Background. In Egypt more than one-third of colorectal cancer (CRC) cases occur in individuals aged 40 years and younger, and are diagnosed at advanced stages; currently, CRC screening is not done as a routine part of preventive care. To lay the foundation for the development of a CRC multilevel screening program in Egypt, this qualitative study aimed to explore the perspectives of Egyptian physicians. Materials and Methods. The PRECEDE-PROCEED model, which focuses on predisposing (intrapersonal), reinforcing (interpersonal), and enabling (structural) factors inherent in health behaviors, served as our theoretical framework. Primary health care physicians, oncologists, and gastroenterologists practicing in Alexandria, Egypt, participated in 1 one-hour semistructured interview. Interviews were audio recorded, transcribed, translated into English, and analyzed by thematic analysis. Results. Seventeen physicians participated (n = 8 specialists and n = 9 primary care physicians). Barriers to CRC screening included socioeconomic status, a lack of emphasis on prevention, fear, and cost (predisposing); a belief that only high risk patients should be screened and a lack of confidence in providers to perform and interpret screening tests appropriately (reinforcing); and cost, lack of availability of the tests, and inadequate training for laboratory technicians and providers (enabling). Potential facilitators included implementing a media campaign emphasizing early detection, curability and prevention (predisposing); educating physicians and eliciting physician engagement (reinforcing); and decreasing costs, making screening tests widely available, and providing well-trained providers (enabling). Conclusion. A CRC screening program is needed in Egypt, and to be successful it would likely need to address barriers at multiple levels. The Oncologist 2020;25:e1525-e1531 Implications for Practice: In Egypt, colorectal screening is not a routine part of preventive care, and colorectal cancer is often diagnosed at an advanced stage in individuals aged 40 years or younger. Screening can prevent and detect colorectal cancer in its early stages, but before designing any screening program, understanding the context is important as cultural beliefs may impact the acceptability of screening methods. By exploring the perspectives of Egyptian physicians, this study found important insights into how screening program components should be considered in the Egyptian culture and lays the foundation for the development of a multilevel colorectal screening program in Egypt.
Introduction This study aims to report the outcome and toxicity of combined hyperthermia (HT) and radiation therapy (RT) in treatment of locally advanced or loco-regionally recurrent breast cancer. Patients and Methods Patients treated with HT and RT from January 1991 to December 2007 were reviewed. RT doses for previously irradiated patients were >40 Gy and for RT naïve patients >60 Gy, at 1.8–2 Gy/day. HT was planned for 2 sessions/week, immediately after RT, for a minimum of 20 minutes and for >4 sessions. Superficial or interstitial applicators were used with temperature measured by superficial or interstitial thermisters based on target thickness. HT treatment was assessed by thermal equivalent dose (TED), >42.5°C and >43°C. Endpoints included treatment response, lack of local progression (local control), and survival. Results 127 patients received HT and RT to 167 sites. These included the intact breast (24.4%), chest wall/skin (67.7%), and breast/chest wall and nodes (7.9%). At a median follow-up of 13 months (mean 30±38), improved overall survival was significantly associated with increasing RT dose (p<0.0001), median TED 42.5°C≥200 minutes (p=0.003), and local control (p=0.0002). Local control at last follow-up was seen in 55.1% of patients. Complete response was significantly associated with median TED 42.5°C≥200 minutes (p=0.002) and median TED 43°C≥100 minutes (p=0.03). Conclusion HT and RT are effective for locally advanced or recurrent breast cancer in patients that have been historically difficult to treat by RT alone. Over 50% of patients achieved control of locoregional disease. Overall survival was improved with local control.
Background: Colorectal cancer (CRC) incidence and mortality rates are increasing in Egypt. Because no national screening guidelines exist, developing an effective evidence-based screening intervention could lower rates by early detection of pre-cancerous and cancerous lesions and polyps. This paper describes the development of a CRC screening intervention in Alexandria, Egypt using Intervention Mapping (IM). Materials and Methods: Between September 2019 and March 2020, the successive steps of the IM process were completed. Beginning with the needs assessment, we conducted a literature review, held focus groups with residents of Alexandria, and conducted interviews with local gastroenterologists and oncologists. Program objectives and target audience were determined before designing the program components and implementation plan. Using the PRECEDE-PROCEED theoretical model, predisposing, reinforcing, and enabling screening barriers were assessed. Finally, we developed a Standard Operating Procedures manual detailing aspects of the intervention and evaluation to serve as a model for an expanded screening program. Results: The needs assessment, e.g., literature review, seven focus groups (N=61 participants) and interviews (N=17 participants), indicated that barriers among residents included CRC knowledge deficits, fear/anxiety regarding testing, high cost, and lack of accessibility. Physicians believed CRC testing should only be performed for high risk individuals. Findings from each step of the process informed successive steps. Our final intervention consisted of training components for medical students (Health Champions) who would deliver the intervention to patients in primary care waiting rooms, providing short descriptions of CRC risks and screening, educational brochures, and distributing vouchers for no-cost guaiac fecal occult blood test kits. Health Champions would then follow up with the patients, providing results and referrals for no-cost colonoscopy testing for those with abnormal results. Conclusion: Utilizing the IM steps successfully led to development of a theory-based CRC screening intervention for Egypt. Next steps include the implementation of a feasibility pilot intervention.
Background: Exploration of the population profile and management of female breast cancer in Alexandria, Egypt, to identify system inefficiencies. Aims: To identify barriers to full implementation of international guidelines in female breast cancer patients. Methods: Data extraction and analysis from records of 3 public oncology services in Alexandria, Egypt in 2007–2016. Results: A total of 5236 of 7125 records were usable. Median patient age was 54 years, and 522 (31.5%) had a positive family history. Median duration of prediagnosis complaint was 3.1 months. For tumour stage, 2527 (55.2%) were early, 1717 (37.6%) were locally advanced and 331 (7.2%) were stage IV. Estrogen receptor, progesterone receptor and HER2 were positive in 3869 (85%), 3545 (78%) and 461 (15.3%) patients, respectively. Chemotherapy started after a median 1.03 months. Adjuvant chemotherapy was given to 3667 (91.7 %) patients and neoadjuvant chemotherapy to 333 (8.3%); 3686 (92.1%) received anthracycline-based combination chemotherapy, and 3613 (86%) received hormonal treatment. One hundred and eighty of 317 eligible patients received trastuzumab. Local and/or distant recurrence was seen in 1109 (21.2%) patients. In nonmetastatic cases, median overall and disease-free survival was 149.1 and 77.1 months, respectively. In metastatic cases, median progression-free survival was 19.6 months. Conclusion: There were defects in the record system, delayed diagnosis and treatment, and nonadherence to targeted therapy in many patients. Promotion of national and hospital-based registries is needed, along with targeted information, education and communication strategies, and a robust patient navigation system. Continuous monitoring of outcomes and adaptation to implementation needs must be sustained.
Background: Molecular targeted drugs are the first line of treatment of advanced hepatocellular carcinoma (HCC) due to its chemo and radio resistant nature. HCC has several well documented etiologic factors that drive hepatocarcinogenesis through different molecular pathways. Currently, Hepatitis C virus (HCV) is a leading cause of HCC. Therefore, we included a unified cohort of HCV-genotype 4 related HCCs to study the expression levels of genes involved in the Insulin-Like Growth Factor 1 Receptor (IGF1R) pathway, which is known to be involved in all aspects of cancer growth and progression. Aim: Determine the gene expression patterns of IGF1R pathway genes in a cohort of Egyptian HCV-related HCCs. Correlate them with different patient/tumor characteristics. Determine the activity status of involved pathways. Methods: Total RNA was extracted from 32 Formalin fixed paraffin embedded tissues of human HCV-related HCCs and six healthy liver donors as controls. qRT-PCR using RT2 Profiler PCR Array for Human Insulin Signaling Pathway was done to determine significantly up and downregulated genes with identification of most frequently coregulated genes. Followed by correlation of gene expression with different patient/tumor characteristics. Finally, Canonical pathway analysis was performed using the Ingenuity Pathway Analysis software. Results: Six genes; AEBP1, AKT2, C-FOS, PIK3R1, PRKCI, SHC1 were significantly overexpressed. Thirteen genes; ADRB3, CEBPA, DUSP14, ERCC1, FRS3, IGF2, INS, IRS1, JUN, MTOR, PIK3R2, PPP1CA, RPS6KA1 and VEGFAwere significantly under expressed. Several differentially expressed genes were related to different tumor / patient characteristics. Nitric oxide and reactive oxygen species production pathway was significantly activated in the present cohort, while the growth hormone signaling pathway was inactive Conclusion: The gene expression patterns identified in this study may serve as possible therapeutic targets in HCV-related HCCs. The most frequently coregulated genes may serve to guide combined molecular targeted therapies. The IGF1R pathway showed evidence of inactivity in the present cohort of HCV-related HCCs, so targeting this pathway in therapy may not be effective.
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