Introduction We aimed to measure the acceptability towards the COVID-19 vaccination in cancer patients and to investigate determinant factors associated with the patient's choice. Methods We conducted a cross-sectional survey with a self-administered questionnaire delivered to 329 cancer patients in 3 oncology cancer centers in Tunisia between February-May 2021. Logistic regression was used to evaluate odds ratio predicting patient's intentions toward the vaccine. Results Acceptance rate was 50.5%, 28.3% (n = 93) reported to definitely refuse the vaccine and 21.2% (n = 70) did not make their decision yet. High educational level, history of comorbidities, history of influenza vaccination in the current season, and patient's opinion about the severity of COVID-19 did not predict vaccine resistance. However, patients who think that the vaccine may interfere with treatment efficacy (OR = 7.28, 95%CI [2.5-12.32]), or may impact cancer outcome (OR = 6.14, 95%CI [2.27-16.7]), were significantly more likely to refuse the vaccine. Patients who disagree that the vaccine is a major weapon against the pandemic (OR = 6.07, 95%CI [2.34-9.52]) or that it could reduce the virus transmission (OR = 7.34,) were also significantly more likely to reject the vaccination. Safety concerns were also significant predictive factors (OR = 7.9, . Confidence level in the authorities played a significant role in patient's acceptance of the vaccine, indeed patients who are not registered (OR = 5.9, or not informed about the Tunisian national vaccination platform EVAX (OR = 5.51, 95%CI [2.1-7.9]) were more likely to be against the vaccine. Conclusion Cancer patient's education about the impact of the vaccine on their disease and on the COVID-19 is needed. Governments should build strategies to gain more population confidence.

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BackgroundBreast cancer is the world’s most common cancer among women. It is becoming an increasingly urgent problem in low- and middle-income countries (LMICs) where a large fraction of women is diagnosed with advanced-stage disease and have no access to treatment or basic palliative care. About 5-10% of all breast cancers can be attributed to hereditary genetic components and up to 25% of familial cases are due to mutations in BRCA1/2 genes. Since their discovery in 1994 and 1995, as few as 18 mutations have been identified in BRCA genes in the Tunisian population. The aim of this study is to identify additional BRCA mutations, to estimate their contribution to the hereditary breast and ovarian cancers in Tunisia and to investigate the clinicopathological signatures associated with BRCA mutations.MethodsA total of 354 patients diagnosed with breast and ovarian cancers, including 5 male breast cancer cases, have been investigated for BRCA1/2 mutations using traditional and/or next generation sequencing technologies. Clinicopathological signatures associated with BRCA mutations have also been investigated.ResultsIn the current study, 16 distinct mutations were detected: 10 in BRCA1 and 6 in BRCA2, of which 11 are described for the first time in Tunisia including 3 variations that have not been reported previously in public databases namely BRCA1_c.915T>A; BRCA2_c.-227-?_7805+? and BRCA2_c.249delG. Early age at onset, family history of ovarian cancer and high tumor grade were significantly associated with BRCA status. BRCA1 carriers were more likely to be triple negative breast cancer compared to BRCA2 carriers. A relatively high frequency of contralateral breast cancer and ovarian cancer occurrence was observed among BRCA carriers and was more frequent in patients carrying BRCA1 mutations.ConclusionOur study provides new insights into breast and ovarian cancer genetic landscape in the under-represented North African populations. The prevalence assessment of novel and recurrent BRCA1/2 pathogenic mutations will enhance the use of personalized treatment and precise screening strategies by both affected and unaffected North African cancer cases.

Breast cancer has different epidemio-clinical characteristics in Middle East and North-African populations compared to those reported in the Western countries. The aim of this study is to analyze the epidemiological and clinico-pathological features of breast cancer in Tunisia and to determine prognostic factors with special interest to family history, Ki-67 proliferation index and comorbidity. We retrospectively reviewed epidemiological and clinico-pathological data from patients’ medical records, treated in the Medical Oncology Department at Abderrahmane Mami Hospital, in the period 2011–2015. Data has been collected on 602 breast cancer patients and analyzed using SPSS software V.23.0. Our study showed high fractions of young breast cancer patients and cases with dense breasts. The most prevalent comorbidities observed in the studied cohort were cardiovascular diseases and diabetes. Familial breast cancer was found in 23.3% of cases and was associated with younger age at diagnosis (p<0.001) and advanced stage (p = 0.015). Ki-67 index >20% was significantly associated with early age at diagnosis, lymph node involvement (p = 0.002), advanced tumor grade (p<0.001) and high risk of relapse (p = 0.007). Ki-67 cut-off 30% predicted survival in luminal cases. Survival was worse in patients with triple negative breast cancer compared to non-triple negative breast cancer, inflammatory breast cancer compared to non-inflammatory breast cancer, moderately to poorly differentiated tumors compared to well-differentiated tumors and with positive lymph nodes compared to pN0 (p<0.05). Our study showed new insights into epidemiological and clinico-pathological characteristics of breast cancer that are not well explored in Tunisian population. Considering our findings along with the implementation of electronic health record system may improve patient health care quality and disease management.

Highlights Amenorrhea and elevated β-hCG could result from an extra genital disease. Choriocarcinoma may originate primarily in the lungs. Adjuvant chemotherapy after surgery significantly improves prognosis.

Background: Prognostic factors are crucial to guide patient’s selection through therapeutic decisions and outcome prediction. Aim: To investigate prognostic factors associated with improved survival in stage III non-small cell lung cancer. Patients and Methods: We retrospectively reviewed clinical data of 88 stage III non-small cell lung cancer patients treated between 2010–2017. Multidisciplinary evaluation prior to therapy onset was mandatory. Univariate analyses and multivariate logistic regression were performed to identify factors associated with survival. Results: Median follow-up was 28 months, 56% of patients experienced recurrence. Median overall survival (OS) was 19 months. On univariable analysis, improved OS correlated with younger age (p = 0.011), better performance score (ECOG PS < 2) (p < 0.01), absence of weight loss (p = 0.019) and smaller tumor size (≤ 7 cm) (p = 0.005). OS was improved in patients receiving therapy planned by multidisciplinary meeting compared with those who did not (p < 0.01), in those with resected tumors (p = 0.001), responding to therapy (neoadjuvant chemotherapy (p = 0.034) and concurrent chemoradiation (p = 0.001), as well as those with lower neutrophil-lymphocyte ratio (p = 0.026) and lower platelet-lymphocyte ratio (p = 0.003). Postoperative adjuvant therapy increased OS (64 vs 24, p = 0.025). Longer recurrence-free interval, locoregional failure and better perfomance status at recurrence were good prognostic factors for OS. Multivariate analysis showed that only upfront surgery followed by adjuvant therapy (hazard ratio (HR) = 0.61; 95% confidence interval (CI) 0.38–0.96; p = 0.034), adherence to multidisciplinary team decision (HR = 0.26; 95% CI 0.15–0.47; p < 0.01) and tumor size > 7 cm (HR = 2.31; 95% CI 1.29–4.13; p = 0.005) were independent prognostic factors affecting OS. Conclusions: Optimal therapeutic strategy and adherence to the decision provided by the multidisciplinary evaluation of patients played an important role in stage III non-small cell lung cancer outcome.

Background: COVID-19 pandemic deeply affected cancer patient management, increasing the burden on their caregivers (CG), who are already overwhelmed. We aimed to identify COVID-19-related challenges and the overload burden experienced by CGs.Methods: Between March and May 2020, 40 CG designated by cancer patients were phone interviewed based on a questionnaire. CGs were requested to enumerate regular and new tasks they have been performing for the care recipient and report caregiving-related challenges faced during the COVID-19 outbreak, coping strategies and unmet needs.Results: CGs were mainly women (67%). Median age was 42 years. they were the spouses in 30% of cases, children in 58% and siblings in 12%. CG lived with the patients in 57% and 18% moved-in with the care recipient during the lockdown. The 25% CG smokers reported an increase in the daily number of cigarettes. All CGs reported strict adhesion to safety precautions; 63% stockpiled food and medical supplies due to panicking. They reported difficulties in obtaining cancer and non-cancer related drugs in 30% of cases. Transportation to and from the hospital was more difficult in 30% of cases, affecting significantly chemo-sessions attendance (p¼0.001). 52% of CGs believed that cancer was more serious than COVID-19 and 45% thought that both were equally serious. 13% decided to miss chemotherapy sessions fearing contagion. CGs were deeply worried that their care recipient might get worse in 92% of cases, 55% feared they might be denied intensive care if they caught the virus because of cancer. Additional financial burden was caused by expenses to buy sanitizer gel and face masks in 77% and transportation in 23%. Increased anxiety was reported in 82% of CGs, 58% had sleep disorders, 7% took sleeping pills. 97% of CGs were satisfied with new screening measures in our medical oncology department while 15% faced communication problems with health workers. Reported unmet needs were: 23 % transportation difficulties, 3% lack of financial support, 18% lack of cancer-related information, 40% lack of psychological support.Conclusions: CGs seemed suffering from an additional burden due to COVID-19 spread logistically, financially, physically and emotionally highlighting the lack of planned strategies in such unprecedented situation.Legal entity responsible for the study: Abderrahman Mami Hospital.

Background and PurposeWe aimed to translate the Comprehensive Score of Financial Toxicity (COST) questionnaire into Arabic and to evaluate its reliability and validity.MethodsWe applied the four-step translation method and conducted a pilot validation study over 179 medical oncology patients. Reliability was tested using the Cronbach alpha coefficient and test–retest stability. Validity was tested using the correlation with Functional assessment of Cancer Therapy-General score (FACT-G), factorial analysis and the content validity index.ResultsQuestionnaire showed high internal consistency and test retest reliability; Cronbach alpha coefficient was 0.77 and Pearson stability coefficient was 0.8. Convergent validity evaluation showed a statistically significant moderate correlation with the FACT-G (r = .42, p = .047). Content validly index was 0.93.ConclusionsThe Arabic version of COST questionnaire, was a valid and reliable tool that could be used in clinical practice by healthcare providers to evaluate financial toxicity in Arab speaking cancer patients.