Journal Issue: Vol.1, No.1 - June 2000

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Cancer Problem: Developed vs Developing

Dr Thomas Koilparampil

  1. Dr Thomas Koilparampil
    MD, FRCS
    Chief Editor, Austral-Asian Journal of Cancer

?Austral-Asian Journal of Cancer? is the first multi-disciplinary, peer reviewed, International cancer journal, released jointly from Asia and Australia. The major objective of the journal is to highlight the effects of cancer in the Australia and Asian countries where more than 60% of the world?s population reside. The economies in these countries range from the most affluent to below the poverty line. It is quite possible that 1/3 of the total caner patients in the next century will be from Asia and Australia. However, the developing countries have only 5% of the resources of the world for cancer treatment. With this meager resource, a therapy oriented cancer control strategy will be fruitless. Intervention programs be introduced for preventable cancers such as a strong anti tobacco program. This is applicable in both Asia and Australia. At present, early cancer detection programs and anti-tobacco campaign are not part of health care delivery system in Asia and Australia. While making efforts to integrate this with the health care system, early awareness program focusing on the effects of cancer can be started immediately with coverage through various media including electronic media. This will encourage people to acquire treatment at early stages of the disease. Sixty percent of the patients who develop cancer in Asia are treatable with radiation even now if detected early. The numbers of radiotherapy equipments available in South Asia are far too few to treat the South Asian population. Imported equipments are extremely costly and not affordable to these countries. Hence local manufacturing of equipments at subsidized cost in countries where technology is highly developed will be the remedy. Asia requires more than 3,000 such units, whereas at present it has only 500. Alternative therapy like chemotherapy cannot also be offered because of prohibitive cost of drugs. Policies focused on curable cancers such as Childhood tumors, Leukemia and Lymphoma, and adult Germ Cell Tumors have to be formulated. Eighty percent of the cancer patients in Asia are seen in advanced stage of the disease where palliative care is possible. However, there is a need of early detection, prevention and cure. In most of the Asian countries cancer patients live with their families and the need of hospice becomes limited. Hence, there should be widespread education on palliative home care and the availability of analgesia for pain relief. Different analgesia are available in large quantities in Asia but it is deplorable that it is not made available to cancer patients for pain relief. Early detection and prevention programs are as relevant in developed world as are in the developing countries. Early detection of skin cancer and prostate cancer would give high cure rates. The anti-tobacco campaign should be included in school curriculum. The harmful effects of tobacco should be explained in schools where more than twenty percent of students smoke. Prohibition of smoking in school premises and public places in recommended.



Obstructions of Central Venous Catheters in Pediatric Cancer Patients: Comparison of a Port-A-Cath versus Broviac

Dr S Postovsky, Dr S Linn, Dr M Dinkin, Dr B Futerman, Dr E Kassis, G Shoshany, Dr L Hayari, Dr R Elhasid, Dr M Weyl Ben Arush

  1. Dr S Postovsky
    Rambam Medical Centre and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
  2. Dr S Linn
    Rambam Medical Centre and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
  3. Dr M Dinkin
    Rambam Medical Centre and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
  4. Dr B Futerman
    Rambam Medical Centre and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
  5. Dr E Kassis
    Rambam Medical Centre and Faculty of Medicine, Technion - Israel Institute of Technology,
  6. G Shoshany
    Rambam Medical Centre and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
  7. Dr L Hayari
    Rambam Medical Centre and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
  8. Dr R Elhasid
    Rambam Medical Centre and Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
  9. Dr M Weyl Ben Arush
    Department of Pediatric Oncology-Hematology, Rambam Medical Centre, Technion - Israel Institute of Technology, Haifa

Objectives: This study was undertaken to compare Port-a-Cath (P) and Broviac (B) central catheters (CVC) for the incidence of their obstructions and efficacy of reopening through the use of low dose urokinase(U). A total of 100 CVC obstructions due to thrombosis were registeredin 45 of 121 patients (pts) who received chemotherapy during the study period; 64 obstructions were in pts with B. Time elapsed from insertion of CVC until its obstruction was significantly shorter (p=0.016) in pts with B (mean 104.5 days (d) than in pts with P (mean 164.5d). Removal of CVC was required in 10 pts. Positive blood cultures taken from obstructed lumen were encountered in 18 pts. 1. Thrombotic complications of CVC are encountered frequently (37.2%) in pediatric oncologic pts, with the incidence of P obstruction significantly higher than that of B (85.3% vs 53.705, P <0.01). 2. Treatment with low dose U is very efficacious in restoration of patency of obstructed CVC. 3. Infectious causes of CVC thrombosis were identified in 18% of pts.

Self-Monitoring and Writing about Emotions to Manage Depression: A Tested Complementary Therapy

Prof Carol E Smith, Carolyn Holcroft, Shelby Rebeck, Noreen Thompson, Caren Dick

  1. Prof Carol E Smith
    RN, PhD
    University of Ka
  2. Carolyn Holcroft
  3. Shelby Rebeck
  4. Noreen Thompson
  5. Caren Dick

This article describes advances in testing a complementary therapy, writing about emotions or feelings to monitor mood. This therapy, is used to mange reactive depression, a frequently recurring co-morbidity of all chronic illnesses. Persons experience recurring reactive depression are at higher risk for diagnoses of major depression. Yet little research was available, until recently, on alternative therapies for treating depression. The objective of this paper is to review both theoretical and practical factors related to treating reactive depression with complementary writing therapy. A series of studies is reviewed with data reported specific to depression causes, frequency, and outcomes of writing therapy for self-management of a reactive depression. The study designs are descriptive correlational or prospective longitudinal trails of the complementary writing therapy. Study subjects include patients who are dependent on technological treatment for life-giving survival and their family members who assist with complex home care. Patient subjects require daily central venous catheter infusions of home parenteral nutrition (HTPN) due to non-malignant bowel diseases such as Crohns or ulcerative colitis. For these patients oral antidepressant medications are poorly absorbed and these medicines are not safe for intravenous administration. Family members become caregivers involved in this daily stringent schedule of complex home care that is fatiguing, worrisome, and often discouraging to them. Thus, alternative complementary therapies are essential to develop and test in both the patient and their family caregivers. Results from patient and family interview data from all studies in the series indicated depression was associated with the worry and family financial strain related to the chronic illness and complex expensive lifelong home care required. Missing out on activities and complications of treatment were themes written about often. Improvement use seen in depression and mood questionnaire scores following the complementary writing therapy. Improvement was evident in both patients and their family caregivers. The conclusion is that the use of complementary therapeutic writing is effective for managing the recurrent brief depression co-morbidites of chronic illness.

Experience with Prostate Cancer in Men Less than 50 years old in a Mexican Oncology Institution

Salazar De La Garza, Rios Jimenez, L Suchil Bernal, Martinez Valenzuela, Juarez Cervera, P Sanchez

  1. Salazar De La Garza
  2. Rios Jimenez
  3. L Suchil Bernal
  4. Martinez Valenzuela
  5. Juarez Cervera
  6. P Sanchez

Prostate cancer is a disease of older men. Some reports indicate that the survival in patients less than 50 years is not as good as older patients. We analyzed the experience with patients with prostate cancer aged 50 and under at the Instituto Nacional de Cancerologia in Mexico. We reviewed retrospectively all patients under 50 years old with prostate cancer with 1987-1998. Information obtained included demographic and clinical data. Among the 704 prostate cancer patients, we found seven cases less than 50 years old at the time of diagnosis. Age ranged from 40 to 49 years. None of them had family history of prostate cancer. Diagnosis was made by trans-rectal ultra-sonographic guided biopsy and trans-urethral resection. Most common clinical presentation was obstructive symptoms. Clinical staging revealed disseminated disease. Tumor grade was two and higher in six patients. Treatment was maximal androgen blockade in all. Five patients died of tumor and two survive longer than 5 years. In our study there is no evidence that prostate cancer is a different disease in younger men. The major objective in this group of patients is to establish a cure and increase the survival.

Kaposi's Sarcoma in African Women Before and During HIV/AIDS Epidemic

Hassan Amir, Ephata E Kaaya, G Kwesigabo, P Biberfeld

  1. Hassan Amir
  2. Ephata E Kaaya
  3. G Kwesigabo
  4. P Biberfeld

Since first described more than a century ago, Kaposi's sarcoma (KS) used to develop as an indolent disease in the limbs of elderly men and less often females, in certain (endemic) Mediterranean areas and in sub-Saharan African countries. A more aggressive form of KS appeared during the 80-ties, associated with acquired immunodeficiency syndrome (AIDS) and other immune suppression states. In this retrospective study (1968-95), clinical characteristics of 300 female adult cases of KS (?15 years) before and during the AIDS epidemic in Tanzania were compared. The total number of registered female KS cases/year increased from 36 to 64 percent during the AIDS epidemic (p=0.0001). Comparing KS prevalence in various age groups, it was clearly more prevalent among sexually active women, (60.2% before and (76.0%) during the HIV epidemic (p=0.003). The overall median age for KS among females was 40.0 years in the pre-AIDS period and this was significantly reduced to 30.5 years in the AIDS epidemic. A significant increase in oral (p=0.0085) and multiple skin lesions was seen (p=0.0001) and virtually absence of lymph node KS in the ongoing AIDS epidemic. The gender ration narrowed from a mean of 5.9:1 (? 500 before, to 2.5:1 (0.0001) during the AIDS epidemic. However this decrease in gender ratio was pronounced in the sexually active age groups (21-30 and 31-40) in both the study period. These findings are discussed in terms of the obvious importance of HIV and possible other STDs for the pathogenesis of KS particularly in women.

Late Sequelae in 171 Long-Term Survivors of Paediatric Cancer

Lourens de Jager, Geoffrey Falkson

  1. Lourens de Jager
  2. Geoffrey Falkson

The aim of this study was to document clinically, late sequelae of onco-therapy in long-term survivors of childhood malignancy, treated at the Department of Medical Oncology at the University of Pretoria. One hundred and seventy one long-term survivors were evaluated by interrogation, physical examination, and limited special investigations. Late-effects were documented in 28% of these survivors. The musculo-skeletal and integumentary systems were involved in 62% of all late sequelae. The second most common late effect was infertility, documented in 21% of married survivors. Three patients developed and malignant neoplasms. In comparing this study?s clinical findings with comparable literature reports, it has been concluded, that a great proportion of the debilitating late sequelae could be detected clinically, and confirmed with the availability of a few inexpensive, readily available, and easily performed special investigations. Certain sequelae may however, only be detected by more sophisticated evaluation procedures. As the community at large is increasingly becoming involved in the management and demands of these survivors, it is recommended that, in order to offer an efficient meaningful surveillance service to these long-term survivors, information gathered through such long-term survivor assessments should be communicated to all involved through training and education programs and all available media.

Gemcitabine: Cisplatin Combination Chemotherapy in Metastatic Non-Small Cell Lung Cancer

Dr Ofer Merimsky

  1. Dr Ofer Merimsky
    Department of Oncology, The Tel-Aviv Sourasky Medical Center,

The combination of gemcitabine plus cisplatin has been selected to be given as our first line service regimen for metastatic disease. Patients recruitment was almost with no exclusion criteria, except for disease-related Karnofsky?s performance status below 50%, the presence of central nervous system or spinal involvement by uncontrolled metastases, or creatinine clearance below 50mg/m2/min. Cisplatin 30mg/m2/d on days 1,8,15 every 4 weeks, were given on an outpatient schedule to patients with metastatic non-small cell lung cancer. Twenty five successive NSCLC patients with histologically or cytologically proven disease were treated. Adenocarcinoma was diagnosed in 32% of cases and squamous cell carcinoma in 68%. Smoking was reported by 72% of the patients. Various medical problems were recorded from 62% of the patients. All the patients were symptomatic. Two patients achieved complete response (8%), and 8 achieved partial response (32%) yielding an overall objective response rate of 40%. Minimal response was observed in 5 patients (20%) and disease stabilization in 4%. Adding the objective response rate to the minimal response stabilization rates, the disease-control (progression-free) rate reaches 64%. The median time to progression was more than 13 weeks. The overall survival of the group ranged from 4 to 98 weeks, with a median of more than 45 weeks. Clinical benefit response was observed mainly in patients who also achieved an objective response. Out-patient cisplatin plus gemcitabine comibination is feasible, efficacious and justified in patients with metastatic non-small cell lung cancer.

Messenger RNA Expression of MUC1 Splice Variants in Epithelial Ovarian Cancer Cell Lines

Dr Robert Zeillinger

  1. Dr Robert Zeillinger
    Department of Obstetrics and Gynecology, Division of Gynecology, Molecular Oncology Group, University of Vienna,

MUC1 has been shown to be the most appropriate epithelial cell-specific marker to highlight ovarian carcinoma cells. Due to alternative splicing, a considerable high number of MUC1 isoforms have been described previously. The present investigation describes patterns of the over-expression of MUC1 splice variants in human ovarian cancer cell lines. Seven ovarian cancer cell lines were investigated. RT PCR was carried out to determine MUC1 splice variants in all cell lines. Examining the cell lines SK-OV-3, PA-1, Caov-3, NIH:OVCAR-3, A2780 and A2780ADR we yielding different size products corresponding to the MUC1 splice variants A,B,C and D. In the PA1 cell line only variant B was not expressed, whereas in all other cell lines variant B was strongly expressed. In the SK-OV-3 cell line variant A was expressed to a higher extent compared to variant B, whereas in all other cell lines, Variant B was expressed to a higher content. MUC1/REP was expressed in all but one cell lines and MUC1/SEC was positive in all but two cell lines. Only two cell lines expressed MUC1/X, MUC1/Y, and MUC1/Z concomitantly. All other cell lines did not express any of these splice variants. We observed a 100% correlation of the expression of either MUC1/X, MUC1/Y, or MUC1/Z. MUC1 variants A, B, and REP could be demonstrated consistently among all seven ovarian cancer cell lines which we have examined. The present study describes the feasibility of detecting a large number of MUC1 variants, including MUC1 variant C and D which have been described in a publication for the first time. Further studies will examine the presence of MUC1 splice variants? expression in human ovarian cancer tissue.

Synchronous Presentation of Adenocarcinoma in Lung and Colon

Dr Hiroaki Satoh

  1. Dr Hiroaki Satoh
    Division of Respiratory, Medicine Institute of Clinical Medicine, University of Tsukuba,

A 58-year-old woman was admitted due to lung mass found on plain chest film in mass screening. Trans-bronchial biopsy showed lung adenocarcinoma. While working up for distant metastasis, CT scan of the abdomen showed tumor in ascending colon. Fiberscopic biopsy of the colon revealed adenocarcinoma. After surgical resection of colon cancer, surgery for lung cancer was carried out. It is extremely rare of find primary colon cancer incidentally during the work up for metastasis of lung cancer. How to approach synchronous primary lung cancer and colon cancer is discussed.

India Puts Science into Practice in Hi-Tech Radiotherapy

Mr Thayal Singh Elias, M Krishnan Nair, C A Davis, V Padmanabhan, G V Subrahmanyam

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