International Journal of Cancer Management
Volume:2 Issue: 1, Winter 2009

To review literature on relationship between quality of life data and the length of survival in cancer patients. A literature search was carried out using MEDLINE to assess existing knowledge on relationship between quality of life data as a prognostic factor and survival in cancer patients. The intention was to review all full publications in English language biomedical journals. The search strategy included the combination of keywords ‘cancer’, ‘prognostic’, ‘predictor’, ‘predictive’, ‘quality of life’ and ‘survival’ in titles of publications. The literature was also examined to ensure that the study used multivariate analyses. Pure psychological studies were excluded. The initial search was carried out twice in December 2008 and twice for a final check in early and late January 2009. A manual search also was performed for including possible additional papers. In all 146 citations were identified and reviewed. Of these, 88 citations on relationship between quality of life and survival were found relevant and examined in this rapid and systematic review of the literature. The findings are summarized under different headings including studies on heterogeneous sample of cancer patients, lung cancer, breast cancer, gastro-oesophageal cancers, colorectal cancer and other cancers. Except a few exceptions most studies found that quality of life data or some aspects of quality of life measures were significant independent predictors of survival duration. Global quality of life, functioning domains and symptom scores such as appetite loss, fatigue and pain individually or in combined were the most important factors that predicted the length of survival in cancer patients after adjusting for one or more demographic and known clinical prognostic factors. Studies reported in this review provide evidence for a positive relationship between quality of life data or some aspects of quality of life measures and the length of survival in cancer patients. Pre-treatment quality of life data are appeared to be most reliable information that could help clinicians to establish prognostic criteria for treatment of their cancer patients. Indeed, conducting studies using valid instruments, applying sound methodological approaches and adequate but not sophisticated multivariate statistical analyses adjusted for demographic characteristics and known clinical prognostic factors are recommended in order to yield more specific quality of life related prognostic variables for specific cancers.

Colorectal cancer is a common (5000 new cases per year in Iran) and lethal disease. Regarding the high incidence (7 cases per 100000) and survival rate of colorectal cancer and the priority of prevalence index in cancer management, in this study, 1, 2-3 and 4-5 year point prevalence were determined according to survival data. In this study, survival and incidence data were used for the determination of cancer prevalence. Incidence data were extracted from cancer registry in Iran and survival data were determined during a descriptive study through the follow up of 2342 colorectal cancer patients. 1, 2-3 and 4-5 year point prevalence were estimated from incidence rates in different years and the proportion of patients surviving 0.5, 1.5, 2.5, 3.5 and 4.5 year(s) from diagnosis. Proportion of cases surviving 0.5, 1.5, 2.5, 3.5 and 4.5 year(s) from diagnosis were 79.2%, 65.08%, 57.36%, 51.76% and 48.87%, respectively. Estimates of 1, 2-3 and 4-5 year prevalence were 4156, 5715 and 4283, respectively. The cumulative 5 year prevalence was 13954 cases. These estimates of 1, 2-3 and 4-5 year prevalence are applicable to the evaluation of initial treatment, clinical follow-up and point of cure, respectively. Therefore, 1, 2-3 and 4-5 year point prevalence estimates are necessary in health service planning for cancer management.

Tumour Necrosis Factor α (TNFα) and Lymphotoxin α (LTα) have been implicated in the pathogenesis of lymphoproliferative disorders. Patients with B-cell non-Hodgkin’s lymphoma (NHL) often have high serum levels of TNF which may be associated with a poor outcome. TNFα and LTα polymorphisms are known to influence expression of these cytokines and may explain the variable response to therapy.Patients and In patients with NHL, serum levels of TNFα and LTα were measured. DNA was typed using allele specific PCR and restriction fragment length polymorphism for the –308 TNFα and +252 LTα polymorphisms and comparison was made with clinical outcome. The presence of high producing alleles was significantly associated with high serum levels of TNFα and LTα. The presence of 2 or more high producing alleles was significantly associated with more advanced disease at presentation (stage III and IV), p=0.024, a higher International Prognostic Index (IPI) score, p=0.038, failure to achieve a complete remission (CR) after 1st line therapy (88% vs 33%, p=0.01) and shorter progression free survival (PFS) (median 24 months compared with 78 months, p=0.001). Multivariate analysis confirmed that TNF high-risk haplotype (HRH) was an independent prognostic factor for PFS. These results demonstrate that TNF polymorphisms are independent prognostic factors in NHL. Further study is required to further define the importance of TNF polymorphisms within different lymphoma subtypes and with different therapeutic approaches.

Probable risk factors of clinical anastomotic leakage and the role of defunctioning stoma in patients undergoing low anterior resection (LAR) for rectal cancer, is still controversial. The goal of our study was to find out possible risk factors of anastomotic leakage and to locate the influence of protective stoma in the rate of anastomotic leakage. In this retrospective study, 44 patients underwent LAR with total mesorectal excision (TME) during the period from 2001 to 2006 were analyzed. From these 44 patients 24 were treated with protective stoma while 20 were not. Overall anastomotic leakage rate was similar among patients with and without protective stoma (odds ratio=0.51, P=0.2357). Male gender, Low anastomosis, Coronery Artery Disease, preoperative radiotherapy, and smoking were great risk factors for developing anastomotic leakage. We did not find any differences between handsewn and stapled anastomosis (odds ratio=0.6). protective stoma will be helpful depending on surgeon experiences and is not recommended for all the patients routinely. Beside this, male gender, low anastomosis, coronary artery disease, preoperative radiotherapy, and smoking are the major risk factors of anastomotic leakage.

In the present set of investigations, the anti-mutagenic and anti-cytotoxic effects of aqueous rosemary leaves extract (RE) beside the dose dependency of these effects on male mice bone marrow and germ cells have been evaluated using in vivo cytogenetic, histopathologic and apoptotic assays, as well as biochemical analysis. Doxorubicin (DXR), a well-known mutagen and cytotoxic agent, was given at a single dose of 25 mg/kg b. wt. intraperitoneally at the fifteenth day. 25, 125, 250 and 375 mg/kg b. wt. of RE were given through oral intubation once a day/three days for 15 days prior to DXR administration. The animals of the positive control group (DXR alone) showed significant increase in the mutagenic effect in bone marrow cells, histological damage, incidence of apoptotic cells (TUNEL-positive cells), level of lipid peroxidation and activity of superoxide dismutase in testis. Though, the activities of the other antioxidant enzymes such as glutathione peroxidase, catalase and glutathione reduced form beside the serum level of testosterone and the rate of primary spermatocytes'' transformation to spermatids were significantly declined (P< 0.001). The ratio of dismutase to glutathione peroxidase and/or catalase was significantly elevated. Pretreatment with each dose of RE showed significant reduction in these frequency of chromosomal aberrations and mitotic index of bone marrow cells and the level of peroxidation, the ratio of SOD/ GPX or CAT, the histological damage and the incidence of apoptotic cells in testes. Also, it caused increase in the levels of some antioxidant enzymes (GSH, CAT and GPX), the level of testosterone and returned the semineferous tubular cell populations'' ratio to the control distribution.The protective efficacy of the RE was much pronounced following pretreatment with 125 mg/kg b. wt.

Breast cancer is the most frequent cancer in women in the western world. With breast cancer now affecting one in ten women, it is important to know how this disease burden is shared among women. This study was undertaken to determine the survival rate of breast cancer in southern Iran.Methods and Material: From December 2001 to December 2006, among 8000 hospital-based registered cancer cases in southern Iran, 863 individuals with breast cancer entered our study. One, 5, 10 and 15 year-survival rates were estimated by Kaplan Meier function. Mean age at the time of diagnosis of breast cancer was 46.3 years (SD=11.5). About 25.4% had a previous family history of cancer in their first and 13.8% in their second degree relatives. About 92.5%, 71.3% and 41.4% of breast cancer cases underwent surgery, radiotherapy and chemotherapy, respectively. Nearly 11.7% of patients had a history of exposure to chemical materials. About 32.3% were passive and 19.2% were active smokers. Totally, one, 5, 10 and 15 year-survival rates were 97%, 67%, 45% and 25%, respectively. The survival rate had a significant negative correlation with age at the time of diagnosis. The survival rate of women with breast cancer in southern Iran seems to be identical to other parts of the country and stands between western and eastern European countries.

Due to the increasing number of breast masses and a more precise attention to them, a greater number of patients refer to clinics for biopsy or resection of breast and axillary lymph nodes. An appropriate anesthesia method can decrease hospitalization time, its expenditure and postoperative complications. Paravertebral anesthesia [1] is a simple and feasible method in most cases and can provide a very suitable analgesia for biopsy and operation and postoperative analgesia. Paravertebral block was used for analgesia for 15 women having breast masses who were candidates for biopsy and pathology examination by frozen section. Biopsy was performed only by a single paravertebral injection (we did not insert catheter for continuos analgesia) with sedation. The patients'' satisfaction and analgesia were evaluated postoperatively. First pain complaint and burning which demanded opioid prescription was considered at the end of analgesia of the block. The patients were evaluated for analgesia for 24 hours. Paravertebral block provides an appropriate analgesia for breast surgery, and with good technical performance it offers a high rate of success. Average duration of analgesia was 17 hours and the patients did not need opioid in this period; 60% of the patients (9 people) were discharged at the same day of the surgery in the afternoon. Those patients requiring mastectomy following the biopsy were anesthetized with tracheal intubation and atracurium muscle relaxant, and no opioid drug was used in their surgery. All the patients (15people) expressed their satisfaction with paravertebral block. Breast surgeries with paravertebral block were performed with a high rate of analgesia and patients'' consent, a good reduction in patients’ expenditure and much lower incidence of complications and early ambulation of patients. Other regional methods like thoracic epidural block, intercostals block and local infiltrations are also used for these surgeries. However, as the duration of surgeries differs from one another, a safe and comprehensive method is important, and paravertebral block has these characteristics.

Primary cardiac lymphoma is extremely rare.Case report: In this care report, we present the case of a 46-year-old man with primary cardiac lymphoma involving left atrium and interatrial septum, presenting as dyspnea palpitation and irregular heart beat. The diagnosis was obtained by transthoracic echocardiography and surgical biopsy with subxiphoid approach which revealed diffuse large B-cell non-Hodgkin''s lymphoma, CD 20+. After 8 courses of chemotherapy, the patient achieved complete remission. After 4 months, however, he developed exertional dyspnea. Right atrial recurrent lymphoma extension was diagnosed. He is currently under external radiotherapy treatment. patients with primary cardiac lymphoma have a very poor prognosis.