Individual prostate cancer screening: Practice survey with general practitioner of Lubumbashi, Democratic Republic of Congo

Objective: To analyze the practices of general practitioners (GPs) in terms of recommendations on individual screening for prostate cancer (PCa). Methods: An anonymous cross-sectional survey using a pre-established questionnaire was conducted among 193 GPs in the city of Lubumbashi from May 1st to July 31st, 2020. The questionnaire included three parts: identity criteria of GPs, screening practice and the opinion of GPs on the recommendations. Results: The participation rate was 79%. Eighty-two-point nine percent of respondents said they offered screening for PCa; 42.5% of them said they offered this screening to all men within a certain age limit, ranging between 50 to 75 years in 38.8% of the cases. Only 12.5% of GPs provided complete prior information to their patients. Thirty-six-point three percent of GPs reported combining digital rectal examination with total PSA testing, but in the presence of an abnormality, 60.6% reported that they referred their patients directly to the urologist without ordering other additional investigations (first or second line). Finally, 32.7% of GPs found that the recommendations disseminated were appropriate for their practice. Conclusion: Individual screening for PCa is widely proposed; but there are differences between the practices reported by GPs and official recommendations of learned societies. Our study highlights the need to popularize the recommendations of learned societies to GPs.

DNA bioelectric field: a futuristic bioelectric marker of cancer, aging and death – A working hypothesis

Telomeres are associated with the ends of DNA double strands. The lengths of the telomeres are controlled by the telomerase enzyme. The shortening of the telomeres is known to relate to aging. In cancers, telomere lengths are abnormally short. Telomeres could act as buffers shielding the part of DNA coding for the proteins. For cancer cells, germ cells and stem cells the length of the telomeres is not varying. There is an analogy with microtubules, which are highly dynamical and carry a longitudinal electric field, whose strength correlates with the microtubule length. Could sticky ends generate a longitudinal field along DNA double strand with strength determined by the lengths of the sticky ends? In the standard picture the flux of the longitudinal electric field would be proportional to the difference of the negative charges associated with the sticky ends. In TGD framework, DNA strands are accompanied by the dark analog of DNA with codons realized as 3-proton units at magnetic flux tubes parallel to DNA strands and neutralizing the negative charge of ordinary DNA except at the sticky ends. This allows considering the possibility that opposite sticky ends carry opposite charges generating a longitudinal electric field along the magnetic flux tube associated with the system. DNA/Telomere bioelectric field could serve as a novel bioelectric marker to be used for prognostic and diagnostic purposes in researches of cancer, aging, surgery grafts and rejuvenation. We propsed that DNA bioelectric field can be used as a futuristic bioelectric marker of cancer, aging and death.

Financial assistance programs for cancer patients

Background： The high costs of oncology care can lead to financial stress and have deleterious effects on the well-being of patients and their families. However, only a handful of financial assistance programs for cancer patients have been implemented and evaluated to date. Recent findings： Key features of reported programs include instrumental support through financial navigation or education for patients, and financial or charitable support for healthcare costs. Only one of the programs successfully reduced actual out-of-pocket costs for patients, though others were associated with psychosocial benefits or increased knowledge of financial resources. Four of the 5 programs evaluated to date were pilot studies with small sample sizes, and most lack control groups for comparison. Conclusions. Additional studies are needed that include larger sample sizes and with comparison groups of cancer patients in order to determine whether the counseling and navigator programs are effective in addressing financial distress in this patient population. Of particular interest are programs designed for low-income patients and those who lack health care insurance. Financial assistance programs that implement solutions at different levels of the healthcare system (individual patients, providers, healthcare institutions) are more likely to be effective. Multi-level interventions are needed that address the systems in which patients access care, the actual costs of services and drugs, and the individual needs of patients in order to reduce financial hardship for cancer patients.

Problems in living among breast cancer survivors

Purpose: Breast cancer survivors may experience worse social, physical, and emotional function compared to the general population, although symptoms often improve over time. Data on problems in living can help to improve interventions and supportive care for breast cancer survivors. Symptoms such as fatigue, pain, difficulties with sleep, and sexual problems may have an adverse effect on the quality of life of breast cancer survivors. Methods: We examined problems in living using data from a survey of 164 breast cancer survivors who had completed primary therapy for the disease. Results: A total of 164 women completed the study questions (response rate 16.4%). The mean age of the women was 67 years. Among all participants, 66.7% were white, 29.5% were African-American, and the remainder were of other races. Almost all of the symptoms were more likely to be reported by participants who were < 55 years of age. Other important correlates of symptoms included non-white race, marital status, and having a household income of less than $50,000 per year. Conclusion: The results of this study highlight the need for caregivers to emphasize screening for and discussion of symptoms, including sleep difficulties, fatigue, loss of strength, aches and pains, and muscle or joint stiffness. Of particular concern are younger survivors and those who are African American or low-income.

Predictors of prostate cancer screening among African American men treated at an Academic Medical Center in the Southern United States

Background: The controversy surrounding prostate cancer screening, coupled with the high rates of incidence and mortality among African American men, increase the importance of African American men engaging in an informed decision-making process around prostate cancer screening. Purpose: To examine predictors of prostate cancer screening via the prostatespecific antigen (PSA) test. Secondary objectives were to examine whether African American men have been screened for prostate cancer; their confidence in making an informed choice about whether PSA testing is right for them; and whether they have talked with their provider about PSA testing and engaged in an informed decision-making process around prostate cancer screening. Methods: We conducted a study among a sample of African American men patients ages > 40 years. Results: A total of 65 men completed the questionnaire (response rate = 6.5%). The mean age of the men was 64.4 years. Most of the participants (90.8%) reported a regular healthcare provider and that their provider had discussed the PSA test with them (81.3%). About 84.1% of the men ever had a PSA test, but only 38.0% had one in the past year. Most of the men reported that they make the final decision about whether to have a PSA test on their own (36.5%) or after seriously considering their doctor’s opinion (28.6%). About 31.8% of the men reported that they share responsibility about whether to have a PSA test with their doctor. About half of the participants (49.2%) reported that they have made a decision about whether to have a PSA test and they are not likely to change their mind. The majority of the men (75%) perceived their risk of prostate cancer to be about the same level of risk as other men who were their age. The men’s knowledge of prostate cancer was fair to good (mean prostate cancer knowledge scale = 10.37, SD 1.87). Knowledge of prostate cancer was positively associated with receipt of a PSA test (p < 0.0206). Discussion: The modest overall prostate cancer knowledge among these participants, including their risk for prostate cancer, indicates a need for prostate cancer educational interventions in this patient population.

Cigarette smoking after surviving breast cancer: A pilot study

Background: Quitting smoking improves cancer survival and improves symptoms of cancer and its treatment. Cancer diagnosis presents a powerful motivation for leading a healthier lifestyle and embracing behavioral changes, such as quitting smoking. Many smokers quit after a cancer diagnosis, but some survivors continue to smoke. This study examined the characteristics associated with being a former rather than a current smoker among women treated for breast cancer. Methods: In this pilot, cross-sectional study, data were collected via postal surveys in women who had a history of smoking and breast cancer (N = 69). Descriptive and logistic regression analyses were conducted to identify factors associated with smoking status. Results: Of this sample, 13 were current smokers and 56 were former smokers. Age, race, education, and employment status were not associated with smoking status. Women with a higher income were significantly more likely to have successfully quit smoking (former smoking OR = 5.94, p < 0.05). Most women were light smokers and reported intentions to quit. Conclusion: The study attests to the addictive nature of smoking and the difficulty in achieving successful quitting even after breast cancer diagnosis. Results highlighted the role of low income as a barrier in smoking cessation. A follow up study is warranted to uncover potential barriers to smoking cessation in order to individualize tobacco treatment to meet the needs of motivated light smoking cancer patients. Intensive innovative tobacco treatment approaches are warranted, to reach successful cessation particularly among cancer patients with lower income.

Day 21 serum Free Light Chain (FLC) levels as a predictor of response to therapy in symptomatic multiple myeloma

Introduction: Serum Free Light Chain (sFLC) assay has a major role in the screening, diagnosis and monitoring in patients with Multiple Myeloma (MM). Measuring involved Free Light Chain (iFLC) has a proven advantage due to the short half-life compared to that of M-protein, thus useful as a prognostic tool for the assessment of response to therapy. It is established that achieving VGPR (very good partial response) or better after induction chemotherapy is associated with better OS (overall survival) and PFS (progression free survival) in myeloma patients. Few studies have shown that early reduction in iFLC during treatment is associated with achievement of VGPR or better. Objective: To study the predictive value of reduction of involved free light chain level on Day 21 of chemotherapy for achievement of VGPR after 4 cycles of induction chemotherapy. Methods: We conducted a prospective observational study in twenty eight patients of newly diagnosed Multiple Myeloma with iFLC ≥ 100mg/L. Serum FLC assay was done at baseline and on day 21 of therapy. All patients were followed up till the end of induction therapy for response assessment based on the IMWG criteria. Receiver Operator Characteristic (ROC) curve analysis was done to determine the cut off value of percent reduction in day 21 iFLC for achievement of VGPR or better. Results: After the induction chemotherapy, out of 28 patients, 13 patients achieved CR, 8 patients achieved VGPR, 4 patients achieved PR and 2 patients had stable disease (≥ VGPR = 21 patients, < VGPR = 6 patients). One patient expired after 2nd cycle of chemotherapy. The mean per cent reduction in day 21 iFLC level as compared to baseline was 91.5% and 57.1% in patients achieving ≥ VGPR and < VGPR (P < 0.0001), respectively. No other baseline parameter was found to be significantly different between the 2 groups. ROC curve analysis demonstrated a cut off of 84% reduction in iFLC value on day 21 (AUC of 0.937) had a sensitivity of 85.7% and a specificity of 100% in predicting the achievement of VGPR after four cycles of induction chemotherapy. Conclusion: Monitoring iFLC levels on Day 21 can be used as an important tool for early identification of responders/non responders to myeloma therapy. We recommend serum FLC assay to be done on day 21 as a real time assessment of treatment response in newly diagnosed myeloma patients. Key words- Multiple Myeloma, involved Free Light Chain (iFLC), Very Good Partial Response (VGPR)

HIF and COX-2 expression in triple negative breast cancer cells with hypoxia and 5-fluorouracil

Our purpose was to understand the effects of normoxia or hypoxia on 5-fluorouracil (5-FU) treatment in triple negative breast cancer (TNBC) cells, and characterize the molecular changes in hypoxia inducible factors (HIFs) and cyclooxygenase-2 (COX-2) following treatment. Cell viability and protein levels of HIFs and COX-2 were determined after wild type and HIF silenced MDA-MB-231 cells, and wild type SUM-149 cells, were treated with 5-FU under normoxia or hypoxia. 5-FU reduced cell viability to the same levels irrespective of normoxia or hypoxia. HIF silenced MDA-MB-231 cells showed comparable changes in cell viability, supporting observations that hypoxia and the HIF pathways did not significantly influence cell viability reduction by 5-FU. Our data suggest that HIF-2aaccumulation may predispose cancer cells to cell death under hypoxia. SUM-149 cells that have higher COX-2 and HIF-2afollowing 24 h of hypoxia, were more sensitive to 96 h of hypoxia compared to MDA-MB-231 cells, and were more sensitive to 5-FU than MDA-MB-231 cells. COX-2 levels changed with hypoxia and with 5-FU treatment but patterns were different between the two cell lines. At 96 h, COX-2 increased in both untreated and 5-FU treated cells under hypoxia in MDA-MB-231 cells. In SUM-149 cells, only treatment with 5-FU increased COX-2 at 96 h of hypoxia. Cells that survive hypoxia and 5-FU treatment may exhibit a more aggressive phenotype. Our results support understanding interactions between HIF and COX-2 with chemotherapeutic agents under normoxia and hypoxia, and investigating the use of COX-2 inhibitors in these settings.