Pictorial warning labels in Jordan: are we maximizing the benefit for smokers?

Background Pictorial warning labels (PWLs) motivate smokers to quit and support continued abstinence. In Jordan, where 70% of adult males smoke, mass media campaigns are non-existent making PWLs of additional importance in communicating the benefits of quitting and prompting quit attempts. Methods We conducted an evaluation of the PWLs used in Jordan after having them in circulation for 2.5 years. We surveyed a cross-sectional convenience sample of smokers aged 17-26 years (n=309). Respondents were asked about: previous quit attempts, beliefs in the need for PWLs and for more information within PWLs, frequency of noticing PWLs and recall of PWL messages, and considering quitting in response to PWLs. Finally, they were prompted with individual PWLs, and requested to rate each on its ability to evoke fear, add information, and motivate quitting. Results Results indicate that: - 49% (150/309) of the respondents have had a failed quit attempt in the 12 months preceding the survey - 48% (149/309) of the respondents believe there is a need for PWLs, among which 54% (81/149) believe that PWLs should provide more information - 63% (195/309) of the respondents noticed PWLs frequently in the month preceding the survey, among which 86% (168/195) correctly recalled at least one PWL message - 36% (71/195) of those reporting frequent notice of PWLs also report considering quitting in response to PWLs Respondents' rating of the individual PWLs is depicted in Figure 1. [Figure 1] Conclusions In Jordan, smokers seem to believe PWLs are necessary and seem to be affected by them to the extent of considering quitting. Yet, given the rate of failed quit attempts, and in light of the request for more information in PWLs, authorities in Jordan should consider supplementing PWLs with content to support self-efficacy to quit, such as including information on the available cessation services and behavioral tips for unaided quitting

Informing tobacco control policy in Jordan: assessing the effectiveness of pictorial warning labels on cigarette packs

Abstract Background Pictorial warning labels (PWLs) deter initiation and motivate quitting. Assessing PWLs is important to track effectiveness and wear out. Jordan introduced an updated set of PWLs in 2013. This study assessed the effectiveness of the set after 2.5 years on the market. Methods We administered a survey in a cross-sectional sample of young adults aged 17–26 years. For convenience, respondents were recruited on university campuses. For heterogeneity, respondents were solicited from the different schools in four geographically diverse university campuses. The study compared perceptions of effectiveness surveyed in 2015 to perceptions gauged in 2010 during a pre-launch evaluation exercise. Outcomes of interest were: salience, fear evocation, adding information, and ability to motivate quitting smoking (for smokers) or deterring starting (for non-smokers). Results Results indicate awareness of the set among smokers and non-smokers, and their recall of at least one PWL message. Results also indicate effectiveness of the set: (1) 1/3 smokers who frequently saw them reported PWLs to trigger considering quitting, (2) and among both smokers and non-smokers the set in 2015 sustained ability to motivate quitting and staying smoke-free. However, results uncover erosion of salience, suggesting that the set has reached its end of life. Finally, results reveal variability in performance among PWLs; the one PWL that depicts human suffering significantly outperformed the others, and its ability to motivate was most strongly associated with its ability to evoke fear. Conclusion Based on the early signs of wear-out (i.e. erosion of salience), and understanding the importance of sustaining upstream outcomes (especially fear evocation) to sustain motivation, we recommend retiring this set of PWLs and replacing it with a stronger set in line with proven standards

Additional file 1: of Informing tobacco control policy in Jordan: assessing the effectiveness of pictorial warning labels on cigarette packs

English translation of survey instrument. An English translation of the survey instrument used to collect data. (PDF 41 kb

Uniportal video-assisted versus open pneumonectomy: a propensity score-matched comparative analysis with short-term outcomes

Objectives Uniportal (U-VATS) pneumonectomy in lung cancer patients remains disputed in terms of oncological outcomes, and has not been compared to open approaches previously. We evaluated U-VATS versus open pneumonectomy at a high-volume centre. Methods Patients undergoing pneumonectomy for lung cancer between 2014 and 2018 were retrospectively reviewed and divided into two groups based on surgical approach. Propensity-score matching was performed (1:1), and intention-to-treat analysis applied. Overall survival, operative time, intraoperative blood loss, hospital-stay and readmission, pain, time to adjuvant therapy, morbidity and mortality were tested. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc. NC) Results 341 patients underwent pneumonectomy; 23 patients with small-cell lung cancer were excluded, thus 318 patients were submitted to surgery by either U-VATS (n = 54) or open (n = 264). After matching, 52 patients were selected from each group. Five patients (9.2%) in the uniportal group required conversion. There was no significant difference in intraoperative outcomes, complication rates, readmission rates or mortality. The U-VATS group experienced significantly shorter hospital stay (mean +/- SD; 6.7 +/- 2.7 vs 9.1 +/- 2.3 days, p < 0.001) and reported less pain postoperatively (p < 0.0001). Adjuvant chemotherapy was initiated sooner after U-VATS (38.1 +/- 8.4 vs 50.8 +/- 11.5 days, p < 0.0001). Overall survival appeared to be superior in U-VATS when pathology stage was aligned (p = 0.001). Conclusions Uniportal VATS is a safe and effective alternative approach to open surgery for pneumonectomy in lung cancer. Complications and oncologic outcomes were comparatively similar. U-VATS showed lower postoperative pain, shorter hospital stay and superior overall survival. The study is a preliminary analysis

Pulmonary metastasectomy in colorectal cancer patients with previously resected liver metastasis: pooled analysis

Data addressing the outcomes and patterns of recurrence after pulmonary metastasectomy (PM) in patients with colorectal cancer (CRC) and previously resected liver metastasis are limited

Thromboembolic events in cancer patients on active treatment with cisplatin-based chemotherapy: another look!

Abstract Background The risk of thromboembolic events is higher among cancer patients, especially in patients undergoing chemotherapy. Cisplatin-based regimens claim to be associated with a very high thromboembolic rate. In this study, we report on our own experience with thrombosis among patients on active cisplatin-based chemotherapy. Methods Medical records and hospital databases were searched for all the patients treated with any cisplatin-based regimen for any kind of cancer. Thrombosis was considered cisplatin-related if diagnosed any time after the first dose and up to 4 weeks after the last. The Khorana risk assessment model was performed in all cases. Results A total of 1677 patients (65.5% males, median age: 50 years) treated with cisplatin-based regimens were identified. Head and neck (22.9%), lung (22.2%), lymphoma and gastric (11.4% each) were the most common primary tumors. Thromboembolic events were reported in 110 (6.6%); the highest was in patients with gastric cancer (20.9%) and the lowest in patients with head and neck cancers (2.3%) and lymphoma (1.6%). Thrombosis included deep vein thrombosis (DVT) in 69 (62.7%), pulmonary embolism (PE) in 18 (16.9%) and arterial thrombosis in 17 (15.6%). A majority (51.1%) of the patients had stage IV disease and only 16% had stage I or II. In a multivariate analysis, significantly higher rates of thrombosis were associated with gastric as the primary tumor, advanced-stage disease, female sex but not age, and the Khorana risk score or type of cisplatin regimen. While the presence of CVC was significantly associated with the risk of thrombosis (p < 0.0001) in the univariate analysis, and such significance was lost in the multivariate analysis (odds ratio, 1.098; 95%CI, 0.603–1.999, p = 0.7599). Conclusions Thromboembolic events in cancer patients on active cisplatin-based chemotherapy were commonly encountered. Gastric cancer, regardless of other clinical variables, was associated with the highest risk

Supportive Care Needs Assessment for Cancer Survivors at a Comprehensive Cancer Center in the Middle East: Mending the Gap

Background: Cancer survivors are often underprepared for what to expect post-treatment, and there are knowledge gaps regarding cancer survivors’ supportive care needs in Jordan and neighboring Arab countries. This study aimed to identify gaps in supportive care needs among adult cancer survivors seen at King Hussein Cancer Center in Amman, Jordan, and explore predictors of unmet needs. Methods: This was an observational cross-sectional study using a modified version of the Supportive Care Needs Survey 34 item short form (SCNS-SF34). Results: Two hundred and forty adult cancer survivors completed the study questionnaire. The assessed needs were highest in the financial domain, including covering living expenses, managing cancer treatment adverse effects and co-morbidities. The least prevalent reported needs were in sexuality and reproductive consultations. Late-stage diagnosis was independently associated with higher physical, psychological, health system/information, financial and overall need scores, with p-values of 0.032, 0.027, 0.052, 0.002 and 0.024, respectively. The overall quality of life score was independently and inversely associated with physical, psychological, health system/information, financial and overall need domains, with p-values of 0.015, \u3c0.0001, 0.015, 0.004 and 0.0003, respectively. Conclusions: This needs assessment identified problem areas for targeting interventions across the Jordanian cancer survivor population, and understanding these findings highlights opportunities for intervention to address gaps in care

Validation of the Arabic Version of the Edmonton Symptom Assessment System

Quality cancer care is a team effort. In addition, patients&rsquo; symptoms change over the course of treatment. As such, the Edmonton Symptom Assessment System (ESAS) is a simple tool designed to quickly monitor symptom change. Here, we present the results from a two-phase study aimed at validating the Arabic version of the ESAS (ESAS-A). Phase one involved the creation of two versions of the ESAS with both reverse and forward translations by bilingual, native Arabic speakers as well as evaluation by an expert panel. The reconciled version was then administered to 20 patients as a pilot from which to create the final version, which was then used with 244 patients. Phase two for the ESAS&mdash;involved an ESAS-based validation of 244 adults aged 18 years and older who were diagnosed with advanced cancer; then, further validation was completed in conjunction with two other symptom survey tools, the EORTC-Pal 15 and the HADS. The ESAS-A items possessed good internal consistency with an average Cronbach&rsquo;s alpha of 0.84, ranging from 0.82 to 0.85. Moreover, the results of ESAS-A showed good agreement with those of EORTC QLQ- 15 PAL (r = 0.36 to 0.69) and HADS (r = 0.60 and 0.57) regarding anxiety and depression. We found the ESAS-A to be responsive to symptom change and a median time to completion of 3.73 min. The results of our study demonstrate that the ESAS-A is a reliable, valid, and feasible tool for the purposes of monitoring symptom change over the course of cancer treatment