Jordanian Cancer Patients Research Articles

Public Attitudes toward Cancer and Cancer Patients: A Jordanian National Online Survey

Background: Public awareness and attitudes toward cancer and cancer patients are highly important in enhancing the effectiveness of cancer screening and early diagnosis programmes. This study aimed to explore the public attitudes toward cancer and cancer patients in Jordan. Method: A cross-sectional design was used to conduct this online survey study in Jordan between March 20th and April 20th 2020.The sample was conveniently selected, and 1157 participants were included from the public. The Public Attitudes toward Cancer Questionnaire was employed. Results: Descriptive statistics, unpaired t-test, ANOVA, and multiple linear regression were utilized. The mean age was 44.2 years (SD= 20.1), and 53% were female. The total mean attitude score was 38.2 (SD = 4.3). Based on the results, having a family member or a friend with cancer (P=.003), willingness to be informed about cancer diagnosis (P=0.001), informing a friend about cancer diagnosis (P=0.021), and willingness to participate in screening and early detection programmes (P<0.001) were significant predictive positive attitudes towards cancer and cancer patients. In addition, being married predicted more negative attitudes compared with being single (P=0.001) Conclusion: This study demonstrated that Jordanians had positive attitudes toward cancer and cancer patients and most were willing to be informed about cancer diagnosis. This calls for healthcare providers to adopt shared decision models when devising health care plans for cancer patients, with more involvement on the parts of both patients and family members rather than adopting a paternal approach. Policy makers and managers should consider positive attitudes when developing healthcare programmes to enhance public participation in early cancer detection and screening programmes so as to reduce cancer mortality and morbidity rates.

Prevalence of Depression and the Quality-of-Life of Breast Cancer Patients in Jordan.

ObjectiveThe objectives of the current study are to evaluate the prevalence of depression symptoms among breast cancer patients in Jordan and impact of the disease on patient’s quality-of-life.MethodsA cross-sectional survey-based study was conducted over a 6-month period among breast cancer patients attending two major hospitals in Jordan. A validated questionnaire was used to evaluate the prevalence of depression symptoms and quality-of-life aspects among those patients utilizing Beck’s Depression Inventory-II score and 36-Item Survey Form (SF-36) score, respectively.ResultsThe mean age±SD of patients (n=169) was 49.12±6.48 years. Depression symptoms were reported in 30.2% of patients. As for quality-of-life, the physical functioning (PF) subscale was significantly associated with the patient’s age (P=0.03). The role-physical (RP) subscale was associated with number of sleeping hours (P=0.038). Marital status of breast cancer patients was significantly associated with role-emotional (RE) (P=0.015) and mental health (MH) (P=0.009) subscales. The number of patient’s siblings was significantly associated with daily habits such as PF (P=0.031) and RP (P=0.005) subscales. Moreover, the occupation of patients was associated with the PF (P=0.041) and MH (P=0.049).ConclusionAbout one-third of breast cancer patients reported depression symptoms. Quality-of-life subscales among those patients were associated with multiple social and health determinants, such as age, marital status, number of siblings, occupation, and number of sleeping hours. There is urgent need to support this group of patients to help them to cope with depression symptoms and to improve their quality-of-life.

BRCA1 and BRCA2 genes mutations among high risk breast cancer patients in Jordan

Familial breast cancer is estimated to account for 15–20% of all cases of breast cancer. Surveillance for familial breast cancer is well-established world-wide. However, this service does not exist in Jordan, due to the scarcity of information with regard to the genetic profiling of these patients, and therefore lack of recommendations for policy-makers. As such, patients with very strong family history of breast or ovarian cancers are not screened routinely; leading to preventable delay in diagnosis. Whole coding sequencing for BCRA1/BCRA2 using next-generation sequencing (NGS)/Ion PGM System was performed. Sanger sequencing were then used to confirm the pathogenic variants detected by NGS. In this study, 192 breast cancer patients (and 8 ovarian cancer cases) were included. The prevalence of recurrent pathogenic mutations was 14.5%, while the prevalence of newly detected mutations was 3.5%. Two novel pathogenic mutations were identified in BRCA2 genes. The common mutations in the Ashkenazi population used for screening may not apply in the Jordanian population, as previously reported mutations were not prevalent, and other new mutations were identified. These data will aid to establish a specific screening test for BRCA 1/BRCA2 in the Jordanian population.

Place of death for patients treated at a tertiary cancer center in Jordan.

Home death is considered to be a marker of good death. Little is known about the place of death and its determinants in patients with cancer in Jordan. A retrospective analysis of regularly collected data of cancer patients who had a palliative care consultation at King Hussein Cancer Center and died between 2011 and 2012. Variables analyzed were related to the patient, disease, and palliative care services. Patient-related factors included age at death, gender, place of residence, and code status; disease-related variables were cancer type (solid vs hematological), major primary site, and time from cancer diagnosis to death; palliative care service-related variables included time of consultation for palliative care services to death, location of first palliative encounter (outpatient clinic vs hospital floor), multidisciplinary palliative home care teams involvement, and the number of home care visits before death. We examined the association between each variable and place of death using Pearson's chi-square and the Mann-Whitney tests. Factors with statistical significance of P value < 0.1 were entered into multivariate logistic regression model. Among 630 patients, 80 (12.7%) died at home. Univariate analysis showed the following to be significantly associated with dying at home: male gender, age more than 65years old, earlier palliative care involvement, and involvement of home care services (P value < 0.05). Independent predictors for dying at home were male gender, age more than 65years old, and involvement of home care services. Hospital death is more prevalent than home death in cancer patients in Jordan. Involvement of home care services can help achieve the goal of dying at home.

Patterns and Prevalence of Germline BRCA1 and BRCA2 Mutations among High-Risk Breast Cancer Patients in Jordan: A Study of 500 Patients.

Purpose Knowledge of BRCA1 and BRCA2 mutations has a significant clinical impact on the management and prevention of breast cancer. In this study, we evaluate the pattern and prevalence of germline mutations in BRCA1 and BRCA2 among high-risk Jordanian breast cancer patients selected as per international guidelines. Methods BRCA1 and BRCA2 testing were performed at a reference genetic lab. Mutations were classified as pathogenic/likely pathogenic and variant of uncertain significance (VUS). Results A total of 517 patients, median age: 39 (range: 19–78) years, were enrolled. Among the whole group, 72 (13.9%) patients had pathogenic or likely pathogenic BRCA1 (n = 24, 4.6%) or BRCA2 (n = 48, 9.3%) mutations, while 53 (10.3%) others had VUS. Among 333 younger (≤40 years) patients, mutations were observed in 44 (13.2%). Positive mutations were found in 40 (16.5%) patients with one or more close relatives with breast cancer and in 20 (35.1%) of the 57 patients with triple-negative disease. Multivariate analysis showed that a triple-negative status, history of two or more close relatives with breast cancer, and history of one or more close relatives with invasive ovarian cancer were associated with significant high odds ratios (OR) of carrying a pathogenic variant, with an OR (95% CI) of 5.08 (2.66–9.67), 3.24 (1.78–5.89), and 2.97 (1.04–8.52), respectively. Conclusions BRCA1 and BRCA2 mutations are not uncommon among Jordanian patients. Young age has the weakest association with positive mutations, while patients with triple-negative disease, especially those with an additional positive family history, have the highest mutation rate.

Symptom Clusters' Content, Stability and Correlation with the Quality of Life in a Heterogeneous Group of Cancer Patients: A Large-Scale Longitudinal Study.

Cancer-related symptoms can negatively affect the quality of life, hinder or delay treatment, and increase suffering. This study aimed to explore symptom clusters among Jordanian cancer patients. A longitudinal survey design was used. The sample consisted of 1280 cancer patients treated in three selected hospitals. Two-thirds of the participants were female (63.5%) with a mean age of 52.7 SD 13.8 years and 40.3% had breast cancer. Five clusters were identified, the first was the psychological cluster of eight symptoms; the second was the treatment side-effects cluster consisting of ten symptoms; the third was the nausea and vomiting cluster comprising four symptoms; the fourth was the pain cluster comprising four symptoms; and last was the fatigue cluster, with three symptoms. Cancer patients through the journey of cancer treatment have several symptoms that tend to occur in five clusters which are negatively correlated with their quality of life.

Survival Rate of Gastric Cancer Patients in Jordan: Secondary Data Analysis.

BackgroundGastric cancer accounts for 2.7% of all newly diagnosed cancer cases in Jordan.ObjectiveThe aim of this study was to calculate the survival rate and its determinants among Jordanian patients who were diagnosed with gastric cancer between 2010 and 2014.MethodsA descriptive study was conducted based on secondary analysis of data from the Jordan Cancer Registry during the period of 2010-2014. Only cancer-related deaths were recorded as “death” in the survival analysis.ResultsA total of 1388 new cases of gastric cancer were recorded between 2010 and 2014. Of these, 872 (62.8%) were Jordanians and 60.5% were males. The mean age at diagnosis was 58.9 years and the median follow-up time was 1.6 years. The 5-year survival rate decreased significantly from 89% in patients with well-differentiated cancer to 32% in patients with poorly differentiated cancer (P=.005). The overall 5-year survival rate was 37.7% and the median survival was 1.48 years (95% CI 1.179-1.783). The 5-year survival rate decreased significantly with increasing age and with advanced stage of the disease: the 5-year survival rate was 75% for localized-stage, 48% for regional-stage, and 22.7% for distant-metastasis disease (P=.005).ConclusionsThis study showed that the overall 5-year survival rate among patients with gastric cancer in Jordan between 2010 and 2014 was 37.7%, which is higher than the reported rates from different countries in the Eastern Mediterranean region such as Egypt.

Abstract P2-09-06: Genetic counseling and genetic testing for germline BRCA1/2 mutations among high risk breast cancer patients in Jordan: A study of 500 patients

Abstract Introduction: Breast Cancer is the most common cancer worldwide and so in our region. In Jordan, almost 50% of patients are diagnosed before the age of 50. Knowledge of BRCA1/2 mutations has significant clinical impact on the management and prevention of breast cancer. In this study, we evaluate the prevalence of germline mutations in BRCA1/2 among high-risk Jordanian patients selected as per the updated NCCN guidelines. Methods: Jordanian breast cancer patients, stages I-IV, with a selected high-risk profile treated at our institution were invited to participate. Blood samples were obtained for DNA extraction, and BRCA sequencing and dosage analysis were performed at Leeds Cancer Center, Leeds-United Kingdom. BRCA1/2 mutations were classified as pathogenic/likely pathogenic and variant of uncertain significance (VUS). Clinical and pathological data were obtained from patients' medical records and a detailed 3-generation family history was also obtained by a genetic counselor. Results: A total of 517 patients were enrolled, genetic testing and counseling have been completed for all. Median age at diagnosis was 39 (range: 20-78) years. Among the whole group, 72 (13.9%) patients had pathogenic or likely pathogenic BRCA1 (n=24, 4.6%) or BRCA2 (n=48, 9.3%) mutations, while 53 (10.3%) others had VUS. Among 333 younger (≤40 years) patients, pathogenic/likely pathogenic mutations were observed in 44 (13.2%) patients and 36 (10.8%) others had VUS. Among 242 patients who had one or more close relatives with breast cancer, diagnosed at age 50 years or younger, 40 (16.5%) had pathogenic/likely pathogenic mutations (Table). Twenty (35.1%) of the 57 patients with triple-negative (TN) disease had pathogenic/likely pathogenic mutations; 16 (28.1%) were in BRCA1. Rate was significantly higher (55.6%, p &amp;lt;0.0001) among those with two family members with breast cancer at any age (n=9). However, compared to older patients, mutation rates were not higher among 37 TN-patients who were 40 years or younger. Conclusions: BRCA1/2 mutations are not uncommon and may contribute to the pathogenesis of familial breast cancer among Jordanians. Young age, per se, has the weakest association with positive BRCA1/2 mutations while TN-disease, especially when associated with positive family history, has significantly higher mutation rate. The establishment of Clinical Cancer Genetics program made running such culturally-sensitive genetic testing and counseling more acceptable even in societies like ours. Table: Rates of positive BRCA1/2 mutation across different indications for testingVariableTotalPositive BRCA mutations*BRCA1BRCA2BRCA1/2P-ValueAge (years)≤4033315 (4.5%)29 (8.7%)44 (13.2%)0.53&amp;gt;401849 (4.9%)19 (10.3%)28 (15.2%)Age ≤ 50 years with one or more close relative with breast cancer at any ageYes2428 (3.3%)32 (13.2%)40 (16.5%)0.1No27516 (5.8%)16 (5.8%)32 (11.6%)Age ≤ 60 with triple negative diseaseYes5716 (28.1%)4 (7.0%)19 (35.1%)&amp;lt;0.001No4628 (1.7%)44 (9.6%)53 (11.3%)Any age with at least 2 breast cancer primariesYes574 (7.0%)4 (7.0%)8 (14.0%)0.98No46020 (4.3%)44 (9.6%)64 (13.9%)Any age with 2 or more close relatives with breast cancerYes1157 (6.1%)21 (18.3%)28 (24.3%)&amp;lt;0.001No40217 (4.2%)27 (6.7%)44 (10.9%)Any age with one or more close relatives with invasive ovarian cancer diagnosed at any ageYes192 (10.5%)4 (21.1%)6 (31.6%)0.023No49822 (4.4%)44 (8.8%)66 (13.3%)All Patients51724 (4.6%)48 (9.3%)72 (13.9%)*Positive mutations: Pathogenic/Likely Pathogenic Citation Format: Hikmat Abdel-Razeq, Lama Abujamous, Amal Al-Omari, Abdelghani Tbakhi, Dima Jadaan. Genetic counseling and genetic testing for germline BRCA1/2 mutations among high risk breast cancer patients in Jordan: A study of 500 patients [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-09-06.

KRAS and NRAS mutational gene profile of metastatic colorectal cancer patients in Jordan.

BackgroundA constitutively active RAS protein in the absence of stimulation of the epidermal growth factor receptor (EGFR) is the result of mutations in KRAS and NRAS genes. Mutations in the KRAS exon 2 and outside exon 2 have been found to predict the resistance to anti-EGFR monoclonal therapy. A substantial proportion of metastatic colorectal cancer cases (mCRC) exhibit RAS mutations outside KRAS exon 2, particularly in KRAS exon 3 and 4 and NRAS exons 2 and 3. No data about RAS mutations outside KRAS exon 2 are available for Jordanian patients with mCRC. We aim to study the molecular spectrum, frequency, and distribution pattern of KRAS and NRAS mutations in Jordanian patients with mCRC.MethodsA cohort of 190 Jordanian metastatic colorectal cancer patients were enrolled in the trial. We detected mutations in exon 2 of the KRAS and NRAS gene as well as mutations outside of exon 2 using the StripAssay technique. The KRAS StripAssay covered 29 mutations and 22 NRAS mutations.ResultsMutations were observed in 92 (48.42%) cases, and KRAS exon 2 mutations accounted for 76 cases (83.69%). KRAS G12D was the most common mutation, occurring in 18 cases, followed by KRAS G12A in 16 cases, and G12T in 13 cases. Mutations outside of KRAS exon 2 represented 16.3% of the mutated cases. Among those, 6 cases (6.48%) carried mutations in NRAS exon 2 and 3, and 10 cases (10.87%) in KRAS exon 3 and 4.ConclusionThe frequency of NRAS and KRAS mutations outside of exon 2 appears to be higher in Jordanian patients in comparison with patients from western countries. KRAS mutations outside of exon 2 should be tested routinely to identify patients who should not be treated with anti-EGFR antibodies.

Health-related quality of life among patients with colorectal cancer.

Up to 35% of cancer patients have clinically significant levels of psychological distress during their treatment. Accordingly, better understanding of health-related quality of life and its predictors will help oncology nurses plan appropriate interventions to improve health-related quality of life. This study was conducted to investigate the relationship between hope, depression and anxiety and health-related quality of life among Jordanian cancer patients during their treatment period. Cross-sectional descriptive correlational design was conducted using the Hospital Anxiety and Depression Scale, Herth Hope Index and Functional Assessment of Cancer Therapy-Colorectal surveys. 260 Jordanian patients with cancer from three Jordanian hospitals completed the study survey. The bivariate analysis indicated significant positive relationships between hope and quality of life (r = .57, p < .0001). A significant negative relationship was found between anxiety and depression and quality of life (r = -.76, p < .0001). A multiple regression analysis indicated that hope, Hospital Anxiety and Depression Scale and time since diagnosis were predictors of quality of life, and explained 66% of the variance in the quality of life for this sample. The assessment of psychosocial elements including hope, depression, anxiety, and quality of life should be a part of daily nurse-caring behaviours and practices. Implement education programmes to increase nurses' competencies in the psychosocial assessment are recommended.

Smoking cessation care can translate to lower hazard of death in the short-run in cancer patients - a retrospective cohort study to demonstrate the value of smoking cessation services within the treatment phase of cancer

BackgroundSmoking cessation is a key step towards improving cancer care and outcomes. However, smoking cessation interventions are underprovided in oncology settings. Within Jordan’s only comprehensive oncology center, we sought to evaluate receipt of care at a smoking cessation clinic and the effect of assisted abstinence through the smoking cessation clinic on short-term (two-year) survival after a cancer diagnosis.MethodsWe employed a retrospective cohort study design. Cancer registry and smoking cessation clinic data for adult Jordanian cancer patients diagnosed between 2009 and 2016, who also were cigarette smokers, and who received full treatment at King Hussein Cancer Center, were analyzed. Specifically, descriptive statistics of patients who visited the smoking cessation clinic were generated, and short-term (two-year) hazard of death of patients based on whether or not smoking cessation clinic-assisted abstinence occurred, were evaluated.ResultsThere were 3403 patients who met our inclusion criteria. Approximately 21% of cancer patients were seen at the smoking cessation clinic, and significant demographic and clinical disparities in who was being seen [at the smoking cessation clinic] existed. In 2387 patients with available survival data, smokers who never went to the smoking cessation clinic (or were seen only once, or seen a year or more from diagnosis) had a hazard of death 2.8 times higher than smokers who had visited the smoking cessation clinic and who also confirmed they had not smoked on atleast two of their 3-, 6- or 12-month follow-up visits (95% confidence interval [CI] = 1.7–4.6). Non-abstainers at the smoking cessation clinic exhibited a similar disadvantage (HR 2.7, 95% CI 1.4–5.0).ConclusionsAlthough evidence-based smoking cessation interventions increase the likelihood of abstinence and can lower the short-term hazard of death during cancer treatment, there is a deprioritization of smoking cessation interventions during cancer care, as indicated by low proportions of patients seen at the smoking cessation clinic. Our findings emphasize the importance of promoting interventions to avail smoking cessation interventions in oncology settings within the cancer treatment phase.

A cross-sectional study on oncology nurses’ knowledge and practice of oral mucositis among cancer patients in Jordan

ObjectivesThis study was conducted to evaluate oncology nurses’ knowledge and compliance with oral mucositis (OM) management guidelines. MethodsA cross-sectional design with a nonparticipant observation approach was utilized. In phase Ⅰ, a cross-sectional convenience sample (n = 140) of oncology nurses completed the knowledge test. In phase Ⅱ, a random sample (n = 20) of oncology nurses from participants in phase Ⅰ was observed during their practice. ResultsFifty-seven (40.7%) of the participants had an unsatisfactory level of knowledge. Most of them had knowledge deficits regarding pathology, OM definition, assessment, scoring, treatment, and patient education and advice. A significant difference existed among nurses with diploma, bachelor, and postgraduate degrees as determined by one-way ANOVA (P = 0.001). There were no significant difference between average scores of male and female nurses were higher than those of nurses (P = 0.45). No significant difference was observed among knowledge scores of nurses with different job titles (P = 0.51). The average score of male nurses in terms of skill performance was higher than that of female nurses (29.20 ± 2.10 vs 27.10 ± 1.80) without statistical significance. ConclusionThe knowledge and compliance with OM management guidelines among Jordanian oncology nurses need to be improved. National OM prevention and management guidelines are adopted in Jordan. Continuing education and training are also recommended.

Lived experience of Jordanian colorectal cancer patients with recurrence: an interpretative phenomenological analysis

ABSTRACTDespite improvement in the cancer treatment modalities, recurrence is still common. This study was conducted to explore Jordanian colorectal cancer patients’ experience during the recurrence phase. Phenomenology – Qualitative design with semi-structured individual interviews with open questions was used. Three main themes and several subthemes were emerged: (1) adequate information and support from professionals (helpful relationship with professionals and disease orientation), (2) disease and treatment impact (being shocked, uncertainty, losing autonomy, isolation, and discomfort), and (3) seeking complementary treatment (spiritual activities and complementary therapy). The results can be helpful in increasing our understanding of the CRC experience during recurrence phase.

Exploring the psychological status of Jordanian nurses working with cancer patients.

This study aims to explore the psychological status of nurses working with cancer patients in Jordan. Literature shows that nurses face many stressors in their job, in particular oncology nurses. Some of them have psychiatric illness such as anxiety and depression. Most of the reviewed studies were conducted in developed countries, and none in the Middle East. A qualitative descriptive approach was adopted, whereby interviews were conducted with 24 nurses that were selected from the oncology departments of one governmental hospital. Participants identified coping with death and dying in nursing care and some cultural issues (that they encountered) as the main factors that influence their psychological well-being, which in turn may have contributed to a reduced quality of care for patients. Findings indicated that the working environment within oncology is highly stressful, which might negatively affect the nurses' job satisfaction and the quality of care that they provided. Findings of this study could help health care managers to understand the impact of psychological stressors on nurses' performance, and the importance of improving the psychological status of oncology nurses.

Occurrence and molecular characterization of metallo-β-lactamases (MBLs) among Acinetobacter baumannii isolates from cancer patients

Background: During the last decade, the prevalence of carbapenem-resistant infection associated with multidrug resistant (MDR) Acinetobacter baumanniiin patients has been continuously increasing. This prospective study aimed to determine the occurrence and molecular characterization of metallo-β-lactamases (MBLs) and carbapenem hydrolyzing oxacillinases among A. baumannii isolates from cancer patients over a period of 6-month.&#x0D; Methods:Antimicrobial susceptibility profile of 70 randomly collected A. baumannii isolates was first determined using disc diffusion test, and second, the MICs of 45 representative multidrug resistant (MDR) isolates were tested to useful drugs in treatment of their infections using E-test. PCR assays were used to detect the common four types of class D carbapenem hydrolyzing oxacillinases, two types of class A carbapenemases, four types of class B metallo-β –lactamases, and prevalence of Class 1 Integron among MDR isolates.&#x0D; Results: All 70 isolates were MDR, including 100% resistance to meropenom, aztreonem, piperacillin/tazobactum and 99% to carbapenem. All isolates carried blaOXA-23 and blaOXA-51, but none carried a blaOXA-24 like or blaOXA-58. The isolates also were positive for NDM-1, NDM, VIM, GES, KPC and SPM at the rates of 29%, 20%, 29%,19%,7% and 2%, respectively. Class 1 Integron was positive in 82% of A. baumanniiisolates.&#x0D; The clonal relationship of 42 MDR A. baumanniiisolates using ERIC-PCR and constructed dendrogram showed 3 major genotype clusters of genetically related isolates. These include 4 genotype groups, each composed of 2 isolates with 100 % similarity of DNA bands. &#x0D; Conclusion:This study demonstrates that A. baumannii colonize frequently cancer patients in association with antibiotic treatment. The organism is mostly carrying wide spectrum of antibiotic resistance genetic factors, especially many types of ESBLs and MBLs and Class 1 Integron. This fact should be considered when therapy is selected for treatment of patients infected with MDR A. baumannii.&#x0D; Key words. Acinetobacter baumannii, ESBLs, MBLs, Class 1 Integron, Jordanian cancer patients.&#x0D;

Health-related quality of life and associated factors in Jordanian cancer patients: A cross-sectional study.

Understanding the factors associated with patients' health-related quality of life along with their social networks can help identify who may benefit from supportive programmes. This study sought to evaluate the impact of a cancer diagnosis on Jordanian cancer patients' health-related quality of life and its relationship with social support and emotional status. A descriptive design was utilized, and 226 clients were participated. Participants completed European Organization for Research and Treatment of cancer quality of life questionnaire (EORTC-version 3), the Hospice Comfort Questionnaire, and the Hospital Anxiety and Depression scale. The results revealed that participants demonstrated unsatisfactory quality of life and many complained of fatigue. A multiple linear regression analysis revealed that social support, hospitalization readmission and being a nonsmoker were significant predictors for poor global quality of life score. In addition, a high educational level, less rehospitalization and high anxiety and depression scores were significant predictors for comfort level. In conclusion, patients with cancer are at an elevated risk of impaired physical functioning and report unsatisfactory quality of life, particularly if they are anxious, depressed and lack social support. The associated factors with decreased quality of life or low comfort level could be amenable to change with appropriate interventions.

Four cycles of adriamycin and cyclophosphamide followed by four cycles of docetaxel (NSABP-B27) with concomitant trastuzumab as neoadjuvant therapy for high-risk, early-stage, HER2-positive breast cancer patients.

BackgroundThe majority of breast cancer patients in Jordan are diagnosed at a young age and present with metastatic or locally advanced disease. The National Surgical Adjuvant Breast and Bowel Project Protocol B27 (NSABP-B27) (four cycles of adriamycin and cyclophosphamide [AC] followed by four cycles of docetaxel) is a standard neoadjuvant regimen in our institution. In this study, we report the efficacy of adding trastuzumab to docetaxel in this regimen for high-risk human epidermal growth factor receptor 2 (HER2)-positive early-stage disease.Patients and methodsConsecutive HER2-positive breast cancer patients treated with this regimen were included. Treatment was given at standard doses and schedules as reported in NSABP-B27. Trastuzumab was given with docetaxel and then continued for 1 year.ResultsA total of 121 patients (mean age 45.4 years) were included. The majority had high-risk features including large tumor size, positive axillary lymph nodes, and grade III disease. Three patients did not complete the planned cycles of AC due to a lack of response. Eight (6.6%) patients missed at least one cycle of docetaxel. Following neoadjuvant therapy, 119 patients underwent surgery, of whom 59 (49.6%) patients achieved pathological complete response. The response was higher in node-negative patients (64.0 vs 45.7%; P=0.03) and in hormone receptor-negative disease patients (69.7 vs 41.9%; P=0.018). Breast-conserving surgery was performed in 21.5% of the patients. The median disease-free survival (DFS) for the whole group was not reached while the 3- and 5-year DFS rates were 84.2 and 74.1%, respectively.ConclusionTrastuzumab added to the NSABP-B27 regimen is a unique combination. When used in high-risk patients, as in our study, outcomes similar to reported data were achieved without unexpected toxicities.

Germline BRCA1/BRCA2 mutations among high risk breast cancer patients in Jordan

BackgroundBreast cancer is the most common malignancy and the leading cause of cancer-related deaths among Jordanian women. With a median age of 50 years at diagnosis, a higher prevalence of hereditary breast cancer may be expected. The objective of this pilot study is to evaluate, for the first time, the contribution of germline mutations in BRCA1/2 to breast cancer among Jordanian patients.MethodsJordanian breast cancer women with a selected high risk profile were invited to participate. Peripheral blood samples were obtained for DNA extraction. A detailed 3-generation family history was also collected. BRCA sequencing was performed at a reference laboratory. Mutations were classified as deleterious, suspected deleterious, variant of uncertain significance or favor polymorphisms. Patients’ medical records were reviewed for extraction of clinical and tumor pathology data.ResultsOne hundred patients were enrolled to the study. Median age was 40 (22–75) years. In total, 20 patients had deleterious and 7 suspected deleterious mutations in BRCA1 or BRCA2 genes. Seven variants of uncertain significance were also detected. After excluding patients tested subsequent to the index case in their families, highest mutation rates were observed among triple negatives (9/16, 56.3%) especially among those with positive family history of breast and/or ovarian cancer (9/13, 69.2%), patients with bilateral or second primary breast cancer (10/15, 66.7%) and those with family history of male breast cancer (2/5, 40.0%).ConclusionsBRCA1/2 mutations are not uncommon among selected Jordanian females with breast cancer. The contribution of these findings to much younger age at diagnosis is debatable.Although small, our selected patient cohort shows an important incidence of deleterious and suspected deleterious BRCA1/2 mutations suggesting that genetic testing should be offered to patients with certain high risk features.

The prevalence and predictors of emotional distress and social difficulties among surviving cancer patients in Jordan.

This study examines the prevalence and degree of emotional distress, anxiety and depression, and social difficulties and their effect on cancer patients' quality of life (QoL). It describes the characteristics of patients who are at high risk of emotional distress. A descriptive cross-sectional design was used. A total of 226 patients with cancer completed the Hospital Anxiety and Depression scale (HAD), social difficulties inventory, comfort scale and EORTC-QoL-C30. Anxiety and depression were identified using the internationally recognized cut-off points of HAD-A ≥ 8 and HAD-D≥ 8. Adjusted odd ratio was calculated using socio-demographic and clinical factors. Both anxiety and depression were common among Jordanian cancer patients, although depression was the main emotional problem with a higher prevalence than anxiety (67.6% vs. 43%). Patients with anxiety or depression were more likely to have lower QoL scores and higher scores for complaints about symptoms. They were more likely to have social difficulties in everyday life. The results of logistic regression indicated that a high depression score was predicted by older age, a poor QOL total score, and a high social difficulty score. A high anxiety score was predicted by advanced cancer stage, in female patients, hospital readmission and a poor QOL total score. The significant level of emotional distress among cancer patients highlighted the importance of early assessment and identification of patients at greater risk of emotional distress, those with an advanced stage of cancer, having a poor quality of life and serious social difficulties.

The Level of Pain and Anxiety and Depression and its Relationship to the Coping Strategies Used by a Sample of Cancer Patients in Jordan

يخلق الألم المرتبط بالسرطان أعباء جسدية ونفسية اجتماعية جسيمة للمرضى في الأردن، ولكن هناك محدودية في المعلومات حول شكاوى مرضى السرطان و إستراتيجيات مواجهة الألم لهذا المرض . هدفت الدراسة إلى تقييم الألم المرتبط بالسرطان، وتحديد استراتيجيات المواجهة التي تستخدمها عينة من المرضى الأردنيين المصابين بالسرطان والذين يعانون من الألم. وأيضاً هدفت لتحديد الارتباط بين كل من الألم والقلق والاكتئاب وإستراتيجيات المواجهة. الإجراءات: تم استخدام التصميم المستعرض، الوصفي، وذلك من خلال المقابلة والاستبيان المنظم مع عينة من 100 مريض مصاب بالسرطان في عيادة الألم من مركز الحسين للسرطان في الأردن. اُستخدمت قائمة تقييم الألم، ومقياس قلق واكتئاب المستشفى، ومقياس إستراتيجيات التكيف المعرفية في جمع البيانات. النتائج: سجل ثلاثة وثمانون مريضاً معاناتهم من الألم ≥ 5. 82 وذكر ≥ 8 أنهم يعانون من القلق، أما الاكتئاب ≥ 8 على مقياس. وقد كان هناك ارتباط كبير بين الألم والقلق والاكتئاب (ع &lt;0.05) من استراتيجيات المواجهة المختلفة كان هناك ارتباط كبير بين الألم والقلق والاكتئاب والكارثية كاستراتيجيات مواجهة (ع &lt;0.05). الخلاصة: في حين أن العديد من العوامل النفسية تؤثر على إدراك المرضى للإحساس بالألم وسلوكهم الناتج، تفترض هذه الدراسة أنه يمكن أن يكون فعالاً تقديم استراتيجيات التكيف قبل أن يصل الألم لدى المرضى لمستويات حرجة وذلك للحد من شدة القلق والاكتئاب لديهم. وينبغي أن تتضمن إدارة الألم تقييم للعوامل النفسية والاجتماعية والتي غالبا ما ترتبط بالألم.