Clinico-pathological profile of breast cancer patients in a radiation therapy centre

Background: The aim of the study was to evaluate the clinico-pathological characteristics of patients with breast cancer at the Radiation Center of Bangabandhu Sheikh Mujib Medical University (BSMMU), a tertiary‑care cancer center in Dhaka, Bangladesh.   Methods: This descriptive study was conducted from March 2021 to February 2022 where patients receiving radiotherapy for breast cancer were included. Data were collected from face-to-face interviews with patients and from their investigation reports. Data regarding age, presenting symptoms, histological type, tumor size, involvement of regional nodes, hormonal receptor status, and human epidermal growth factor receptor 2 (HER2) amplification were recorded and then analyzed. Results: The mean age of the patients was 52.53 years. Most of the patients (93%) were multiparous and 62.24% were postmenopausal. The most common symptom was breast lump (91.6%). Infiltrating ductal carcinoma and lobular carcinoma were seen in 136 (95.1%) and 7 (4.9%) cases respectively. The TNM stage distribution was stage I, 6 (4.2%); stage II, 52 (36.36%); stage III, 76 (53.15%); and stage IV, 9 (6.29%). Locally advanced breast cancer constituted 42.66% of the cases. Among the patients 90 (62.94%) patients were ER/PR positive and 42 (29.37%) patients were HER2 positive. Triple negative breast cancer (TNBC) constituted 25.17% (36) of the study population. All receptors were positive in 25 patients (17.48%). Conclusions: Majority of our patients receiving breast radiotherapy at our center are middle aged and have advanced disease. TNBC and HER2 positive breast cancer are more common in our population

Presenting features of locally advanced breast cancer : a crosssectional study

Worldwide, breast cancer is the most frequently diagnosed life-threatening cancer in women. This cross sectional study was done to assess the presenting features of locally advanced breast cancer. The mean age was 42.6 years with standard deviation 9.56, 86% were house wife, 53.5% were illiterate, 16% were postmenopausal and 75.8% had BMI of 20Kg/m2. Ninety one point five percent had menarche at or above 12 years of age and 26.6 % had history of using hormonal contraceptives. Tobacco user and positive family history were found in 21.2% and 5.35% of the cases. 84% were presented with only lump and 16% with both lump and ulceration. Right breast was involved in 51.1%. About 37% cases presented on 3rd month of their symptoms. Around 71.2% patients presented with lump >5cm in diameter, axillary lymph nodes were palpable in 81% and fixed in 31% of patients. Around Sixty three percent of patients were in stage IIIA. Still a large fraction of patients present with advanced stage with varied presentation, sometimes surgeons face difficulties to offer the treatment. Proper awareness, early presentation and early detection give them the opportunity to receive the best treatment. BSMMU J 2021; 14(4): 148-15

Molecular Subtyping: status of the molecular factors in the locally advanced breast cancer and its correlation with risk factors

Molecular factors play an important role in the management and treatment outcome of breast cancer. Molecular subtyping has been developed depending upon estrogen and progesterone receptors, human epidermal growth factor receptor-2 and ki76 level. This cross-sectional study was done to assess the molecular subtypes of locally advanced breast cancer and its associated risk factors. Total 94 patients with locally advanced breast cancer were included in the study. The mean age was 42.6 years with a standard deviation of 9.56. In total, 91.5 percent of respondents had menarche at or after the age of 12, and 26.6 % had used hormonal contra- ception in the past. Tobacco users and positive family history were found in 21.2% and 5.35% of the cases. Among the patients, 3.4 % of cases had their first childbirth after the age of 30 and 95.5% of patients feed their babies from their both breasts. Among 94 cases 5 did not have any child. Estrogen receptor was found positive in 35% of cases, progesterone receptor-positive patient was 33% and HER-2 was found positive in 39.4% of cases. Ki-67 level was found high in 66% of cases. Among the 94 cases, the Luminal A subtype was found in 18% and the Lumi- nal B subtype was found in 27.7% cases. The human epidermal growth factor receptor-2 subtype was found relatively less frequent than Luminal type B (24.5% vs. 27.7%). Triple-neg- ative breast cancer was most commonly diagnosed among the patients (almost 30%). The increased number of triple-negative variants signifies poor prognostic outcomes. The risk factor of breast cancer did not show any statistical correlation with molecular subtypes. BSMMU J 2021; 14(3): 57-6

Post treatment outcome and quality of life in patients with inoperable advanced gastric carcinoma

Background: The outcome of treatment for advanced gastric carcinoma can vary depending on a number of factors, including the stage and aggressiveness of the cancer, the patient's overall health, and their response to treatment. In general, the prognosis is poor, with a median overall survival of less than one year. Quality of life (QOL) is an important consideration for patients with advanced gastric carcinoma, as they may experience a range of symptoms such as pain, fatigue, and difficulty eating. This study aimed to evaluate the post-treatment outcomes and QOL in patients with inoperable advanced gastric carcinoma after treatment with cisplatin-capecitabine and with oxaliplatin-capecitabine. Methods: This Quasi-experimental study was conducted at the department of oncology, Bangabandhu Sheikh Mujib medical university, Dhaka, Bangladesh. The study duration was 1 year, from February 2021 to March 2022. During this period, a total of 64 cases of advanced gastric cancer were divided in two equal groups, arm A who had received cisplatin capecitabine, and arm B who received oxaliplatin capecitabine. Result: The mean age at diagnosis was 55.85 and 56.76 respectively. The majority of the patients, 43.8% in arm A and 50% in arm B, ranged in age from 61 to 70. The gender distribution was similar, 78% and 69% of patients in arm A and B respectively were male. Both groups had the majority of patients receiving an ECOG performance rating of 2, with 68.8% in arm A and 59.4% in arm B, and the liver being the most common metastatic site for 56.3% in arm A and 50.0% in arm B. The most frequent risk factor was Helicobacter pylori infection, observed in 68.8% of arm A and 78.1% of arm B. The most common primary tumor site was the antrum, with 50% and 53.1% patients in arm A and B respectively had the primary tumor in the antrum of the stomach. Conclusions: In inoperable advanced gastric cancer, the cisplatin-capecitabine regimen is equally effective as oxaliplatin-capecitabine in terms of disease outcome. Furthermore, the cisplatin-capecitabine regimen is less costly than the combination of oxaliplatin-capecitabine, and provides almost similar QOL. As a result, the cisplatin-capecitabine regimen could be utilized as an alternate choice in patients who are unable to afford an oxaliplatin-based regimen.

Survival and toxicity outcomes of induction chemotherapy followed by concurrent chemoradiotherapy compared with concurrent chemoradiotherapy alone in inoperable stage III and IVA/B head and neck cancer

Concurrent chemoradiotherapy with or without induction chemotherapy is widely practiced in inoperable stage III and IVA/B head and neck cancer. The aim of this study was to investigate the survival and toxicity outcomes of induction chemotherapy combined with concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in inoperable stage III and IVA/B head and neck cancer patients. From June 2018 to July 2020, 86 patients participated in a quasi-experimental study. Patients were purposively assigned to one of the two arms (arm A or arm B). Arm A got induction chemotherapy and concurrent chemo- radiotherapy, while arm B got only concurrent chemoradiotherapy. According to our findings, the 2-year progression-free survival rate in arm A was 48.8% vs 37.2 % in arm B (p-value=0.042), and the 2-year overall survival rate in arm A was 65.1 % versus 60.5 % in arm B (p-value= 0.416). There were no statistically significant variations in treatment-related toxicities between the two groups (p-value > 0.05). In conclusion, inoperable stage III and IVA/B head and neck cancer patients who got induction chemotherapy plus concurrent chemotherapy had a better progression-free survival rate than those who received concur- rent chemoradiotherapy alone. BSMMU J 2021; 14(4): 144-14

Comparative outcome of cisplatin-capecitabine regimen with oxaliplatincapecitabine regimen in advanced gastric carcinoma: a quasi-experimental study

Chemotherapy is the primary therapeutic choice for advanced gastric cancer. The goal of this study was to assess the effectiveness and toxicity of the cisplatin-capecitabine regimen versus the oxaliplatin-capecitabine regimen in treating advanced gastric cancer. Between February 2021 and March 2022, this quasi-experimental study was conducted on 64 advanced gastric cancer patients. Purposive sampling was used to include those who met the inclusion criteria and distributed them evenly between the two arms. Arm A got an injection of cisplatin (80 mg/m2 on day 1) with oral capecitabine (1000 mg/m2 b.i.d. on days 1–14), whereas arm B received an injection of oxaliplatin (130 mg/m2 on day 1) plus oral capecitabine (1000 mg/m2 b.i.d. on days 1–14), every 3 weeks for 6 cycles. A final check-up was done at 12 weeks after the treatment. In arm A, 18 (56.2%) patients exhibited partial response compared to 15 (46.9%) in arm B. Stable diseases were also reported in both arms (18.8% in arm A and 21.9% in arm B). There were 8 (25.0%) cases of progressive disease in arm A and 10 (31.2%) cases in Arm B. The median progression-free survival in arms A (5.6 months) was almost similar to arm B (5.9 months). The most prevalent toxicities in both arms were vomiting, diarrhea, anemia, neutropenia, oral mucositis, paresthesia, handfoot syndrome, and renal toxicity. There were no statistically significant variations in outcomes between the two arms. In conclusion, the cisplatincapecitabine regimen is as effective as the oxaliplatin-capecitabine regimen in advanced gastric cancer. BSMMU J 2022; 15(3): 180-18

Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial

BACKGROUND: Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. OBJECTIVE: The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. METHODS: A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients' increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. RESULTS: Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients' mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. CONCLUSIONS: It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. TRIAL REGISTRATION: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30191

Perceptions about Telemedicine among Populations with Chronic Diseases amid COVID-19: Data from a Cross-Sectional Survey

Chronic diseases, including non-communicable diseases (NCDs), have arisen as a severe threat to health and socio-economic growth. Telemedicine can provide both the highest level of patient satisfaction and the lowest risk of infection during a pandemic. The factors associated with its usage and patient adherence are not visible in Bangladesh's resource-constrained settings. Therefore, this study aimed to identify perceptions about telemedicine among populations with chronic diseases amid the COVID-19 pandemic. A closed-ended self-reported questionnaire was created, and the questionnaire was written, reviewed, and finalized by a public health investigator, a psychiatrist, and an epidemiologist. The data for this study were collected from individuals using simple random sampling and snowball sampling techniques. Ethics approval was granted, and written/verbal consent was taken before interviews. Most of the participants showed a positive attitude towards telemedicine. People aged 35-54 years old and a higher level of education were less frequently associated with willingness to receive telemedicine services for current chronic disease (WRTCCD) than their counterparts. People living in urban areas and lower-income participants were more strongly associated with WRTCCD. Additionally, people who did not lose their earnings due to the pandemic were less strongly associated with WRTCCD. However, the main strength of this research is that it is a broad exploration of patient interest in several general forms of telehealth. In Bangladesh, there are many opportunities for telemedicine to be integrated into the existing healthcare system, if appropriate training and education are provided for healthcare professionals

Factors Associated with Tobacco Use Among Nepalese Men Aged 15–49 Years: Data from Nepal Demographic and Health Survey 2016

© 2020 INDIACLEN Background: Tobacco is one of the leading causes of premature death around the world. In Nepal, tobacco kills 15,000 people every year. Men are also the primary users of tobacco. This study aimed to discern the prevalence and associated factors of tobacco use among Nepalese men aged 15–49 years. Methods: This was a cross-sectional study. This study used data from the Nepal Demographic and Health Survey 2016. A total of 4059 study participants aged 15–49 years were included in the final analysis. The primary outcome of interest in this study was ‘tobacco use’, which was further categorized into smoked and smokeless tobacco use. Multivariable logistic regression was performed to identify determinants of tobacco use, smoking, and smokeless tobacco use. Results: The prevalence of overall tobacco, smoked tobacco, and smokeless tobacco use were 52.3% (95% CI: 50.0–54.6), 27.3% (95% CI: 24.5–30.3), and 40.2% (95% CI: 38.0–42.4), respectively. The prevalence of tobacco use was significantly higher among the elderly, manual workers, those of lower educational status, those of lower economic status, and residents of Province No. 2. In multivariable logistic regression analysis, older age, poor education, poor economic status, and residence in the Terai region were each found to be significantly associated with tobacco use. Conclusion: As one out of every two Nepalese men is a tobacco consumer, pertinent public health programs need to increase advocacy against tobacco use among the mass population. Tobacco control programs should also target high-risk groups when designing interventions

Comparative outcome of cisplatin-capecitabine regimen with oxaliplatincapecitabine regimen in advanced gastric carcinoma: a quasi-experimental study: Comparative outcome of cisplatin-capecitabine regimen with oxaliplatin-capecitabine regimen in advanced gastric carcinoma

Chemotherapy is the primary therapeutic choice for advanced gastric cancer. The goal of this study was to assess the effectiveness and toxicity of the cisplatin-capecitabine regimen versus the oxaliplatin-capecitabine regimen in treating advanced gastric cancer. Between February 2021 and March 2022, this quasi-experimental study was conducted on 64 advanced gastric cancer patients. Purposive sampling was used to include those who met the inclusion criteria and distributed them evenly between the two arms. Arm A got an injection of cisplatin (80 mg/m2 on day 1) with oral capecitabine (1000 mg/m2 b.i.d. on days 1–14), whereas arm B received an injection of oxaliplatin (130 mg/m2 on day 1) plus oral capecitabine (1000 mg/m2 b.i.d. on days 1–14), every 3 weeks for 6 cycles. A final check-up was done at 12 weeks after the treatment. In arm A, 18 (56.2%) patients exhibited partial response compared to 15 (46.9%) in arm B. Stable diseases were also reported in both arms (18.8% in arm A and 21.9% in arm B). There were 8 (25.0%) cases of progressive disease in arm A and 10 (31.2%) cases in Arm B. The median progression-free survival in arms A (5.6 months) was almost similar to arm B (5.9 months). The most prevalent toxicities in both arms were vomiting, diarrhea, anemia, neutropenia, oral mucositis, paresthesia, handfoot syndrome, and renal toxicity. There were no statistically significant variations in outcomes between the two arms. In conclusion, the cisplatincapecitabine regimen is as effective as the oxaliplatin-capecitabine regimen in advanced gastric cancer. BSMMU J 2022; 15(3): 180-18