BackgroundPunjab is the most populous province of Pakistan, with only 12 countries in the world succeeding it in terms of population.AimsThis review article has the objective of providing novel statistics regarding available cancer therapeutics in Punjab across four different sectors—including government, semi‐private, trust and private sectors.Methods and ResultsKeywords such as “cancer treatment,” “facilities,” “Pakistan,” were used to search Pubmed Database. 36 results were generated: after sifting based on a personal reference list as well as for relevance, 16 articles were finally reviewed. Novel statistics regarding current state of access to cancer facilities were drawn from personal references as well as from studies conducted in other LMICs. There is a gross deficit of oncological services in Punjab, with the ratio of medical oncologists to population being 0.027 per 100, 000, and every oncologist checking 1300‐1500 patients annually. Only 21.4% of the population has access to radiotherapy facilities. Major problems include lack of healthcare professional awareness; poor infrastructure including drug access, radiotherapy, and cancer pain management facilities; lack of planning; and lack of educational and research programs.ConclusionsImproving education & training, developing infrastructure based on public‐private‐partnership models, building cancer registries and organizing national cancer screening programs, as well as encouraging basic health education and research in oncology, are measures that can ensure Punjab's healthcare delivery system becomes capable of handling increasing incident burden of cancer.

Objective: Our aim was to identify factors favoring long term survival in patients presenting with stage IV epithelial ovarian cancer.Methods: We did retrospective analysis of thirty patients with stage IV epithelial ovarian cancer diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan from 2006 to 2013. Patient’s demographics, clinical data and histopathology were abstracted from cancer registry department of our hospital. Chi-square test was used to find the association between clinic-pathological variables and long term survival. Result: All patients received chemotherapy and surgery as per ovarian cancer guidelines. Of the thirty patients, eleven patients survived greater than four years median survival was recorded as thirty five months. Absence of co-morbidities and good performance status indicated good results of therapy however did not have statistically significant impact on survival. Higher CA-125 at presentation i.e.>1000(normal range : <21 U/ml), response to initial chemotherapy, interval cytoreductive surgery and complete response after induction therapy were significantly associated with long term survival (P<0.05).Conclusion: Prognosis of patients presenting with stage IV epithelial ovarian cancer remains poor. Very high values of CA-125 (>1000) at presentation, response to initial chemotherapy, interval surgical resection and complete remission after induction therapy, appear to be significant prognostic factors for long term survival. Further studies exploring molecular profiling and immunological factors are warranted.

Objective: Our aim was to identify factors favoring long term survival in patients presenting with stage IV epithelial ovarian cancer.Methods: We did retrospective analysis of thirty patients with stage IV epithelial ovarian cancer diagnosed and treated at Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan from 2006 to 2013. Patient’s demographics, clinical data and histopathology were abstracted from cancer registry department of our hospital. Chi-square test was used to find the association between clinic-pathological variables and long term survival. Result: All patients received chemotherapy and surgery as per ovarian cancer guidelines. Of the thirty patients, eleven patients survived greater than four years median survival was recorded as thirty five months. Absence of co-morbidities and good performance status indicated good results of therapy however did not have statistically significant impact on survival. Higher CA-125 at presentation i.e.>1000(normal range : <21 U/ml), response to initial chemotherapy, interval cytoreductive surgery and complete response after induction therapy were significantly associated with long term survival (P<0.05).Conclusion: Prognosis of patients presenting with stage IV epithelial ovarian cancer remains poor. Very high values of CA-125 (>1000) at presentation, response to initial chemotherapy, interval surgical resection and complete remission after induction therapy, appear to be significant prognostic factors for long term survival. Further studies exploring molecular profiling and immunological factors are warranted.

Epithelial ovarian cancer (EOC) is common among ovarian cancers. The majority of existing literature shows combined data of stage III and stage IV. Therefore, we aimed to look for whether achieving complete radiological and biochemical response after initial treatment of stage IV epithelial ovarian cancer as a predictor of long-term survival in the Pakistani population. MethodsA cross-sectional study was conducted of patients with stage IV epithelial ovarian cancer diagnosed and treated from 2006-2013 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Overall survival was defined as the number of months between patients' diagnosis at the hospital and any cause of death or last follow-up date. Kaplan Meier curve was used to report the overall survival. The log-rank test was used to distinguish the survival difference in complete and no complete response. P-value <0.05 was considered statistically significant. ResultA total of fifty patients of stage IV epithelial ovarian carcinoma, with a mean age of 53 ± 2 received neoadjuvant chemotherapy and suitable patients underwent interval-debulking surgery. Among these fifty patients, twenty-one (42%) patients who achieved complete radiological and biochemical response had a median survival of greater than five years. Patients without co-morbidities (46%) and having good performance status (52%) showed better results of the treatment. Patients' tolerance to chemotherapy with good response and fit enough to undergo interval-debulking surgery, achieving complete radiological and biochemical response after initial induction therapy were significantly associated with long-term survival (P<0.05). ConclusionOutcomes of patients who present with stage IV EOC remains dismal. Patients who achieved complete radiological and biochemical response after neoadjuvant chemotherapy and interval-debulking surgery was significantly associated with long-term survival.

Objective: To identify the prognostic factors in relapsed Hodgkin’s Lymphoma patients with regards to their impact on the outcome of autologous hematopoietic stem cell transplant. Study Design: Retrospective observational study. Place and Duration of Study: Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Jun 1999 to Jun 2019. Methodology: Out of a total of 2061 Hodgkin’s Lymphoma patients, 37 (1.8%) patients with relapsed disease underwent autotransplant and were studied using the Hospital Information System. We obtained details of clinicopathological factors, treatment, and outcome. In our study, the outcome variable was event after transplant (relapse/disease progression/death). Results: Among the 37 relapsed Hodgkin’s Lymphoma patients undergoing auto-transplant, 24 (64.9%) patients had an early relapse after first-line chemotherapy. In this early relapse group of 24 patients, 9 (37.5%) remained well after auto-transplant but 15 (62.5%) patients had an event. Out of 37 relapsed Hodgkin’s Lymphoma patients undergoing auto-transplant, a complete response on pre-transplant imaging was observed in 24 (64.9%) patients. In those 24 patients with a complete response on pre-transplant imaging, 16 (66.7%) patients remained well after transplant while 8 (33.3%) patients had a worse event. Twoyear progression-free and overall survival proportions were 56% and 77% respectively. Conclusion: Complete metabolic response on pre-transplant imaging was associated with better overall survival. Adverse factors observed were initial short duration of complete response, bulky disease at relapse, variables comprising international prognostic score, B symptoms, and raised erythrocyte sedimentation rate at relapse.