HIGH INFECTION RELATED MORTALITY IN PAKISTANI CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKAEMIA DURING REMISSION INDUCTION CHEMOTHERAPY: REVIEW OF DATA FROM A SINGLE INSTITUTION

Purpose: Despite advances in the treatment of acute lymphoblastic leukaemia (A.L.L.), the outcome for children living in the developing countries is still poor. This is in large part due to high treatment-related mortality (TRM). This study was carried out to review the data and analyze the factors resulting in high TRM during remission induction chemotherapy. Methods: Data for children treated at our centre during the calendar year 2007 were retrospectively analysed. Standard four-drug induction chemotherapy was used without risk strati cation. Bone marrow evaluation was carried out at days 8 and 28. Cerebrospinal uid analysis was carried out on day 1 and with each subsequent intrathecal chemotherapy injection. Modern supportive care facilities including antibiotics, nutritional support and intensive care unit were available. Results: Eighty-one children were eligible for analysis. Median age was 5 years (range 2–16), 72% were male with M:F ratio of 2.5:1. Seventy- five (92%) children had precursor B-cell A.L.L. Only 2 children had central nervous system leukaemia at presentation. Median presenting white blood cell count was 8.83 (range: 1–446). Severe malnutrition (weight <5th centile for age) was seen in 42% of children. Median symptom duration was 6 (range 1–30) weeks at the time of presentation. Induction mortality was 25%. Induction mortality was 25.6% (n = 21). Twenty were related to infections, while more than half (52%) occurred as a result of an outbreak of Acinetobacter infection. Severe malnutrition and Acinetobacter infection (due to an outbreak in our unit during the study period) were highly predictive of TRM during remission induction chemotherapy. Conclusions: Infection control measures, health education and reduction in treatment intensity may improve survival for children with A.L.L. in Pakistani population. Key words: Acute lymphoblastic leukaemia in children, malnutrition, Pakistan, treatment-related mortalit

Efficacy of Chemotherapy for Locally Advanced and Metastatic Pancreatic Cancer: A real life experience and outcome from a tertiary referral centre.

Introduction: To report response rate, progression-free survival and overall survival in patients with advanced pancreatic cancer treated with different available chemotherapeutic regimens over ten years. Materials and Methods: This is a retrospective observational study. All patients with locally advanced and metastatic pancreatic cancer at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from January 2008 to December 2017 were studied. Data were collected from the hospital information system. The characteristics and outcomes of all the patients were analyzed. Progression-free survival and overall survival were also estimated. Kaplan Meier curves and Log-rank test were applied, and SPSS version 20 was used for data analysis. Results: Eighty-seven (87) subjects with a median age of 56 years (range 21-76) were included. Sixty-two (71%) subjects were male. The most common tumor location was the head of the pancreas in 46(53%) of all the subjects. Sixty-three (72%) subjects had elevated CA-19.9 values. About 47(54%) subjects had locally advanced pancreatic cancer (LAPC), and 40(46%) subjects had metastatic pancreatic cancer (MPC). Chemotherapy regimens used were FOLFIRINOX in 23(26%), gemcitabine-based 66(65%) and capecitabine-based in 8 (9%) of the subjects.  One (1%) subject had a complete response (CR), 12(14%) had a partial response (PR), 10 (11%) had stable disease, and 59(68%) of the subjects had progressive disease (PD). The objective response rate (ORR) was 15%, and the disease control rate (DCR) was 26%. In MPC, the ORR was 10%, DCR was 18%, and tumor progression was seen in 72% of the patients, while in LAPC, the ORR was 19.1, DCR 34% and tumor progression was documented in 64% of the patients, respectively. The FOLFIRNOX chemotherapy regimen had better ORR, DCR and lesser number of progressions as compared to Gemcitabine and Capecitabine based chemotherapy regimens. The Median PFS of the whole group was 32-weeks, and the median OS was 54-weeks. The PFS was significantly higher for LAPC (39 weeks) as compared to the MPC group (25 weeks) (p=0.028). There was no statistically significant difference between the OS of these 2 groups (p=0.451). In addition, PFS was significantly higher with FOLFIRINOX chemotherapy as compared to the other chemotherapy regimens. Regarding OS, there was no statistically significant difference among all chemotherapy regimen groups (p=0.267). Conclusion: Based on our results, FOLFIRINOX remained the most effective chemotherapy regimen despite the dose modifications and toxicities in all groups, indicating that modified FOLFIRINOX could be considered as a first-line regimen in south East Asian population

Cancer in Faisalabad and Nankana Sahib, Pakistan: 2017-2019; an Observational study

Introduction: The Punjab Cancer Registry's catchment area includes the districts of Faisalabad and Nankana Sahib. It is an observational, descriptive study that covers the three years from 2017 to 2019, evaluating the distribution of cancer in these two districts. Material and Methods: Data on incident cancer cases diagnosed between 2017 and 2019 among residents of Faisalabad and Nankana Sahib in Pakistan, reported by the participating centers of the Registry, were reviewed retrospectively. Figures and proportions for adults, children, and adolescents were computed. Results: During 2017 and 2019, 5,678 cases were reported from Faisalabad and 390 from Nankana Sahib, with over 50% seen in females. In both districts combined, among adult females, cancers of the breast, reproductive system, and hepatobiliary system were commonly diagnosed, while cancer of the lip/oral cavity/pharynx, hepatobiliary system, and non-Hodgkin lymphoma were the leading diagnoses among adult males. In children and young adults (0-19 years), acute lymphoblastic leukemia, Hodgkin lymphoma, and non-Hodgkin lymphoma were the most common diagnoses. Conclusion: The cancer distribution reported from Faisalabad and Nankana Sahib is of utmost importance. However, the underreporting of cancer cases cannot be ruled out. More input from the collaborators is needed to ensure the completeness of cancer surveillance in the region

Cardiovascular disease risk factors in Pakistani population with newly diagnosed Type 2 diabetes mellitus: A cross-sectional study of selected family practitioner clinics in four provinces of Pakistan (CardiP Study)

Objective: To explore cardiovascular risk factors in people with newly-diagnosed type 2 diabetes mellitus. Methods: The cross-sectional, prospective, multicentre, study was conducted from June 2014 till July 2015 at family practice clinics in 27 cities across Pakistan, and comprised individuals aged 30-50 years diagnosed with type 2 diabetes mellitus within the preceding six months. Laboratory investigations were conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, and Aga Khan University Hospital, Karachi. The 10-year absolute risk of fatal or non-fatal coronary heart disease and stroke was calculated using the United Kingdom Prospective Diabetes Study Risk Engine version 2.0. Data were analysed using SPSS 19. Results: Out of 888 subjects, 362(40.8%) were women and 526(59.2%) were men. The overall mean presenting age was 42.4±5.8 years. After stratification by age, those ≥40 years were significantly associated with higher glycated haemoglobin (p=0.02) and those ≤39 years were associated with higher levels of very low density lipoprotein (p=0.001) and triglyceride (p=0.006). The mean risk estimate for CHD was 9.7% (95% Confidence Interval (CI) 9.0- 10.1)), for fatal CHD 4.4% (95% CI 4.0-4.6), for stroke 1.5% (95% CI 1.2-1.7), and for fatal stroke 0.25% (95% CI 0.24- 0.26). Conclusion: There is a need for screening cardiovascular risk factors even in younger age groups of newlydiagnosed diabetes

Caesarean Section rates in South Asian cities: Can midwifery help stem the rise?

Introduction: Caesarean section (CS) is a life-saving surgical intervention for delivering a baby when complications arisein childbirth. World Health Organization recommends a rate of CS from 10% to 15%. However, CS rates increased steadily in recent decades and have almost doubled from 12.1% in 2000 to 21.1% in 2015. Therefore, this has become a global public health problem. The main purpose of the scoping review article is to give an overview and analysis of the rising CS use in four South Asian countries: Bangladesh, India, Nepal and Pakistan. Methods: A scoping review was carried-out using several bibliographic electronic databases (MEDLINE, EMBASE, SCOPUS, CINAHL and Web of Science), organizational websites and open access journal databases. Literature was searched from December 2011 to December 2018 for articles reporting hospital-based CS rates.Inclusion criteria were primary studies conducted ininstitutional setting in Bangladesh, India, Nepal and Pakistan and published in the English language. Results: We have included 43 studies. Together these studies show that the rate of CS is increasing in all four countries: Nepal, Bangladesh, Pakistan and India. However, this isuneven with very low rates in rural and very high rates in urban settings, theco-existence of ‘Too Little Too Late & Too Much Too Soon’. Hospital based studies have shown that the CS rate is higher in urban and private hospitals. Age, education andsocio-economic status of women, urban residence and distance from health facility are associated with CSs. CS is higher among highlyeducated affluent urban women in private hospitals in South Asian Countries. Conclusion: Rising CS rates in South Asian cities, particularly in specific groups of women, present a challenge to hospital staff and managers and policy-makers. The challenge is to avoid ‘Too Much Too Soon’ in otherwise healthy urban women and avoid ‘Too Little Too Late’ in women living in remote and rural area and in poor urban women

Editorial: Cancer Registration in Pakistan, a Reality Check

An editorial on the current practices of cancer registration in Pakistan.&nbsp

Surgically treated rectal cancer patients—Outcomes at a tertiary care cancer hospital in Pakistan

The aim of this study was to analyze our experience with rectal cancer patients who underwent surgical excision at our institution. Data on 112 rectal cancer patients who underwent surgical resection with total mesorectal excision, from January 2005 to December 2008, were evaluated retrospectively. We achieved an initial complete remission rate of 74.1%. Overall, 92.8% of patients had a complete total mesorectal excision. The overall survival analysis for all patients showed a 1-year survival rate of 98%, a 3-year survival rate of 82%, and a 5-year survival rate of 70%. We report a 41.9% rate of postoperative complications. The 1-, 3-, and 5-year survival rates for females were 100%, 90%, and 72%, respectively and for males, they were 90%, 80%, and 68%, respectively. Differences in overall survival by sex were not statistically significant (p > 0.05). Those patients who were treated with only surgery had the best outcomes with survival being worse in those treated with surgery and adjuvant therapy. Neoadjuvant treatment followed by surgery led to better results. We conclude that we have been successful in achieving high rates of curative resection, complete remission, and overall survival. Neoadjuvant and adjuvant chemotherapy significantly impact rates of remission

HEALTH-RELATED QUALITY OF LIFE (HRQoL) ASSESSMENT FOLLOWING RADICAL CYSTECTOMY IN POPULATION OF A SOUTH ASIAN COUNTRY

Purpose: Radical cystectomy is carried out for muscle invasive bladder (BL) cancer, which greatly affects the quality of life. The objective of our study was to assess the health-related quality of life (HRQoL) in patients following radicalcystectomy.Methods: A retrospective review was done in patients that underwent radical cystectomy between July 2009 and November 2014 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. HRQoLassessments of 34 patients done during clinical psychology review were included in this study. HRQoL was assessed using functional assessment of cancer therapy-BL questionnaire.Results: Low scores were observed in physical well-being and emotional well-being domains with mean scores of 7.32 and 7.97, respectively. Patients scored high on social and family well-being, functional well-being and additionalconcerns, with mean scores of 24.9, 17.24 and 21.73, respectively.Conclusions: Psychological evaluation and rehabilitation should be an integral part of surveillance after radical cystectomy.Key words: Bladder cancer, functional assessment of cancer therapy-bladder, health-related quality of life, radicalcystectomy, South Asia

Surgically treated rectal cancer patients—Outcomes at a tertiary care cancer hospital in Pakistan

Aim: The aim of this study was to analyze our experience with rectal cancer patients who underwent surgical excision at our institution. Methods: Data on 112 rectal cancer patients who underwent surgical resection with total mesorectal excision, from January 2005 to December 2008, were evaluated retrospectively. Results: We achieved an initial complete remission rate of 74.1%. Overall, 92.8% of patients had a complete total mesorectal excision. The overall survival analysis for all patients showed a 1-year survival rate of 98%, a 3-year survival rate of 82%, and a 5-year survival rate of 70%. We report a 41.9% rate of postoperative complications. The 1-, 3-, and 5-year survival rates for females were 100%, 90%, and 72%, respectively and for males, they were 90%, 80%, and 68%, respectively. Differences in overall survival by sex were not statistically significant (p > 0.05). Those patients who were treated with only surgery had the best outcomes with survival being worse in those treated with surgery and adjuvant therapy. Neoadjuvant treatment followed by surgery led to better results. Conclusion: We conclude that we have been successful in achieving high rates of curative resection, complete remission, and overall survival. Neoadjuvant and adjuvant chemotherapy significantly impact rates of remission