<abstract><title style='display:none'>Abstract</title> Many symptoms are experienced by dying patients. Any symptom can be debilitating and affect the patient’s and the family’s quality of life. Symptom research is complicated, especially in patients receiving palliative care because the studies needed are methodologically challenging. Symptoms management is the essential goal in palliative care. Many people rate this as one of the most important issues whether they are at home, in a hospital or at other assisted care. Bowel obstruction is rarely an emergency, and usually evaluated by multidisciplinary teams. Tailored management is based on the underlying aetiology and pathophysiology. When several symptoms occur together, they can be interrelated and management can be complex. This article discusses the management of intestinal obstruction experienced by palliative care patients</abstract>

Oncology Center, King Abdullah Medical City-Holy Capital, Saudi Arabia

Department of Medical Oncology, Faculty of Medicine, Zagazig University, Egypt

Gastrointestinal obstruction in palliative care: a review

<abstract><title style='display:none'>Abstract</title><sec id="j_fco-2015-0023_s_007_w2aab3b7ab1b6b1aab1c17b1Aa"><title style='display:none' id="d237192e10349_w2aab3b7ab1b6b1aab1c17b1aAa">Background</title>Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and survive with reduced quality of life.</sec><sec id="j_fco-2015-0023_s_008_w2aab3b7ab1b6b1aab1c17b2Aa"><title style='display:none' id="d237192e10358_w2aab3b7ab1b6b1aab1c17b2aAa">Purpose</title>We aimed to study patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy.</sec><sec id="j_fco-2015-0023_s_009_w2aab3b7ab1b6b1aab1c17b3Aa"><title style='display:none' id="d237192e10367_w2aab3b7ab1b6b1aab1c17b3aAa">Patients</title>Ten patients (mean age 63.8 years) were included.</sec><sec id="j_fco-2015-0023_s_010_w2aab3b7ab1b6b1aab1c17b4Aa"><title style='display:none' id="d237192e10376_w2aab3b7ab1b6b1aab1c17b4aAa">Methods</title>Oral mucositis, pain and xerostomia, maximum mouth opening (MMO) and functional abnormalities before and after RT were recorded. The 35 mm MMO or less was accepted as trismus. Patients completed the EORTC QLQ C-30 and Head/Neck35 questionnaires.</sec><sec id="j_fco-2015-0023_s_011_w2aab3b7ab1b6b1aab1c17b5Aa"><title style='display:none' id="d237192e10386_w2aab3b7ab1b6b1aab1c17b5aAa">Results</title>Mean RT dose was 64.3 Gray. Six patients received chemoradiotherapy. Severe mucositis, pain and xerostomia were recorded in 6 and 5 patients respectively. MMO was reduced in all patients. The mean MMO (34 mm) reached the level of trismus. The total number of symptoms increased from 3.1 to 6.3 in C-30 and from 3.1 to 8.8 per patient in the H/N35. Severe fatigue, pain, limitations at work, weakness, sad feelings, family problems, sleeping problems, anorexia, financial difficulties, tense/irritable, constipation, nausea, vomiting and depression were most often reported with C-30. Most patients reported low to moderate quality of life. Severe oral, jaw and neck pain, swallowing problems, taste alterations, sticky saliva, dry mouth, coarseness, dental problems, feeling sick and reduced interest in life/sex were the most common symptoms reported with N/H35.</sec><sec id="j_fco-2015-0023_s_012_w2aab3b7ab1b6b1aab1c17b6Aa"><title style='display:none' id="d237192e10395_w2aab3b7ab1b6b1aab1c17b6aAa">Conclusions</title>The observed trismus, 2- to 3-fold increase of symptoms and poorer quality of life highlighted the need for support of oral cancer patients, who receive postoperative radiotherapy or chemoradiotherapy.</sec></abstract>

Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy

<abstract><title style='display:none'>Abstract</title>In normal B-cells, Bruton tyrosine kinase (Btk), a non-receptor tyrosine kinase involved in B-cell receptor (BCR) signalling, is essential for cell survival and maturation. Not surprisingly, Btk is also implicated in the pathogenesis of B-cell lymphomas, like Chronic Lymphocytic Leukaemia/Small Lymphocytic Lymphoma (CLL/SLL), Mantle Cell Lymphoma (MCL) and Waldenström’s Macroglobulinemia (WM), which are driven by aberrant BCR signalling. Thus, targeting Btk represents a promising therapeutic strategy in the treatment of B-cell lymphoma patients. Ibrutinib, a selective Btk inhibitor, has already been approved as second-line treatment of CLL/SLL, MCL and WM patients, while more clinical studies of ibrutinib and novel Btk inhibitors are currently under way. In light of results of the RESONATE-2 trial, the approval of ibrutinib as a first-line treatment of CLL/SLL may well be approaching. Herein, we review Btk’s role in normal and malignant BCR signalling, as well as ibrutinib’s performance in B-cell lymphoma treatment and prognosis.</abstract>

Targeting Bruton Tyrosine Kinase: A novel strategy in the treatment of B-cell lymphomas

27th Hellenic Conference of Clinical Oncology

5th Hellenic Congress of Oncology

<abstract><title style='display:none'>Abstract</title>In our centre, among 1965 registered cancer patients between May 2011 and December 2013, we report three cases with multiple primary malignant neoplasms. One of them was excluded due to lack of data, and so we present the remaining two cases. The first case is an 82-year-old female patient with colon and thyroid cancer and the second case is a 61-year-old female patient with colon and breast cancer. Both cases were metachronous and discovered accidently during the regular follow up, and managed with a curative intent. Conclusion: It is important for the clinicians to keep in mind that individuals with cancer are at increased risk for subsequent primary malignancies, which must be differentiated from recurrent or metastatic disease.</abstract>

Oncology Center, King Abdullah Medical City - Holy Capital, Saudi Arabia.

Double primary cancers registered in a tertiary care hospital: review of two cases

<abstract>
<title style='display:none'>Abstract</title>
Drug dosing based on the body surface area (BSA) has been the mainstay of oncological treatment over the last decades. Although this seems to be an adequate measure of an individual’s appropriate dose for traditional chemotherapeutic drugs according to their somatometric data, it is currently being questioned due to the delivery of novel treatments such as monoclonal antibodies. Most modern regimes require either a flat (fixed)-dosing model, independent of body weight, or a weight-based administration pattern, mainly depending on specific pharmacokinetic data. However, even in this case, some controversy exists about whether this model is sufficient. Given the recent findings from pharmacokinetic studies, perhaps we should reconsider the solid hypothesis that drug efficacy correlates with dose, as many molecules seem to be efficient even in the lowest doses administered, with minimum toxicity.
</abstract>

Change of dosing paradigm in oncology

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Breast cancer is a growing concern in Iraq, posing significant health challenges for Iraqi women. The objective of this study was to describe the demographic and clinical characteristics associated with breast cancer among Iraqi women, with a specific focus on age-related differences.
</sec>
<sec><title style='display:none'>Materials and Methods</title>
Medical records of 500 female patients diagnosed with breast cancer between 2017 and 2022 were retrospectively analyzed. Demographic information, clinical history, presentation details, treatment modalities, and outcomes were collected and analyzed.
</sec>
<sec><title style='display:none'>Results</title>
Among the studied cohort, 62.4% of breast cancer cases were diagnosed in women aged 50 and older. Marital status correlated significantly with age, with 89.9% of those diagnosed before 50 being married compared to 74.7% of those diagnosed after 50. Notably, 48% of patients diagnosed before 50 had breastfeeding duration of 1–3 months, contrasting with 28.5% of those diagnosed after 50. Diabetes mellitus, hypertension, hypercholesterolemia, heart disease, and vitamin D deficiency were significantly more prevalent among patients diagnosed after 50. Clinical presentation revealed 67.8% with tumor stage II. Metastasis to lymph nodes occurred in approximately 50% of patients. Among patients who were diagnosed after 50 years of age, 34% had metastasis, compared to 22.9% of those diagnosed before the age of 50. Mortality rates were higher in patients diagnosed after 50 (23%) compared to those under 50 (12.8%).
</sec>
<sec><title style='display:none'>Conclusion</title>
The findings emphasize the need for targeted public health campaigns, early detection initiatives, and treatment optimization to improve patient outcomes and mitigate the burden of breast cancer.
</sec>
</abstract>

Demographic and Clinical Characteristics of Females with Breast Cancer in Iraq with Respect to Age: A Single-Center Study

Supplementary FCO 2023

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
The global impact of the Coronavirus Disease 2019 (COVID-19) pandemic on health professionals has been profound. In response to these circumstances, the coordination committee of the Hellenic Group of Young Oncologists (HeGYO) embarked on an investigation into the well-being of its members.
</sec>
<sec><title style='display:none'>Methods</title>
For the purposes of this study, we developed a 44-question questionnaire. The responses were electronically collected and exported into data frames, which were then subjected to statistical analyses.
</sec>
<sec><title style='display:none'>Results</title>
The study cohort comprised 77 oncologists, of whom 81.7% (n=67) were under the age of 40. Survey responses highlighted the profound impact of the COVID-19 pandemic on young oncologists in Greece, with 67.5% (n=52) feeling that their work lives have not returned to pre-pandemic levels, 74% (n=57) experiencing changes in duties, and 74.0% (n=57) reporting increased working hours. Additionally, 82% (n=63) of participants reassessed their work–life balance. Notably, 92.2% (n=71) expressed fears of COVID-19 contamination, unrelated to the perceived quality of protective measures (p=0.291). Time allocated to clinical and pre-clinical research was also decreased, as reported by 36.4% (n=28) and 41.6% (n=32) respectively. Surprisingly, the pandemic did not prompt the initiation of unhealthy habits, but 51.2% (n=40) reported a reduction in physical activity.
</sec>
<sec><title style='display:none'>Conclusions</title>
In summary, this study reveals that the COVID-19 pandemic significantly altered the professional landscape for young oncologists in Greece, impacting work dynamics, research productivity, and overall well-being. These findings underscore the necessity for targeted interventions during emergencies in the healthcare in order to maintain a resilient workforce in oncology.
</sec>
</abstract>

Impact of the COVID-19 pandemic on young oncologists: The Greek perspective

<abstract>
<title style='display:none'>Abstract</title>
Fungating growths are most distressing causing substantial psychological distress for patients and families. Malodor associated with fungating growth causes social isolation, yet malodor management remains suboptimal. Management of fungating cancer growth of oral cavity is unique and difficult. This paper discusses the management of malodor and infection associated with fungating wound including definitive treatment of fungating growth of an oral cavity cancer patient.
</abstract>

Management of Fungating Oral Cancer: A Case Report

<abstract>
<title style='display:none'>Abstract</title>
The optimal management of locally advanced rectal cancer (LARC) often presents a therapeutic challenge. Balancing the benefits of treatment against toxicities and reducing the risk for local and distal recurrences are the mainstay of therapeutic approaches. Recently, several studies have compared a more aggressive approach of delivering several cycles of systemic chemotherapy to the established standard of combined chemoradiation. This approach is termed total neoadjuvant therapy and appears to be beneficial, at least for a subset of patients. The results of the main Phase III studies along with their variations in study design are hereby discussed with the goal of extracting useful clinical suggestions for treatment.
</abstract>

Total neoadjuvant therapy in rectal cancer: a review across studies

<abstract><title style='display:none'>Abstract</title>Purpose: Assessment of pain response in patients with bone metastasis after treating with two radiation schedules and to compare toxicity profile in both arms. Patients &amp; Methods: A prospective randomised study was designed to include 100 patients from May 2011 to May 2013. Patients with histopathologically proven primary malignancy having symptomatic secondary deposits to bone were selected for the study. Patients were randomised to 8 Gy in a single fraction (arm A) or 20 Gy in five fractions (arm B). Initial pain response was assessed using numeric rating scale, and compared using the same scale 3 months after completion of treatment. Acute toxicities were assessed using the radiation therapy oncology group criteria for adverse events Results: Arm A comprised 51 patients while 49 patients were enrolled in Arm B. Baseline patient characteristics were comparable. Twelve patients were lost to follow-up. So the 3-month pain score assessment was completed by 88 of the 100 patients; A complete response was observed in 20.4% (18 patients) of the 88 patients, and partial response was observed in 54.5% (48 patients), for an overall response rate of 75% (66 of 88 patients); only 10% (9 patients) of the 88 patients had progression of pain. Mild GI toxicity was noted in both arms but differences in two arms were not statistically significant (p = 0.45), no interruption of treatment was required because of side effects. Conclusions: In our study, we found both the radiation fractionation schedules for palliative bone metastasis treatment is equally effective in pain control.</abstract>

Single Fraction versus Multiple Fraction Radiotherapy for treatment of painful bone metastases: A Prospective Study; Mansoura experience

<abstract><title style='display:none'>Abstract</title>Background: Despite the documentation of addressing healthcare disparities in detection and treatment of cancer and health outcomes for cancer patients, the inequalities persist. Cancer patients of several vulnerable groups suffer disproportionally the effect of economic crisis on health and healthcare.Patients &amp; Methods: A cross sectional survey was carried out between July and October 2014 in order to assess the cancer patients’ barriers to healthcare access. A total of 426 cancer patients, members of cancer patient organization participated in the study. Data were collected by using an online, self reported questionnaire evaluating three main areas: healthcare access (7 items), economic status and financial burden of the disease (17 items) and the alteration on several aspects related to the disease (8 items) from 2009 to 2014.Results: Approximately 31% of cancer patients reported that they faced barriers to healthcare access for cancer treatment during the last 12 months. The main barriers included long waiting time for a medical appointment (51%) and inability to visit a private physician due to the incapability to pay the out of pocket cost (44%). One in four patient encountered obstacles in medication access which resulted to treatment delay (46%), worsened health status (96%) and increased out of pocket costs (39%).Conclusions: Results suggest that there are vulnerable groups among cancer patients in Greece who suffer disproportionally more the impact of economic crisis on health and healthcare. Healthcare reforms and targeted interventions should be implemented in order to effectively address the inequities in access for cancer patients.</abstract>

Healthcare access for cancer patients in the era of economic crisis. Results from the HOPE III study

<abstract><title style='display:none'>Abstract</title><sec id="j_fco-2016-0007_s_333_w2aab3b8b8b1b7b1aab1c13b1Aa"><title style='display:none'>Purpose</title>Adjuvant trastuzumab is currently an internationally standard for the treatment of localised breast cancer that over express HER2 with the most adverse effect being cardiotoxicity. We conducted this study to evaluate the cardiac safety of trastuzumab in clinical practice.</sec><sec id="j_fco-2016-0007_s_334_w2aab3b8b8b1b7b1aab1c13b2Aa"><title style='display:none'>Methods</title>This study is a retrospective observational single institutional study conducted in the Oncology Center of King Abdulla Medical City (KAMC), Makkah, Saudi Arabia, from June 2011 to January 2014. We evaluated the incidence of cardio toxicity and associated risk factors during adjuvant trastuzumab treatment.</sec><sec id="j_fco-2016-0007_s_335_w2aab3b8b8b1b7b1aab1c13b3Aa"><title style='display:none'>Results</title>Of 57 patients, 20 patients (35%) exhibited cardiotoxicity. About 14% of patients had drop of left ventricular ejection fraction (LVEF) below 50%, whilst 10% and 15% drop of LVEF below their baseline levels were found in 30% and 5% of patients, respectively. About 98.3% of our patients have completed treatment, of whom 21% had a provisional interruption because of a fall in LVEF. A definitive trastuzumab discontinuation has been made in 1.75% of cases because of a nonregressive reduction in LVEF. Analysis of risk factors related to trastuzumab cardio toxicity found that patients older than 40 years were more likely to develop cardio toxicity compared to those younger than 40 years. This difference was statistically significant (p = 0.042).</sec><sec id="j_fco-2016-0007_s_336_w2aab3b8b8b1b7b1aab1c13b4Aa"><title style='display:none'>Conclusion</title>In our study, the cardiac safety seems comparable with the literature data. Trastuzumab-related cardiotoxicity is manifested by an asymptomatic decrease in the LVEF and less commonly by clinical heart failure. Most instances are transient, asymptomatic and reversible.</sec></abstract>

Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt, Mansoura,

Cardiology, King Abdulla Medical City Makkah, Kingdom of

Medical Oncology, Oncology Center of King Abdulla Medical City (KAMC), Makkah, Kingdom of

Cardiotoxicity of the adjuvant trastuzumab in a Saudi population: clinical experience of a single institution

<abstract><title style='display:none'>Abstract</title>The emergence of cyclin-dependent kinase (CDK) 4 and 6 inhibitors has brought a new approach in the treatment of advanced hormone receptor (HR) positive breast cancer and human epidermal growth factor (HER) 2 negative breast cancer. To date, three CDK 4/6 inhibitors, palbociclib, ribociclib, and abemaciclib, are approved by the Food and Drug Administration (FDA); the first two agents are approved by the European Medicines Agency (EMA) as well. The family of CDKs consists of key regulatory enzymes that play a significant role in cell cycle progression. The aim of this review is to give an overview of the mechanism of action and the efficacy of CDK4/6 inhibitors and to highlight the most serious adverse events and the drug interactions related to these agents.</abstract>

The Pharmacological Profile of Cyclin-dependent Kinase (CDK) 4/6 Inhibitors: Clinical Management of Toxicity and Drug Interactions Related to CDK 4/6 Inhibitor-based Treatment in Advanced/Metastatic Breast Cancer

<abstract><title style='display:none'>Abstract</title><bold>Background:</bold> Innovation is one of the most difficult words to define, especially when it comes to health technology. The aim of this article is to get a better understanding of the multi-dimensional facet of innovation, how this is valued by different stakeholders and the way forward in order to create innovative interventions for the sake of the patients and the society.<bold>Methods:</bold> A literature search was performed using mainly the PubMed database and reports from various organisations (EFPIA, etc.).<bold>Results:</bold> In the past, innovation in the pharmaceutical industry was the result of the findings of basic science translated into clinical compounds, ending up in marketed drugs. This model is not valid anymore since significant changes reshaped the drivers of innovations and the key players. Rising costs, increased competition, new scientific and technological developments, well-informed patients created a much more challenging environment where coordinated and committed collaboration seemed to be the only way to overcome these obstacles and reach innovation in order to discover, develop and deliver medicines to patients.<bold>Conclusions:</bold> Innovation initiatives have already proved their value by providing solutions to the major challenges the industry faces. It is now clear that a healthy biomedical ecosystem is determined by all stakeholders-academia, nonprofit/for-profit research institutions, government agencies, pharma/biotech industry and patients. Innovation initiatives provide the platform needed in which all stakeholders can meet and share their knowledge in order to deliver through innovation improved outcomes for patients while shaping an efficient and sustainable healthcare system.</abstract>

The Various Shapes of Innovation

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