Pattern of breast cancer presentation during the coronavirus disease pandemic: results from a cohort study in the UK

Background: This study aimed to explore the hypothesis that the stage of breast cancer at initial diagnosis in 2020 is more advanced compared with 2019. Methods: Tumor, node, metastasis and Union for International Cancer Control (UICC) stages of new breast cancer diagnoses at the Bucks Breast Unit from May to October 2019 and 2020 were reviewed. A p < 0.05 was considered significant. Results: Average UICC stage increased from 1a in 2019 to 2a in 2020 (p < 0.01). Excluding cancers detected through screening, UICC stage still increased from 1b in 2019 to 2a in 2020 (p = 0.0184). There was a significant increase in the percentage of node-positive patients (p = 0.0063) and patients with metastatic disease (p = 0.0295) on initial presentation. Conclusion: Overall, patients presented with higher UICC stages and more node-positive and metastatic disease on initial diagnosis in 2020 compared with 2019.

Overview of Cancer Control in Armenia and Policy Implications

Cancer is the second leading cause of death in Armenia. Over the past two decades, the country has seen a significant rise in cancer morbidity and mortality. This review aims to provide up-to-date info about the state of cancer control in Armenia and identify priority areas of research. The paper analyzes published literature and local and international statistical reports on Armenia and similar countries to put numbers into context. While cancer detection, diagnosis, and treatment are improving, the prevalence of risk factors is still quite high and smoking is widespread. Early detection rates are low and several important screening programs are absent. Diagnosis and treatment methods are not standardized; there is a lack of treatment accessibility due to insufficient government coverage and limited availability of essential medicines. Overall, there is room for improvement in this sector, as research is limited and multidisciplinary approaches to the topic are rare.

Perceptions of cervical cancer care among Ethiopian women and their providers: a qualitative study

Background Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country’s first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical. Methods This qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women’s and providers’ perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data. Results Providers lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking. Conclusions In-service provider training should be intensified and should include discussions of cervical cancer symptoms. Better distribution of screening and diagnostic supplies to lower-level facilities and better maintenance of treatment equipment at tertiary facilities are also a priority. Expanded cervical cancer health education should focus on stigma reduction and emphasize a broad, wide-spread risk of cervical cancer.

Prognostic Value and Risk Factors of Treatment-Related Lymphopenia in Malignant Glioma Patients Treated With Chemoradiotherapy: A Systematic Review and Meta-Analysis

Background: Immunotherapy has shown promising therapeutic efficacy in various cancers but not gliomas. Circulating lymphocytes play critical roles in cancer control and responses to immune checkpoint inhibitors. Treatment-related lymphopenia has been associated with poor survival in patients with various tumors. This meta-analysis evaluated the risk and impact of lymphopenia in patients with glioma.Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases were comprehensively searched. Eligible studies were included if they reported the incidence and risk factors of lymphopenia and the impact of lymphopenia on survival. Stata 16.0 was used for this meta-analysis.Results: A total of 21 studies were included in the final systematic review and 20 were included in the quantitative analysis. The overall incidence of grade III/IV lymphopenia was 31.6% [95% confidence interval (CI), 22.3–40.8%]. Pooled results based on pathology of glioma revealed that the incidence in astrocytoma and astrocytoma oligodendroglioma patients was 20.2% (95% CI:5.9–34.4%), and the incidence in glioblastoma patients was 27.6% (95% CI:16.2–38.9%). Lymphopenia was associated with poor overall survival (hazard ratio, 1.99; 95% CI, 1.74–2.27; P&lt; 0.001) compared to no lymphopenia. Brain receiving radiation dose of 20 or 25 Gy, female sex, older age, lower baseline lymphocyte count, and dexamethasone dose &gt; 2 mg instead of baseline use were risk factors for lymphopenia.Conclusions: Treatment-related lymphopenia was associated with decreased survival in patients with glioma. Optimization of chemoradiation regimens, particularly in patients with concurrent risk factors, can reduce lymphopenia and potentially improve survival in the era of immunotherapy.

Cancer Scenario in Kashmir—A Study Conducted in a Tertiary Care Center, Srinagar, Kashmir, India

Background Cancer can have profound social and economic consequences for the people in India, often leading to family impoverishment and societal inequity. Reported age-adjusted incidence rates for cancer are still quite low in the demographically young country. Slightly more than 1 million new cases of cancer are diagnosed every year in a population of 1.2 billion. It accounts for about 23 and 7% deaths in United States and India, respectively. The world's population is expected to be 7.5 billion by 2020 and approximations predict that about 15.0 million new cancer cases will be diagnosed, with deaths of about 12.0 million cancer patients. Early detection of cancers is a challenging task because clinical symptoms develop slowly. Objective The aim of the present study was to analyze the cancer scenario in the Kashmir valley. Materials and Methods This was a retrospective study. So, all patients were included who had histopathologically confirmed neoplasm registered at Regional Cancer Centre of Government Medical College Srinagar, Kashmir between 2015 and 2018. All the patient characteristics including age, sex, and anatomical site of the disease were studied in detail. Results The number of cancer patients in 2015, 2016, 2017, and 2018 were 230, 239, 391, and 511, respectively, with a combined total of 1,371. Thus, it is clear from these figures that the number of cancer cases has increased gradually with time. Stomach cancer is the most common cancer in the Kashmir territory. In males the most common cancer is stomach cancer with 175 (12.8%) reported cases and in females the most common cancer is breast cancer with 151 (11%) reported cases. The male to female ratio was 1.4:1. Conclusion A careful reading the reported cancer cases indicates an increased number of cancer patients every year in Indian-occupied Kashmir. Kashmir is a growing state in India playing a crucial role in the development of India and, hence, it needs special attention on this issue. A multidisciplinary approach to cancer treatment is essential and this has to be made available at all regional cancer centers. Cancer control is an area in which we need participation from all sectors of the society.

A Promising Treatment Strategy for Lung Cancer: A Combination of Radiotherapy and Immunotherapy

Lung cancer is a leading cause of cancer-related deaths worldwide despite advances in treatment. In the past few decades, radiotherapy has achieved outstanding technical advances and is being widely used as a definitive, prophylactic, or palliative treatment of patients with lung cancer. The anti-tumor effects of radiotherapy are considered to result in DNA damage in cancer cells. Moreover, recent evidence has demonstrated another advantage of radiotherapy: the induction of anti-tumor immune responses, which play an essential role in cancer control. In contrast, radiotherapy induces an immunosuppressive response. These conflicting reactions after radiotherapy suggest that maximizing immune response to radiotherapy by combining immunotherapy has potential to achieve more effective anti-tumor response than using each alone. Immune checkpoint molecules, such as cytotoxic T-lymphocyte-associated protein 4, programmed cell death-1/programmed death-ligand 1, and their inhibitors, have attracted significant attention for overcoming the immunosuppressive conditions in patients with cancer. Therefore, the combination of immune checkpoint inhibitors and radiotherapy is promising. Emerging preclinical and clinical studies have demonstrated the rationale for these combination strategies. In this review, we outlined evidence suggesting that combination of radiotherapy, including particle therapy using protons and carbon ions, with immunotherapy in lung cancer treatment could be a promising treatment strategy.

Analysis of novel antineoplastic drugs treatment impact on the federal project «cancer control» goals achievement

The Federal project “Cancer Control” was launched in 2019. Its main objective is to reduce mortality from malignant neoplasms in Russia. The main goal of this research is to develop a methodology for assessment of innovative drugs treatment impact on reducing mortality from neoplasms (including malignant) and testing it in the case of some novel drugs. Materials and methods. Firstly, we assessed the number of patients, who annually can start a novel drug treatment. Afterwards we estimated the number of deaths, which could be avoided due to the efficacy differences between innovative drugs compared to the standard of care in terms of overall survival. Obtained results were than correlated to the reduction in malignant mortality ratio needed to achieve annually (comparing to the basis 2020). For the approbation of the model, we chose durvalumab, osimertinib and olaparib, which are indicated for lung and ovarian cancer treatment. Results. Annually 6 746 patients can start the treatment: 2 391 with durvalumab, 2 334 with osimertinib, 2 021 with olaparib. In the 2021-2023 frame durvalumab treatment can help to avoid 779 deaths, osimertinib treatment can help to avoid 723 deaths, olaparib treatment can help to avoid 679 deaths (totally 10,8% of reduction in deaths needed to achieve 2021-2023 goals). Conclusion. Novel antineoplastic drugs treatment leads to a quantifiable reduction in mortality from malignant neoplasms in Russia.