RESUMEN
BACKGROUND: Cancer is a major cause of disease burden in Pakistan, so that knowledge of physicians about all aspects should be adequate, especially for palliative care for end stage management, given the generally late stage presentation. METHODOLOGY: A cross-sectional study was conducted in three tertiary care hospitals and areas of general practice in Pakistan. RESULTS: A total of 236 non-oncologist physicians were assessed. Most of them claimed to have cared for cancer patients in someway and considered that cancer treatment is often long and protracted. However, one-third were unaware of the fact that cancer is a major disease burden in our society. About half of them thought that chemotherapy makes patients miserable. Oncology as a practice was considered financially of low reward by about a quarter. Most physicians, including consultants, were unaware of the term hospice. Many did not know where to refer cases of cancer and about the commonest cancers in Pakistani males. CONCLUSIONS: Awareness about cancer and palliative care among primary physicians needs to be improved for cancer prevention and control.
RESUMEN
INTRODUCTION: Febrile neutropenia (FN) is a major complication of chemotherapy, costly in terms of morbidity, mortality and associated financial expenditure. The present study was conducted with the goal of highlighting FN as a serious problem in Pakistan, with the longer term objective of improved cancer survival, reduction in length of stay (LOS) in hospital, morbidity, mortality and costs in our existing developing country scenario. METHODS: A cross-sectional descriptive study was conducted on patients, > or =18 years, admitted with FN as a consequence of chemotherapy at a referral hospital in Karachi from 1st September 2006 to 30th April 2007. RESULTS: A total of 80 patients [43 (53.8%) males and 37 (46.2%) females] were selected. The mean age was 47.4 (SD +/-16.6; range 18-79) years. Sixty eight patients (86%) were < or = 65 years, 50% were < or = 50 years. Overall, inhospital mortality was 11%; 4% for patients on granulocyte colony stimulating factor (G-CSF) prophylaxis as against 20% for those without. The cause of death was either pneumonia or septic shock. Mean LOS was 7.53 (SD +/-3.8; range 2-17) days. Hematological malignancies, older age, severity of dehydration, pneumonia and culture positivity were significantly associated with LOS and death. Those above 50 years of age were 1.5 times as likely to be hospitalized longer and > three times as likely to die. Bacteremia conferred a 5-fold and pneumonia an 8-fold increase in the risk of death. CONCLUSION: The results of this study indicate that age, vital instability, dehydration, high creatinine, culture positivity and hematological malignancies are high risk factors in chemotherapy induced FN. Identification of FN risk factors with poor outcomes may help in devising protocols for modified dosage or including GCFs initially. This may help reduce the cost of cancer care as well as mortality and morbidity. Prospective studies of FN in multiple centers in Pakistan may be beneficial in evaluating these risk factors further.