The predictors of poor quality of life in a sample of Saudi women with breast cancer

Anwar E Ahmed,1,2 Abdulrahman G Alharbi,3 Mohannad A Alsadhan,4 Alaa S Almuzaini,5 Hanin S Almuzaini,5 Yosra Z Ali,6 Abdul-Rahman Jazieh6 1King Abdullah International Medical Research Center (KAIMRC), 2College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, 3College of Medicine, Imam Abdulrahman Al Faisal University, Dammam, 4College of Medicine, King Saud University, 5College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 6Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia Background: The protocols for treatment, along with many adverse effects, can strongly affect cancer patients’ quality of life (QoL). As there is limited research on the QoL of Saudi Arabian women being treated for breast cancer, the purpose of this study was to identify the predictors of poor QoL in a sample of Saudi women with breast cancer. Methods: A cross-sectional study was conducted on 145 Saudi women with breast cancer who attended the Oncology Outpatient Clinic at King Abdulaziz Medical City, Riyadh for routine follow-up. Sociodemographic and clinical data were collected for each patient, and a Medical Outcome Study Health Survey 36-Item Short Form (SF-36) instrument was used to assess QoL. Results: Of 145 breast cancer patients studied, 42.1% had a family history of cancer and 52.4% were newly diagnosed cancer patients (first-year-after-cancer diagnosis). According to linear regression analyses, cancer patients with metastasis tended to have pain, along with poor physical function, little vitality, and poor general health (a decrease in SF-36 scores of 22.9, 15.0, 19.4, and 16.9, respectively). Regular exercise was a positive predictor of poor general health (an increase in the SF-36 score of 8.2). Patients with first-year-after-cancer diagnoses tended to have poor emotional well-being (a decrease in the SF-36 score of 8.5). Conclusion: In breast cancer patients, regular exercise was a significant positive predictor of better general health. Breast cancer patients with multiple tumors, metastasis, or fever tended to experience significantly poor QoL in several SF-36 domains. Clearly, a routine assessment of QoL in breast cancer patients is important. Keywords: multiple tumors, fever, metastasis, regular exercise, SF-3

Associated factors for oral health problems in a sample of Saudi cancer patients

Nagarajkumar Yenugadhati,1,2 Alhanouf Naji Albalawi,3 Aisha Taha Qureshey,3,* Eiman Taha Qureshey,3,* Hamdan Al-Jahdali,4 Abdul Rahman Jazieh,5 Anwar E Ahmed1,2 1King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard, Riyadh, Saudi Arabia; 2College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard, Riyadh, Saudi Arabia; 3Riyadh Elm University, Riyadh, Saudi Arabia; 4Department of Medicine, Pulmonary Division-ICU, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard, Riyadh, Saudi Arabia; 5Department of Oncology, King Abdulaziz Medical City for National Guard, Ministry of National Guard, Riyadh, Saudi Arabia *These authors contributed equally to this work Purpose: Oral health in cancer patients was known to influence the quality of life. However, the knowledge of possible factors associated with oral health in cancer patients is seriously lacking in Saudi Arabia. In this study, we aimed to determine the burden of adverse oral health in cancer patients and identify the associated factors for oral health problems. Materials and methods: A cross-sectional study design was used to recruit a total of 375 cancer patients who attended oncology outpatient clinics at King Abdulaziz Medical City – Riyadh (KAMC-R) by using a consecutive sampling technique. A self-reporting questionnaire was used to collect the sociodemographic information, clinical symptoms, and lifestyle factors of cancer patients. Furthermore, depression, anxiety, and stress were assessed by using Depression Anxiety and Stress Scale. The authors assessed the oral health complaints based on seven common conditions (bleeding gums, toothache, mouth ulcers, bruxism, xerostomia, problems affecting speech, and satisfactory dietary intake). Unadjusted and adjusted risk ratios (aRR) and 95% CIs for the factors associated with the number of oral complaints experienced were computed using Poisson regression model. Results: The prevalence of oral health conditions experienced by cancer patients was 86.1% (95% CI: 82.2%–89.5%). Female sex (aRR=1.37, 95% CI: 1.05–1.78), low income (aRR=1.58, 95% CI: 1.23–2.04), smoking (aRR=1.29, 95% CI: 1.02–1.64), anxiety (aRR=1.75, 95% CI: 1.36–2.24), and stress (aRR=1.25, 95% CI: 1.00–1.55) were associated with increased risk of oral health problems in cancer patients (p≤0.05), whereas breast cancer patients experienced reduced risk (aRR=0.72, 95% CI: 0.56–0.93). Conclusion: Our study highlighted the significant burden of oral health problems in Saudi cancer patients at KAMC-R and identified several key associated factors for oral health to aid healthcare practitioners in improving cancer management practices. Keywords: oral health, cancer survivors, prevalence, associated factor

Modeling risk assessment for breast cancer in symptomatic women: a Saudi Arabian study

Anwar E Ahmed,1,2 Donna K McClish,3 Thamer Alghamdi,4 Abdulmajeed Alshehri,4 Yasser Aljahdali,4 Khalid Aburayah,4 Abdulrahman Almaymoni,4 Monirah Albaijan,1 Hamdan Al-Jahdali,1,4–6 Abdul Rahman Jazieh4–6 1King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; 2College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; 4College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 5King Abdulaziz Medical City, Riyadh, Saudi Arabia; 6Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia Background: Despite the continuing increase in the breast cancer incidence rate among Saudi Arabian women, no breast cancer risk-prediction model is available in this population. The aim of this research was to develop a risk-assessment tool to distinguish between high risk and low risk of breast cancer in a sample of Saudi women who were screened for breast cancer.Methods: A retrospective chart review was conducted on symptomatic women who underwent breast mass biopsies between September 8, 2015 and November 8, 2017 at King Abdulaziz Medical City, Riyadh, Saudi Arabia.Results: A total of 404 (63.8%) malignant breast biopsies and 229 (36.2%) benign breast biopsies were analyzed. Women ≥40 years old (aOR: 6.202, CI 3.497–11.001, P=0.001), hormone-replacement therapy (aOR 24.365, 95% CI 8.606–68.987, P=0.001), postmenopausal (aOR 3.058, 95% CI 1.861–5.024, P=0.001), and with a family history of breast cancer (aOR 2.307, 95% CI 1.142–4.658, P=0.020) were independently associated with an increased risk of breast cancer. This model showed an acceptable fit and had area under the receiver-operating characteristic curve of 0.877 (95% CI 0.851–0.903), with optimism-corrected area under the curve of 0.865.Conclusion: The prediction model developed in this study has a high ability in predicting increased breast cancer risk in our facility. Combining information on age, use of hormone therapy, postmenopausal status, and family history of breast cancer improved the degree of discriminatory accuracy of breast cancer prediction. Our risk model may assist in initiating population-screening programs and prompt clinical decision making to manage cases and prevent unfavorable outcomes. Keywords: breast cancer management, risk assessment, modeling, patient stratification, predictive too

Improving risk prediction for pancreatic cancer in symptomatic patients: a Saudi Arabian study

Anwar E Ahmed,1,2 Faris S Alzahrani,2 Ahmed M Gharawi,2 Salman A Alammary,2 Fahad H Almijmaj,2 Fahad M Alhusayni,2 Donna K McClish,3 Hamdan Al-Jahdali,1,2 Ashwaq A Al Olayan,4 Abdul Rahman Jazieh4 1King Abdullah International Medical Research Center (KAIMRC), Riyadh, Saudi Arabia; 2King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA; 4King Abdulaziz Medical City, National Guards Health Affairs, Riyadh, Saudi Arabia Background: Imaging tests used in our center are usually inadequate to confirm the high risk for pancreatic cancer. We aimed to use a combination of potential predictors including imaging tests to quantify the risk of pancreatic cancer and evaluate its utility. Methods: This was a retrospective cohort study of patients who were suspected as having pancreatic cancer and underwent biopsy examination of pancreatic mass at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between January 1, 2013, and December 31, 2016. We retrieved data on demographics, clinical history, imaging tests, and final pancreatic diagnosis from medical records. Results: Of the 206 who underwent pancreatic biopsies, the mean age was 63.6 years; 54.4% were male. Of all the biopsies, 57.8% were malignant and 42.2% were benign masses. Nine factors contributed significantly to the risk of pancreatic cancer and were noted: older age (adjusted odds ratio [aOR] =1.048; P=0.010), male gender (aOR =4.670; P=0.008), weight loss (aOR =14.810; P=0.001), abdominal pain (aOR =7.053; P=0.0.001), blood clots (aOR =20.787; P=0.014), pancreatitis (aOR =4.473; P=0.021), jaundice (aOR =7.446; P=0.003), persistent fatigue (aOR =22.015; P=0.015), and abnormal imaging tests (aOR =67.124; P=0.001). The model yielded powerful calibration (P=0.953), excellent predictive utility (area under the receiver operating characteristic curve 96.3%; 95% CI =94.1, 98.6), with optimism-corrected area under the curve bootstrap resampling of 94.9%. An optimal cut-off risk probability of 0.513 yielded a sensitivity of 94% and specificity of 84.7% for risk classification. Conclusion: The study developed and validated a risk model for quantifying the risk of pancreatic cancer. Nine characteristics were associated with increased risk of pancreatic cancer. This risk assessment model is feasible and highly sensitive and could be useful to improve screening performance and the decision-making process in clinical settings in Saudi Arabia. Keywords: pancreas, cancer, fatigue, weight loss, blood clots, jaundice, Saudi Arabi