapy regimens with stem cell rescue used to treat patients with recurrent or persistent stage III/IV ovarian cancer, with the goal of taking one forward into a Phase III comparison with conventional therapy.Methods. Patients under 65 with clinically or pathologically persistent disease after initial chemotherapy or those relapsing >6 months after a complete remission (CR) were randomized to CMC carboplatin (1500 mg/m2), mitoxantrone (75 mg/m2), and cyclophosphamide (120 mg/kg)], or CTC: [cisplatin (165 mg/m2), thiotepa (600 mg/m2), and cyclophosphamide (5625 mg/m2)] with stem cell rescue.Results. Of 67 randomized, the 32 and 26 eligible in the CMC and CTC arms were matched including age (median 49), maximum tumor diameter, and disease status at transplant. Low-risk disease (maximum diameter disease ≤ 0.5 cm and platinum sensitivity) was demonstrated in only approximately one-half of the patients. There were two treatment-related deaths in each arm. The median PFS was 13 and 8 months, respectively, for the CMC and CTC arms. The median OS was 29 and 22 months for the CMC and CTC arms. In a multivariate analysis of PFS, normal CA125 at transplant and CR to primary therapy were significant; for OS, normal CA125 and platinum sensitivity were significant.Conclusions. The CMC regimen was the superior regimen. However, few patients were long-term progression-free survivors. A clinical CR to primary therapy and a normal CA125, seen in a minority of patients, were requirements for a favorable outcome. [Copyright &y& Elsevier]

Treatment of patients with lung cancer during the current COVID-19 pandemic is challenging. Lung cancer is a heterogenous disease with a wide variety of therapeutic options. Oncologists have to determine the risks and benefits of modifying the treatment plans of patients especially in situation where the disease biology and treatment are complex. Health care visits carry a risk of transmission of SARS-CoV-2 and the similarities of COVID-19 symptoms and lung cancer manifestations represent a dominant problem. Efforts to modify treatment of lung cancer during the current pandemic have been adapted by many healthcare institutes to reduce exposure of lung cancer patients to SARS-CoV-2. We summarized the implications of COVID-19 pandemic on the management of lung cancer from the perspective of different specialties of thoracic oncology multidisciplinary team. [ABSTRACT FROM AUTHOR]

Lung cancer ranks first in the world in incidence and mortality. Multiple risk factors have been identified and the majority of lung cancer cases are preventable. In constrast, lung cancer is not the most common cancer in the Kingdom of Saudi Arabia as it ranks third among men and 12th among females. This manuscript presents a summary of the epidemiology of lung cancer and its risk factors in the Kingdom of Saudi Arabia. [ABSTRACT FROM AUTHOR]

Last year we reported on the needs assessment and development of a Symptom Management Clinic (SMC). The SMC was formed to care for outpatient oncology patients at one location who presented with complex symptoms. The SMC has a collaborative and interdisciplinary team approach. Medical oncologists, clinical pharmacist, nurses, complimentary therapist, social worker and dietician comprise the team. This year we report on a nine month evaluation of the SMC and patient outcomes. 1. To describe oncology patients referred to SMC. 2. To describe presenting symptoms. 3. To determine patient outcomes. Retrospective review of medical records and appointment schedules was undertaken for the first nine months of SMC. Of the 49 patients referred, the mean age was 55 years, most were males (27), Caucasian, (28), unemployed (36) and had a diagnosis of head and neck cancer (12). The most common referral was for pain management (40). Pain Scores (0-10 linear scale; n=49) Pain Initial Third Visit Current 5.8 4.6 Usual 6.0 5.0 Worse 9.1 8 Quality of Life (QoL) was measured using the FACT-G at the initial visit and 3 months later. QoL scores can range from 0 to 104, the higher score indicating a better QoL. Pain & QoL Scores n=11 Initial 3 mon Pain 5.7 5.9 QOL 54.3 58.4. Pain and QoL scores tended to change in the expected direction. Although changes in pain and QOL scores were not statistically signifi- cant, patients stated satisfaction with their clinical improvement. SMC is a model for delivery of care for oncology patients with complex and chronic symptoms and represents an appropriate platform to address these symptoms and alleviate patient suffering. [ABSTRACT FROM AUTHOR]