International Journal of Cancer Management
Volume:12 Issue: 2, Feb 2019

 Peaceful death is a primary goal in the philosophy of palliative care. However, there are some distressing situations that can cause this unachievable that are termed “dying process crises”. The leading causes are interrelated to cultural and religious backgrounds of different societies. The main causes of end of life crises are sought from integration of viewpoints of health care providers and extracted results are discussed as priorities for a future implication on a cancer end of life framework.  A literature search for was performed published English qualitative studies that measured challenges or crises of end of life care in dying patients in perspective of health care providers by interview-based content analysis approaches from January 2008 to March 2018 via PubMed, MedLine, Google Scholar, ScienceDirect, and PsycINFO databases.  Studies related to death in acute or non-hospital settings, hastened death, and structural or modeled studies were excluded. At the end, 8 articles were entered in the Meta-synthesis of qualitative studies.  The selected articles were repeatedly read and related themes to research question were extracted. Then, overarching themes were synthesized among descriptive themes of each article. The identified overarching themes were poorly controlled symptoms, unexpected death, time and facility constrains, lack of education or knowledge, weak coping skills, communication barriers, family conflicts, and systematic issues. By discussion on the cultural aspects and isolated palliative care framework of Iran, important priorities to prevent death crises were symptom management and appropriate communication skills. Regarding the themes in priority, planning educational programs for family meetings directed to the Iranian cultural and religious context, besides developing high quality cancer palliative services, are in a real necessity.

Breast cancer is the most prevalent cancer in women all over the world. The most common and effective treatment for the early stage of breast cancer patients is breast conserving surgery (BCS) followed by radiotherapy. The aim of this study is to evaluate and compare the dosimetric parameters of three-dimensional conformal radiation therapy (3D-CRT), using virtual wedge and field in field (FIF) techniques for patients having left breast cancer in early stages. Twenty-four patients with left breast cancer participated in this study. They were divided into thr3ee categories (small, medium, and large) based on breast volume: ≤ 1500 cc small, 1500 - 2000 cc medium, and > 2000 cc large. Two treatment planning techniques were generated for each patient by prowess treatment planning system. The following parameters were compared: Maximum, minimum, and mean dose in planning target volume (PTV), homogeneity (HI) and conformity indexes (CI), percentage of volume receiving greater than 107% of the prescribed dose (hot spots) and less than 95% of the prescribed dose (cold spots), and total monitor unit (MU) and doses received to organs at risks (OARs) such as heart and left lung. The mean values were compared using student’s t-test. The FIF technique reduced either the maximum dose in PTV or hot spots in all groups significantly (P < 0.05). Conformity index and cold spots in conformal technique were significantly better than FIF technique in all groups (P < 0.05). Other parameters such as MU, HI, and doses received by OARs did not show any significant difference between two methods in all groups (P > 0.05). It is recommended that two techniques can be combined and used together to cover their weak points. Also, it seems that if there is no equipment of intensity modulated radiation therapy (IMRT) techniques such as FIF in some centers, conformal technique by using virtual wedge is a proper alternative.

Despite major advances in cancer research, breast cancer still remains the most common cancer in women. Breast cancer is a heterogeneous disease, including at least 5 subtypes. Overexpression of human epidermal growth factor receptor 2 (HER2) in the patients denotes poor prognosis leading to a reduced survival rate compared to other subtypes of breast cancer. Therefore, HER2 can be a potential therapeutic target. To enhance the potency of HER2 blockers, the conjugation of specific cytotoxic agents with these types of anticancer agents may be successful. Application of antibody-based agents are important emerging anticancer therapies. One novel approach to increase the potency of monoclonal antibodies (mAbs) is combining them with toxic molecules. Pseudomonas exotoxin A (PE), ricin toxin (RT), and others in very minor quantities can be more potent and biologically active for this purpose. In this study, we used trastuzumab as a ligand for HER2 receptor along with Pseudomonas exotoxin A (PE38) and A subunit of Shiga toxin 2a (Stx2a). This fusion protein selectively bound to the HER2 receptor. Upon uptake by the target cells, apoptosis and cell eradication was observed. An in silico method was used before the in vitro study to illustrate the properties and construction of the protein. Physicochemical properties, structure, stability, and ligand-receptor interaction of this chimeric protein were predicted by means of computational and bioinformatics tools and servers. The results of this study showed that codon adaptation index of s1 and p2 fusion gene has improved to 0.98 and .99, respectively. The mfold result has revealed that s1 and p2 mRNA were stable sufficient for efficient translation in the new host. Based on Ramachandran plot, s1 and p2 were categorized as constant fusion protein. Finally, based on docking software analysis, the binding ability of Herceptin was robust enough to its receptor, so these constructs could be assigned as a new antitumor candidate in cancer therapy. The results suggested that s1 and p2 were stable fusion proteins with accurate affinity to the overexpressed receptors making them potential candidates for inducing apoptosis in breast cancer cells.

Cancer is considered one of the most important health issues in Iran. Regarding that Iranians have a positive attitude towards complementary medicine; the demand for this type of treatments is increasing. However, those undergoing this treatment often have limited awareness on it. This study aims at determining the perspective of cancer patients on using complementary medicine. In this descriptive study, 176 cancer patients from all over the country were selected by purposeful sampling, according to the inclusion criteria and, then, completed demographic characteristics questionnaire and the Questionnaire on Integrating Complementary Medicine in Oncology Treatment. The data were analyzed, using SPSS software version 20. More than half of the patients used complementary medicine and according to their viewpoints, using herbal medicine was considered their first priority. At the same time, 46% of the research samples consulted with care providers on how to use complementary medicine for cancer treatment. The most frequent referrals to specialists were referrals to complementary medicine experts. The researchers expected complementary medicine to improve their symptoms of anxiety, fatigue, and depression. The use of complementary medicine as a complementary approach in cancer patients can have an impact on the improvement of symptoms, which ultimately enhances the quality of life in patients. Due to the concerns about applying these approaches, it is necessary to train care providers in order to consider the perspective of cancer patients in this regard and to obtain their past medical history.

The use of chemotherapy drugs can affect the salivary characteristics of the affected patients and, consequently, cause a change in soft and hard tissues of these patients. The present study examines the changes in pH and sodium bicarbonate in saliva of patients with acute myeloid leukemia before and after chemotherapy. This study was conducted on 40 patients over the age of 18 years, including 24 men (60%) and 16 women (40%) with definite diagnosis of acute myeloid leukemia. After completing the consent forms, the patients participated in the study. In the first and the final sessions of chemotherapy, a sample of saliva was taken from the patients, and saliva flow, pH, and sodium bicarbonate were measured. Information were entered into the SPSS (version 16.0). Paired t test was analyzed and the results were recorded. Non-stimulated saliva flow, salivary pH, and sodium bicarbonate showed a significant decrease in all patients compared to pre-chemotherapy (P < 0.05). Regarding the role of saliva and its flow, pH and sodium bicarbonate in maintaining healthy hard, and soft tissues of the mouth, it is important to conduct similar studies with larger sample sizes to absorb therapists’ attention to this aspect of the complications of chemotherapy, which affect patient’s quality of life.

Fatigue, loss of sleep quality and resiliency are considered as some of the complications of androgen deprivation therapy (ADT) in metastatic prostate cancer. Third-wave therapies of psychology mainly help to increase well-being through expanded resilience. The present study aimed to comparing the effectiveness of mindfulness-based cognitive therapy (MBCT) with acceptance and commitment therapy (ACT) on severity of fatigue, sleep quality and the resiliency in a patient with prostate cancer. A 64-year-old man with localized prostate carcinoma was selected among respondent-driven sampling (RDS). He was treated with methadone after radical prostatectomy and was receiving the treatment for androgen deprivation therapy. After two 3-week baselines he received MBCT and ACT for three weeks. This A1B1C1A2B2C2 reversed design was along with a multiple baseline and a 6-month follow-up (during February to September 2015). The data were analyzed by means of a generalized estimation equation (GEE) and repeated measures correlation (rmcorr). The primary outcomes showed that both MBCT and ACT were effective on fatigue severity, sleep quality and resiliency (P < 0.01). There was no difference between the two treatments (P = 0.084) and the changes did not persist until follow-up stage (P > 0.01). Secondary outcomes showed that there is an inverse relationship between the severity of fatigue, sleep quality and the resiliency (P < 0.01). The findings of this study, consistent with the research background, suggested the effectiveness of third wave interventions in the improvement of psychological indices in patients with cancer.