Kuwait Cancer Research Articles

Clinicopathological Pattern of Nonmelanoma Skin Cancer in Kuwait: A Retrospective Study

Objective: One in every three diagnosed malignancies is skin cancer, making it the most prevalent type of cancer in the world. As skin cancer is not commonly reported in Kuwait, this study was conducted to analyze the clinicopathological characteristics of nonmelanoma skin cancers (NMSC), primarily basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), during the last 13 years in a tertiary dermatology center in Kuwait. Materials and Methods: Data were searched for patients with NMSC, primarily BCC and SCC, from 2010 to 2022. A retrospective review was conducted and descriptive data analysis was performed. Results: Of 7,645 cases, a total of 146 patients had NMSC. The patient’s average age was 64.9 years. 123 cases (84.2%) had BCC, whereas 23 (15.8%) had SCC. Most of the tumors were seen on the face (35.6%), scalp (20.8%), and nose (17.8%), followed by the back (6.2%), trunk (5.5%), and ear (5.5%). Well-differentiated Cutaneous SCCs were detected in 82.6% of cases. Ulceration was observed in (21.9%) of tumors. The nodular BCC subtype was observed in 50.4% of patients. Conclusion: BCC is the most common type of NMSC detected in Kuwait, with the scalp and face being the most common sites of involvement. Any suspicious lesions should be biopsied to rule out skin malignancy.

Comparing the Quality of Life of Caregivers for Patients with Hematologic and Solid Malignancies in Kuwait: A Cross-Sectional Study

Cancer incidence is escalating globally, and the Middle East, including Kuwait, is no exception. This study delves into a comparative analysis of the Quality of Life (QOL) experienced by caregivers for patients with hematologic and solid malignancies in Kuwait. The prevalence of cancer in Kuwait is rising, becoming the second leading cause of death after cardiovascular diseases. Colorectal and breast cancer are predominant forms, with an increased occurrence in females. Notably, haematological malignancies, rooted partly in consanguineous marriages, exhibit a distinct prevalence pattern, accounting for a significant proportion of deaths. Kuwait has made substantial investments in bone marrow transplantation programs to address this issue. To understand the impact of caregiving on the QOL of individuals supporting cancer patients, a cross-sectional study was conducted. Caregivers were recruited from the Kuwait Cancer Control Centre outpatient clinics between February 25 and March 25, 2020. Caregivers’ QOL was assessed using the Caregiver Quality of Life Cancer Index (CQoLC) through face-to-face interviews. The study aimed to determine if caregivers were adequately informed before their patients’ discharge and analyse reasons for non-participation. Previous research on caregiver QOL has predominantly focused on Western societies, while this study addresses the Kuwaiti context. The expectation is that findings will contrast with Western studies due to unique cultural and societal dynamics, where women play a pivotal role in caregiving. While males may experience reduced QOL due to work-home time constraints, female caregivers in Arab countries tend to be efficient, albeit with potential skill deficiencies. The study enrolled 117 caregivers, with 65 supporting patients with solid malignancies and 52 caring for hematologic malignancy patients. The demographic characteristics of caregivers were analysed, revealing trends related to age, gender, marital status, employment, education, and living arrangements. Caregivers of solid malignancy patients displayed higher levels of burden compared to hematologic malignancy caregivers, with emotional strain, worry, and sadness being significant factors. While there was a notable refusal rate among potential participants, the study’s insights are valuable. To enhance the QOL of caregivers, especially those supporting outpatient cases, targeted interventions such as palliative care and training programs are crucial. The economic burden on caregivers necessitates policies addressing financial support. The findings of this study contribute to the ongoing efforts to improve the QOL of caregivers in Kuwait, thereby alleviating the multifaceted challenges posed by cancer and its care. This research underscores the importance of tailoring interventions to the specific cultural, social, and economic context of Kuwait to optimize caregiver well-being and patient outcomes.

AML-419 Molecular Aberrations in Acute Myeloid Leukemia (AML) and Myelodysplastic Syndrome With Excess Blast II (MDS-EB II) in Kuwait

AML is a heterogeneous disease. Different mutational profiles have been described and correlate with variable outcomes. Genetic abnormalities are not well-described in our region. Our aim is to describe the molecular aberrations observed in the first cohort of patients. We recently introduced DNA based Oncomine Myeloid Gene Panel, testing 55 genes. We collected clinical, cytogenetic and molecular data prospectively since we introduced the test in late 2020. We also reviewed medical charts to collect baseline clinical data. We included patients aged 16 yrs and above with AML or MDS-EB II treated at Kuwait Cancer Center. Fifty-seven patients were included in the study with median age of 51 yrs. Almost one third of the patients were Kuwaitis (36%). We have 53 patients with AML (92%), 3 patients with MDS-EB II (5%), and 1 patient with chronic myeloid leukemia in myeloid blast crisis (CML-MBC). Most of the patients had at least one mutation (91%) detected by the panel. The most common mutations were FLT3 (ITD & D835), detected 26.3%, followed by NPM-1, detected in 21%. We have noticed an increased PTPN11 mutation, detected in 17.5% of the cases. This is an important study showing extensive molecular abnormalities in AML patients in the region. This will facilitate more understanding of the disease biology.

Trends in Childhood Cancer in Kuwait: Data From the 2004-2017 Registry.

Background and objectiveThere is a lack of updated data regarding pediatric cancer in Kuwait, with no separate childhood cancer registry available in the country prior to this study. We aimed to determine the trends in different cancer types with respect to international statistics, in order to understand their nature and identify gaps in their diagnosis and management.MethodsThis retrospective study was based on data obtained from the first national childhood cancer registry of the National Bank of Kuwait (NBK) Specialized Hospital for Children, the only hospital that manages pediatric cancer patients in Kuwait. The registry included the data of all children with cancer in Kuwait from 2004 to 2017 and had complete data files.FindingsThe total number of patients in the childhood cancer registry was 1,387. A total of 1,009 files met our eligibility criteria. In 2017, the incidence of childhood leukemia was determined to be six per 100,000 people, and for other cancers, it was 12.6 per 100,000 people. The most common cancer was leukemia (457 patients), followed by lymphoma (141 patients), and brain tumors (92 patients). The majority of children received chemotherapy (n=891, 88.3%). Post induction or treatment, the majority of patients achieved complete remission (n=790, 78.3%). The overall survival rate of children with cancer was around 80%. Major complications developed in 9% of patients.ConclusionThese findings highlight the importance of hospital‐based cancer registries. Active data management programs are essential to monitor outcomes, measure the effectiveness of current practice, and improve the quality of care.

Histopathological and epidemiological findings of colonoscopy screening in a population with an average risk of colorectal cancer in Kuwait.

Background:Colorectal cancer (CRC) is the second most common cancer in women and the third most common in men worldwide, with a significantly rising incidence in the Middle East region over the last few decades. This study investigates the histopathological and epidemiological characteristics of colonoscopic findings in a population with an average risk of CRC in Kuwait.Methods:In this study, 1,005 asymptomatic average-risk Kuwaiti adults aged over 40 years had their first colonoscopy screening during the 2015–2018 period. Data on lifestyle behaviors (cigarette smoking, alcohol consumption, and physical activity), body mass index (BMI), and comorbidities were routinely collected from these individuals. All colorectal polyps or masses were assessed for their site, size, and number and then resected and sent for histopathological examination.Results:The mean age of the participants was 54 years, and 52.2% were women. In screened individuals, the polyp detection rate, adenoma detection rate, and carcinoma detection rate were 43.8%, 27.7%, and 1.2%, respectively. Tubular, tubulovillous, and villous types of adenoma constituted 17.3%, 2.8%, and 1.3% of all screened participants. Neoplastic lesions, particularly in the proximal colon, were more common among men aged 40–49 years. Age of 70 years and older (OR: 9.6; 95% CI: 4.7–19.9; P < 0.001), male gender (OR: 1.6; 95% CI: 1.1–2.3; P = 0.011), increased BMI (OR: 1.05; 95% CI: 1.02–1.08; P = 0.001), and smoking (OR: 3.5; 95% CI: 2.3–5.4; P < 0.001) were the most significant independent risk factors for colorectal neoplasia.Conclusions:The high adenoma detection rate (ADR) in Kuwaiti population calls for the establishment of a national programe for CRC screening. The higher ADR in those younger than 50 years calls for assessment of the threshold age at which to start screening.

Uptake of cervical cancer screening in Kuwait: A cross-sectional study

Abstract Background Despite the low incidence of cervical cancer in Kuwait in 2018, it is projected that it will increase by 48% by 2035. This is of concern considering that cervical cancer is a preventable disease if detected early. With limited research in this area in Kuwait, we sought to assess the prevalence of cervical cancer screening (CCS) among Kuwaiti women. Methods This study is part of the WHO's 2014 STEPS risk factor surveillance study. A representative random sample (n = 3915) of Kuwaiti citizens was recruited (response rate= 89.2%). CCS was assessed with the question “Have you ever had a screening test for cervical cancer using any of the methods described above”. All women aged 21-69 years who responded to the CCS question (n = 2183) were included in the analysis. Independent variables included age, area of residence, marital status, level of education, work status, smoking status, BMI level, history of CV disease, and history of diabetes. Statistical analysis included descriptive statistics, bivariate analysis, and multivariable logistic regression adjusted for participants' characteristics. Results The overall weighted CCS prevalence was 15.7% (95% CI [14.3-17.4]). CCS was associated with age (OR = 5.0 [2.5-10]) for age group 60-69, and OR = 3.1 [1.9-5.1] for age group 45-59 compared to the age group 21-29, area of residence (ORs ranged from 0.3 to 0.5 for those living in different governorates compared to those who lived in the Capital), marital status (OR = 4.4 for married and OR = 5.2 for divorced/widowed compared to those who were single), and level of education (ORs ranged from 2.7 to 2.9 for those who completed at least high-school education compared to those who did not). Conclusions The current uptake of CCS among Kuwaiti women is low. Disparities exist in terms of age, area of residence, level of education, and marital status. More efforts are needed to promote CCS through an organized screening program while considering the existing disparities. Key messages The current use of cervical cancer screening among Kuwaiti women is low. More efforts are needed to promote cervical cancer screening while paying attention to existing socioeconomic disparities.

Radiotherapy in localized gastric cancer management: To be or not to be?

e16511 Background: Gastric adenocarcinoma still have dismal outcome in spite of the progress made in systemic treatment in last 2 decades. In localized disease, treatment outcome still suboptimal, with up to 88% suffer from recurrence/metastasis. Hence, improvement in radical initial treatment is mandatory. Recent trials showed survival benefit of adding radiotherapy (preoperative or adjuvant) with favorable toxicity profile when using current advances radiation techniques. Methods: We retrospectively analyzed impact of radiotherapy in management of localized gastric cancer in Kuwait. 87 adult patients with newly diagnosed gastric cancers were treated and followed up at Kuwait Cancer Control Center (KCCC) between 2009-2015, 12 were excluded due to inoperability. 13 patients were excluded as they had early disease and underwent only surgery. Finally, 62 patients were submitted in study 48 patient received radiotherapy (RT group) as part of treatment (44 postoperative, 3 postoperative after induction Chemotherapy, 1 preoperative). 14 patients did not receive radiotherapy (NRT group); five received perioperative chemotherapy, nine received postoperative chemotherapy). Survival analysis was done using Kaplan-Meier, and comparison was done according to clinicopathological features. Results: The median age at diagnosis was 55 (range 25-70). Men represented 65.5%. Asian were 17 patients and Caucasian were 70 patients. 68.9% were nonsmoker while 31% were smoker. Median follow up was 45 months (1-89). 2 year Overall survival in the NRT group was 50% while in RT group was 79.1%. 3 year OAS was 42.8% and 64.5% in NRT group and RT group respectively. Median overall survival for NRT group was 82 months. While for the RT group median survival was not reached at time of analysis with p value (0.025). 2 year DFS in NRT group was 50% while in RT group was 66.6%. 3 year DFS was 42.8% and 54.1% in NRT group and RT group respectively. Median DFS not reached in both groups p value (0.04). On correlation of prognostic clinicopathological features with benefits of adding radiotherapy it was noticed that high grade, positive margins statistically benefit more from local radiotherapy and had better local control. Distal tumours behave badly whether received radiotherapy or not. Interestingly benefit of adding radiotherapy was not significantly affected by nodal status. Conclusions: Radiotherapy should be part of management in postoperative locally advanced gastric cancer especially with high grade tumours and positive margins. However still ongoing trials to clear the role of radiotherapy in preoperative setting.

AB007. National registry for children with cancer in Kuwait

: The scope of this talk would be about registries of cancer and hematological diseases around the world and the impact on the improving the health system of countries. Registries in a developing country could be very challenging; however very rewarding to assess the services provided. We will share our experience in developing a registry of childhood cancer in Kuwait and the steps taken as well as obstacles faced during this journey. This study was conducted at the children specialty hospital at the National Bank of Kuwait (NBK) hospital, Sabah health district, which is the only center for cancer management in children in Kuwait. Since the establishment of the unit back in the seventies the patient's' statistics was gathered by personal effort of the doctors of the unit and it was not official, and some of these data was gathered by Kuwait cancer control registry center which is basically adult service. There is an estimate of 120 new cases are received every year, and currently there are more than 800 children on regular follow up at NBK children hospital; receiving children with cancer from birth to 16 years. The objective of this study was to addresses the need to have a separate national registry for children with cancer, in order to follow the international statistics and improve the services provided at NBK children hospital. This study used a prospective/cross sectional/retrospective method. This project started in May 12th 2016. A data sheet form which contained patient biography, investigations, clinical course, complications, and outcome of cancer in children was designed. The inclusion criteria were all children with cancer were included in this registry, and the exclusion criteria were children presented with benign diseases. Data was collected from the files of the patients with leukemia who received treatment in the NBK hospital since the year 2004, and for patients with oncology diseases since 2005. Data was analyzed using SPSS form for data analysis. This study was approved by the ethical committee of the ministry of health of Kuwait, and was sponsored by the Kuwait Foundation for the advancement of sciences. The total number of all patients from 2004 to 2017 was 1,387: for children with oncology diseases were 850 retrieved 597, and children with leukemia were 537 retrieved 537. There were 593 Kuwaitis and 416 non-Kuwaitis who came from at least 28 other nationalities. There were 588 males and 421 females. It is noted that second most common cancer after leukemia in this registry is lymphoma (14%). Most children presented at diagnosis and have not received any treatment yet (76%), or received partial treatment (11%). In our study 76.3% of children are alive and are following at our centre, and we lost around 10%, and unfortunately 11% were lost to follow. The national registry for children with cancer project is a vital study for all researchers in the field. This study showed that our overall statistics are in keeping with the international statistics.

Epidermal growth factor receptor mutations in nonsmall cell lung carcinoma patients in Kuwait.

Context:Nonsmall cell lung carcinoma (NSCLC) is the most frequently diagnosed form of lung cancer in Kuwait. NSCLC samples from Kuwait have never been screened for epidermal growth factor receptor (EGFR) gene aberration, which is known to affect treatment options.Aims:This study investigated the feasibility of using fine-needle aspiration (FNA) material for mutational screening, and whether common EGFR mutations are present in NSCLC samples from Kuwait.Settings and Design:Eighteen NSCLC samples from five Kuwaitis and 13 non-Kuwaitis were included in this study.Materials and Methods:DNA was extracted from FNA cell blocks and screened for EGFR gene mutations using peptide nucleic acid (PNA)-clamp assay, and EGFR gene amplification using fluorescent in situ hybridization (EGFR-FISH). EGFR protein expression was assessed using immunohistochemistry.Results:Five EGFR mutations were detected in five non-Kuwaiti NSCLC patients (27.8%). EGFR gene amplification was evident in 10 samples (55.5%) by direct amplification or under the influence of chromosomal polysomy. Four samples had EGFR mutations and EGFR gene amplification, out of which only one sample had coexisting EGFR overexpression.Conclusions:Given the evidence of EGFR gene alterations occurring in NSCLC patients in Kuwait, there is a need to incorporate EGFR gene mutational screen for NSCLC patients to implement its consequent use in patient treatment.

Quality of life for Palestinian patients with cancer in the absence of a palliative-care service: a triangulated study

<h3>Background</h3> Cancer is a devastating illness that can deplete the resources of both the individual and the community. In the occupied Palestinian territory (oPt), it is the second leading cause of death (12%). Most cases are diagnosed at a late stage and patients are given little pain control and palliative care. In this study, we aimed to assess the determinants of quality of life (QoL) scores, and the symptoms in patients with cancer. <h3>Methods</h3> The study was done in the three main hospitals—Beit Jala Governmental Hospital, Watani Governmental Hospital, and Augusta Victoria Hospital—for cancer care in the West Bank, oPt, between May 1, to July 31, 2012. Patients (aged 18–90 years) with cancer who were attending the hospitals for treatment and follow-up were selected by convenient sampling and had qualitative in-depth interviews guided with five open-ended questions that were reviewed and validated by a palliative care doctor, a palliative care nurse, an oncologist, a social worker, and a researcher, and completed the cross-sectional quantitative European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30; scale 0–100). We did several statistical tests (<i>t</i>, ANOVA, χ², multiple linear regression analysis) using IBM-SPSS (version 19.0.0). We obtained written informed consent from all participants and interviewees, and study approval from the faculty board at the School of Public Health, Al-Quds University, East Jerusalem, West Bank, and the Helsinki Committee, Gaza Strip, oPt. <h3>Findings</h3> Ten patients completed the qualitative in-depth interviews and 323 (92%) of 350 completed the cross-sectional quantitative questionnaire EORTC QLQ-C30. In the qualitative interviews, respondents expressed several needs: financial aid, pain management, properly equipped health-care facilities in their vicinity, availability of medication, eradication of stigma, improved communication by the health-care team with the patient and psychosocial support, home nursing care, and palliative care. In the regression analysis, predictors of poor-health-related QoL (defined as <50; mean score 41·8) were advanced stage of cancer (β=−0·3; p<0·0001), poor economical situation (income <2000 NIS; β=0·19; p=0·001), low educational level (<10 years; β=0·12; p=0·04), and longer than 6 months of treatment (β=−0·11; p=0·04). The QoL domains with poor scores were physical (mean score 48·5), role (48·8), emotional (46·0), and social functioning (50·0), whereas the scores were worse for financial difficulties (64·6) and symptoms (fatigue [66·6], pain [63·0], and insomnia [56·4]). All these results were worse than were those for patients with cancer in Kuwait, Turkey, and the UK. <h3>Interpretation</h3> Palestinian patients with cancer encounter many difficulties in terms of their QoL. Palliative care for these patients should be integrated into the health-care system to improve their QoL. We recommend that policy makers integrate special services, such as palliative care, into the health-care system in the oPt to improve QoL and reduce suffering of these patients. <h3>Funding</h3> None.

Profile of Lung Cancer in Kuwait

Lung cancer is the most frequent cancer in males and the fourth most frequent site in females, worldwide. This study is the first to explore the profile of lung cancer in Kuwait. Cases of primary lung cancer (Kuwaiti) in Kuwait cancer Registry (KCR) were grouped in 4 periods (10 years each) from 1970-2009. Epidemiological measures; age standardized incidence rate (ASIR) with 95% confidence intervals (CI), Standardized rate ratio (SRR) and Cumulative risk and Forecasting to year 2020-2029 used for analysis. Between years, 2000-2009 lung cancer ranked the 4th and the 9th most frequent cancer in males and females respectively. M:F ratio 1:3. Mean age at diagnosis (95%CI) was 65.2 (63.9-66.4) years. The estimated risk of developing lung cancer before the age of 75 years in males is 1.8% (1/56), and 0.6 (1/167) in females. The ASIR for male cases was 11.7, 17.1, 17.0, 14.0 cases/100,000 population in the seventies, eighties, nineties and in 2000-2009 respectively. Female ASIR was 2.3, 8.4, 5.1, 4.4 cases/100,000 population in the same duration. Lung cancer is the leading cause cancer death in males 168 (14.2%) and the fifth cause of death due to cancer in females accounting for 6.1% of all cancer deaths. The ASMR (95%CI) was 8.1 (6.6-10.0) deaths/100,000 population and 2.8 (1.3-4.3) deaths/100,000 population in males and females respectively. The estimated Mortality to incidence Ratio was 0.6. The incidence of lung cancer between years 2000-2009 is not different from that reported in the seventies. KCR is expecting the number of lung cancer cases to increase.

Clinicopathological features and prognosis of triple negative breast cancer in Kuwait: A comparative/perspective analysis

AimThe aim of this study was to determine the incidence of TNBC in Kuwait, to analyze the clinicopathologic features and prognosis of this type of breast cancer, and compare it with reports from other regions of the world. BackgroundTriple negative breast cancer (TNBC) is defined as a subtype that is negative for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2). There is a growing evidence of the heterogeneity of such entity on the molecular level that may cause discrete outcomes. MethodsWe analyzed the clinicopathologic features of 363 TNBC cases which were diagnosed in Kuwait from July 1999 to June 2009. The disease-free survival (DFS) and overall survival (OS) were analyzed by Kaplan–Meier method. Comparison was done with reports from USA, Europe, Middle and Far East. ResultsAmong 2986 patients diagnosed with breast cancer in Kuwait, 363 patients (12.2%) were TNBC. The median age was 48 years, 57.2% had lymph nodes (LN) metastasis, 56.9% were of grade III tumor and 41.9% had stage II disease. 81% developed recurrences and 75% of deaths occurred by 2.5 years after treatment. There is marked variation of clinicopathologic features according to country of patients’ cohort. ConclusionThe incidence of TNBC in our study is similar to other studies. TNBC patients showed an early major recurrence surge peaking at approximately year 2.5. Regional variation of clinicopathologic features indicates a need for molecular studies to define underlying molecular features and its impact on survival.

The place of death of patients with cancer in Kuwait

BackgroundThe place of death (PoD) has a significant effect on end-of-life care for patients dying of cancer. Little is known about the place of cancer deaths in our region.MethodsTo identify...

Pancreatic cancer: Incidence, clinical profile, and frequency of associated factors in Kuwait

BackgroundPancreatic cancer is an uncommon tumor, but because the mortality rate approaches 100%, this form of cancer has now become a common cause of cancer mortality. Diabetes has been postulated to be both a risk factor and a consequence of pancreatic cancer, but the degree of risk and associated clinical factors remain unclear. ObjectivesThe objectives of this study were to investigate the incidence, clinical profile, and the frequency of associated factors of pancreatic cancer in Kuwait. MethodsThe study design was a retrospective hospital-based record study in which records of 251 pancreatic cancer patients registered, evaluated and treated at Kuwait cancer control center from January 2004 through December 2010 were studied. ResultsThe overall pancreatic cancer incidence was 0.9/100000 population. Pancreatic cancer was more frequent in older, obese, smoker, diabetic Kuwaiti males with family history of pancreatic cancer. Metastasis was diagnosed in 67.7% of patients at diagnosis of pancreatic cancer. ConclusionsPancreatic cancer in Kuwait is diagnosed in late stages. Screening for this disease was indicated specially in diabetic patients. A comprehensive comparative study is required for determination of risk factors that could be associated with the disease.

Some Epidemiological Measures of Cancer in Kuwait: National Cancer Registry Data from 2000-2009

Cancer is the second cause of death in Kuwaiti people after cardiovascular diseases. This study is the first in the country to describe epidemiological measures related to cancer in this population. Data obtained from the Kuwait cancer registry included all Kuwaiti patients between years 2000-2009. Analyses were conducted using age-specific rates, the age-standardization-direct method, 95% confidence intervals (95% CI), cumulative risk by the age of 74 years, limited-duration prevalence, mortality and forecasting to year 2029. It was noted that the commonest cancer sites were colorectal with an age standardized incidence rate (ASIR) of 16.1/100,000 in males and breast (49.4/100,000) in the female population. The trend of cancer incidence (1974-2009) showed no statistically significant change. First causes of death due to cancer were female breast 8(6.4-9.6)/100,000 and lung (males) 8.1/100,000 (6.6-10.0). The risk of developing cancer by the age of 74 was 13.4% (1/8) and 14.3% (1/7) in males and females respectively, and the risk of dying from cancer in the same age group was 1/17 and 1/23. By the end of 2009, prevalent cases represented 0.52% of the Kuwaiti population. In the year 2029, the total number of cancer cases is expected to reach 1200 cases compared to 889 cases in 2009. The most common cancers in Kuwait (breast, colorectal and lung) are largely preventable. Prompt and effective interventional prevention programs that vigorously involve diet, anti-smoking and physical activity for both sexes are urgently required.

The Palliative Prognostic Index for the Prediction of Survival and In-Hospital Mortality of Patients with Advanced Cancer in Kuwait

Prognostic scoring systems are increasingly used in cancer care. One of these systems is the Palliative Prognostic Index (PPI) which is based on clinical findings. Few studies validated the PPI in different settings. Our aim was to test the predictive value of the PPI in an acute cancer care setting. Prospective study that included patients with advanced cancer admitted to a tertiary cancer center in Kuwait. Patients were divided according to the PPI score into three groups: A (PPI≤3), B (PPI>3- ≤6), and C (>6). The study included 91 hospitalized patients. At the time of PPI assessment, the plan of treatment was best supportive care only in 70 (77%) patients. The majority (80%) of included patients died in-hospital. The in-hospital mortality rate for patients with a PPI>6 was significantly higher than those with ≤6 (93% versus 56%, p<0.001). Using a cutoff point of PPI>6, in-hospital mortality was predicted with a 73% sensitivity, 78% specificity, 93% positive predictive value, and 41% negative predictive value. The median survival was 61 days (95% confidence interval [CI]: 25.8-96.2) for group A, 20 days (95% CI: 4.5-35.5) for group B, and 6 days (95% CI: 4-8) for group C. The difference in survival was highly significant (p<0.001). The results suggest that the PPI may be helpful for oncologists in predicting survival and in-hospital mortality of patients with advanced cancer in the acute care setting.

Detection Rate and Clinical Pattern of Prostate Cancer in Kuwait: A Single-Center Experience

Objective: To determine the detection rate and clinical pattern of prostate cancer in Kuwait. Subjects and Methods: One hundred and fifty-three males suspected of having prostate cancer based on elevation of prostate-specific antigen (PSA) of more than 4 ng/ml underwent transrectal-ultrasound (TRUS)-guided needle biopsy of the prostate between January 2003 and January 2008; these formed the study group. Analysis of prostate cancer was based on age, prostate volume, PSA level and on finding any abnormality based on a combination of the diagnostic tools. Results: A diagnosis of prostate cancer was histologically confirmed in 42 (27.4%) patients. In those aged <55, 56–65, 66–75 and >76 years, the detection rates were 16.7, 17.6, 33.3 and 40.7%, respectively. In those with prostate volumes of >71, 51–70, 31–50 and <30 g, the detection rates were 18.2, 23.8, 30.8 and 42.9%, respectively. When the PSA levels were divided into groups of 4–10, 10–20, 20–100 and >100 ng/ml, the cancer detection rate was 11.8, 20.5, 47.1 and 83.3%, respectively. When 1, 2 and 3 of the 3 diagnostic tools (digital rectal examination, PSA, TRUS) were abnormal, the detection rate was 15.6, 27.9 and 80%, respectively. Conclusions: Our data showed that the prostate cancer rate differs according to the region and that the rate was low in our center. Higher PSA and higher number of diagnostic tools with abnormal findings were associated with a higher incidence of prostate cancer.

Symptom Burden in Hospitalized Patients With Cancer in Kuwait and the Need for Palliative Care

We conducted this study to describe the symptom burden among hospitalized patients with cancer in a Kuwaiti cancer center. Twenty physical symptoms were assessed in 45 patients with cancer. The majority (82%) of patients had an advanced incurable cancer and 42% were receiving best supportive care only. The median number of symptoms per patient was 6.4 ± 2.8. The most common symptoms were pain (82%), weakness/fatigue (80%), anorexia (67%), weight loss (49%), and dyspnea (42%). Pain was the most distressing symptom in 31% of patients, followed by dyspnea (24%) and weakness/fatigue (11%). The high prevalence of advanced disease and the demonstrated high symptom burden mandate the initiation and development of culturally sensitive palliative care models, especially hospital-based ones, to relieve the suffering of patients with cancer in Kuwait.

The first pilot study on characteristics and practice patterns of Kuwaiti breast cancer patients

Nongenetic breast cancer risk factors have never been evaluated in Kuwait. Accordingly, we aimed at examining these factors as well as the immune profile of the patients. Fifty stage I breast cancer patients and 50 age group-matched normal controls were assessed for the level of their peripheral blood lymphocyte subsets and for risk factors associated with their demographic and reproductive characteristics and with diet. The percentages of CD4+ T lymphocytes, CD4+:CD8+ ratio, and CD19+ B lymphocytes were significantly higher in the patients as compared to controls, while the percentages of CD8+ T lymphocytes and natural killer (CD56+) cells were significantly reduced. Risk factors associated with the disease included higher BMI, lack of regular exercise and physical activity in the past 5 years, early age at menarche, late age at first pregnancy, lack of previous information about breast cancer, hormonal therapy, and presence in Kuwait during the invasion/liberation. Other parameters included significantly more frequent consumption of carbohydrate, sweets, animal fat, and vegetable oil (margarine) and less frequent consumption of fresh vegetables and olive oil. This is the first study to highlight the environmental risk factors associated with breast cancer among the Kuwaiti women. We recommend introducing a nationwide campaign to further investigate these factors and to address them accordingly.

The First Pilot Study on Characteristics and Practice Patterns of Kuwaiti Breast Cancer Patients

Nongenetic breast cancer risk factors have never been evaluated in Kuwait. Accordingly, we aimed at examining these factors as well as the immune profile of the patients. Fifty stage I breast cancer patients and 50 age group-matched normal controls were assessed for the level of their peripheral blood lymphocyte subsets and for risk factors associated with their demographic and reproductive characteristics and with diet. The percentages of CD4+ T lymphocytes, CD4+:CD8+ ratio, and CD19+ B lymphocytes were significantly higher in the patients as compared to controls, while the percentages of CD8+ T lymphocytes and natural killer (CD56+) cells were significantly reduced. Risk factors associated with the disease included higher BMI, lack of regular exercise and physical activity in the past 5 years, early age at menarche, late age at first pregnancy, lack of previous information about breast cancer, hormonal therapy, and presence in Kuwait during the invasion/liberation. Other parameters included significantly more frequent consumption of carbohydrate, sweets, animal fat, and vegetable oil (margarine) and less frequent consumption of fresh vegetables and olive oil. This is the first study to highlight the environmental risk factors associated with breast cancer among the Kuwaiti women. We recommend introducing a nationwide campaign to further investigate these factors and to address them accordingly.