Clinico-pathological presentation and therapeutic options for hairy cell leukemia

To look at clinical and hematological presentation as well as treatment outcome of patients with diagnosis of Hairy Cell Leukemia [HCL] in our population. All patients diagnosed with HCL by morphological and immunohistochemical methods presenting to Medical Oncology Ward at Hayatabad Medical Complex, Peshawar since August 2008 were included in the study. Out of 7 patients diagnosed with HCL, 6 were male and 1 was female [M:F ratio 6:1]. Median age at diagnosis was 44 years. Fever, pallor, palpitations and fatigue were the commonest presenting complaints. Spleenomegaly was noted in all patients [100%]. Pancytopenia was noted in all patients at presentation. Five patients were treated with Interferon while 2 were treated with Cladribine. At 18 months of follow-up, one out five patients treated with IFN had relapse while both the patients treated with Cladribine were in complete remission. Our study showed that HCL patients present at a younger age in our region but further studies with larger sample size are required to confirm this. All patients showed a complete response to Interferon and Cladribine with all patients alive at 18 months of follow-up.

Breaking bad news - perceptions of cancer patients and their relatives

To study the perceptions of cancer patients and their relatives regarding disclosure of cancer related information. A cross sectional survey was conducted at Medical Oncology Ward, Hayatabad Medical Complex, Peshawar from September 2009 to January 2011. A total of 114 patients and their relatives were interviewed using a pre-designed questionnaire. Eighty Three [73%] were male while 31 [27%] were female. Median age of cancer patients was 36 [18-70] years. Forty-eight percent [29/60] cancer patients wished for full disclosure of bad news while 39% [21/54] of their relatives wanted full disclosure [p= Not Significant]. Sixty two percent [37/60] cancer patients and 74% [40/54] relatives wanted to be informed in case of recurrence [p= Not Significant]. Over 90% of patients and relatives wanted bad news to be broken by a senior consultant. Fifty eight percent [35/60] cancer patients and 52% [28/54] relatives wished for their relatives to make treatment decisions for them [p= Not Significant]. However, 93% [56/60] of cancer patients and 78% [42/54] of their relatives wanted full information about all side-effects of treatment [p < 0.02]. Fifty eight percent [35/60] cancer patients and 32% [17/54] relatives wanted their close relatives to be present while bad news was being broken [p<0.007]. Almost half of patients wished for full disclosure of information regarding cancer diagnosis. Over 90% patients wanted full information regarding all side-effects of chemotherapy. It is recommended that training regarding how to break bad news be made mandatory part of our medical training both at undergraduate and postgraduate levels