[What could be the contribution of general practitioners in the management of cancer patients from the central region of Tunisia: a retrospective study about 215 physicians]

Objective: To evaluate the contribution of general practitioners of the public and private sectors in the management of cancer patients during and after the treatment protocol. To analyze the problems they encounter and find the possible solutions

Method: A retrospective declarative KAP [Knowledge, Attitudes and Practices] survey was conducted from first September 2010 to 28 February 2011 in the central region of Tunisia among 215 primary care physicians in the public and private sectors. The questionnaire focused on their effective involvement, the role during treatment, follow up and supportive care

Results: Nearly 80% of physicians who participated in the survey were involved in the management of their patients, primarily by ensuring adherence to their treatment [42.9%], in the follow up care after treatment [42.3%] and in palliative care [29%], however the majority has never prescribed opioid drugs [66.5%]. Only 46.6% of the physicians announced the diagnosis of cancer to their patients. The questioned doctors deplored the lack of training in oncology [22.8%] and the feeling of being excluded from the management of their patients once they have addressed them to their specialist peers [48.8%]. The interviewed physicians expressed their wish to have a further medical training in oncology [79.5%] and to join a structured cancer network [55.8%]

Conclusion: The majority of interviewed general practitioners of our region were engaged in cancer patients' care. However, gaps were identified especially in palliative care and in prescribing opioid drugs. Promoting continuing education in this field and the establishment of cancer networks will allow extend the scope of general practitioners' intervention in the cancer network

Assessment of MYCN amplification status in Tunisian neuroblastoma: CISH and MLPA combining approach

Background: Neuroblastoma [NB] shows a complex combination of genetic aberrations. Some of them represent poor genetic prognosis factors that require specific and intensive chemotherapy. MYCN amplification consists of the major bad outcome prognostic factor, it is indeed frequently observed in aggressive neuroblastomas. To date different methods are used for MYCN status detection

Objectives: The primary aim of our study was to provide a critical assessment of MYCN status using 2 molecular techniques CISH and MLPA. We also focused on the correlation between neuroblastoma genetic markers and patient's clinical course among 15 Tunisian patients

Methods: we developed a descriptive study that includes 15 pediatric Tunisian patients referred to our laboratory from 2004 to 2011. We reported the analysis of fresh and FFPE NB tumors tissues

Results:No significant correlation was found between COG grade and patients overall survival. Assessment of NMYC gene copy number by kappa statistic test revealed high concordance between CISH and MLPA tests [kappa coefficient = 0.02]

Conclusion: Despite misdiagnosing of MYCN status fewer than 5 copies, MLPA remains an effective molecular technique that enables a large panel of genomic aberrations screening. Thus combining CISH and MLPA is an effective molecular approach adopted in our laboratory. Our results allow pediatric oncologists to set up the first Neuroblastoma therapeutic strategy based on molecular markers in Tunisia

[Reasons of diagnosis delay of breast cancer in Tunisian women [160 patients in central region of Tunisia]]

The diagnosis of breast cancer is, in Tunisia, still done at a late stage. To identify the principal obstacles against early diagnosis of breast cancer for patients consulting at advanced locally stage or with metastasis. We have asked 160 patients with breast cancer showing local T3 or T4 evolution or metastasis at the time of diagnosis, about reasons for the late diagnosis of their breast cancer. The average delay in consultation was 11.6 months and the average size of the tumor was 6.3 cm. The cause of delays in diagnosis was, in 92.5% of cases linked to the patient, and in 24% of case to medical personnel. Two many causes found in patients were:- a none-attribution of the symptoms as cancer [35%], and the absence of self-examination of the breasts [23.5%]. A comparison of patients according to the cause of delay demonstrated that the distance from a medical centre is more frequent in the case of medical delays, the level of education is lower in patients who fail to carry out self-examination, the more frequent relevant family history of patients who have not attributed the symptoms to cancer, and the relative distance from a medical centre is more pronounced in women in difficult financial circumstances. Changing patient behaviour by public health education, besides professional educational programs could help to ovoid diagnosis delay of breast cancer in Tunisia and improve its outcome

Quality of life in patients with colo-rectal cancers in the region of tunisian center. a case witness study with a healthy population unhurt of cancer

The aim of our study is to value the quality of life [QOL] in patients with colo-rectal cancers in the region of tunisian center and to compare it to the QOL in a healthy population unhurt of cancer. Our population is made by 80 patients treated for colo-ractal cancers. The population witness includes 80 healthy individuals unhurt of cancers. The assessment of the QOL in patients is achieved with the specific colo-rectal cancer questionnaire: the FACT-C. The comparison of the QOL in the 2 populations is made by the general questionnaire of quality of life of Spitzer. The QOL in patients is good in 55% of cases, average in 44% of cases and bad in 11% of cases. The QOL is better in case of favourable socioeconomic conditions [p< 0,05], colic localization [p < 0,015], absence of metastases [p< 0,05], not mutilating surgery [p< 0,01] especially the absence of stoma [p< 0,001] and the restoring of the continuity [p< 0,002], absence of pain [p < 0,0001], absence of current treatment [p< 0,01]. The comparison of the different domains of QOL between the 2 groups [patients and healthy] finds a better QOL in healthy group, in all domains except for the relational ship domain witch turned to be comparable for the 2 samples

Local Regional Recurrance of Breast cancer in Tunisian Center

To evaluate locoregional recurrence rate of breast cancer, determine its anatomoclinical characteristics and discuss the available therapeutic alternatives. Patients and methods A retrospective study including 41 patients with LRR following modified radical mastectomy or conservative surgery of invasive breast carcinoma without metastasis, between January 1993 and December 2002. 38 cases of LRR occurred after mastectomy and 3 cases after conservative surgery. LRR rate was 4.84%. mean follow-up 44.7 months. Mean age of patients was 45 years and LRR mean occurrence time-interval 22.4 months. Recurrence was parietal in 25 cases, mammary in 2 cases, and nodal in 14 cases. 18 patients had to be operated on. Conclusion Prognosis of breast cancer depends on distant metastasis. LRR constitutes the second major risk liable to influence the overall prognosis

[Knowledge, attitude and behavior about the inherited population to cancer. A survery of a population without any history of cancer in central Tunisia]

The genetic bases of inherited predisposition to cancer are now established. The aim of our study is to value the knowledge, attitude and behavior of the general population about the inherited predisposition to cancer. Our study involved a population of 200 individuals. without any history of cancer. The mean age of our population was 37.5 years [18 to 74 years]. The education level was low in 62.5% of cases [Illiterate or primary education]. About knowledge heredity was considered a predisposing factor to cancer by 42.5% of the respondents. About attitude: we noted a cancerophobia in 82% of cases. 86.5% of our respondents thought that an early diagnosis increased the chance of recovery. About behavior: 72.5% of the studied population wished to know if they were predisposed to develop cancer. In case of pregnancy 79% wished to know if the foetus was a cancer gene predisposition carrier. 28% would keep this foetus in case of positive genetic testing. These results are encouraging to develop ontogenetic counselling in Tunisia

Les predispositions hereditaires aux cancers du sein: profils epidemiologique et anatomoclinique de 11 familles dans le centre Tunisien

Five to 10% of women with breast cancer have a positive family history of breast cancer [9.1% in our study]. We designed a comparative study to investigate the potential differences of epidemiologic, clinicopathologic profiles between patients with sporadic breast cancer and those with hereditary breast cancer. Eleven case families [of 27 patients living in the central region of Tunisia occured during the period between 1990 to 1995] are included in the study. Compared to sporadic breast cancer patients, those with hereditary breast cancer are characterized by younger ages of the cancer onset [p = 0.04], higher social and economic situations [p = 0.005], lower pregnancy rate and lower tumor size [p = 0.005]. a good knowledge of genetic factors involved in breast cancer may have important consequences in screening high risk individuals from affected families