ABSTRACT
BACKGROUND: Breast cancer (BC) is a prevalent form of cancer and a leading cause of death among women worldwide. In Saudi Arabia, it accounted for 31.8% among females of all new cancer cases reported in 2018. Following the declaration of COVID-19 as a global pandemic, there was a complete redistribution of healthcare resources to face this crisis, which caused a significant delay in the management of various diseases, including BC. There is currently a lack of research in our region on the facility time interval in BC management. Therefore, this study aimed to fill this gap by determining the timelines of diagnosis, management, and factors influencing the delay. METHODS: This observational retrospective study included all female patients diagnosed with BC at or referred to King Abdullah Medical City (KAMC) in Makkah, Saudi Arabia, between January 2020 and August 2021. The data for this study were obtained from a centralized electronic chart review of all included patients at the KAMC center. RESULTS: A total of 76 patients were included in the study, with a mean age of 50 ± 11 years. In terms of the disease management duration, 20 patients (26.3%) completed their management within 30 days, 28 patients (36.8%) had a management duration between 31 and 60 days, and the management duration of 28 patients (36.8%) exceeded 60 days. Patient deposition showed a significant association with delay (p = 0.033). A higher incidence of delays at the initiation of treatment was observed in patients who failed to attend appointments (p < 0.001). Among patients who skipped two or more appointments, 12 individuals (80%) experienced a delay of more than 60 days. Moreover, appointment cancellation was associated with delayed treatment initiation (p = 0.03). Patients' age and comorbidity showed no significant association (p = 0.49, p = 0.24, respectively). CONCLUSION: Our findings highlight the significant impact of patient deposition and canceled or skipped appointments on delayed initiation of therapy for BC patients. Further research should be conducted to evaluate the impact of COVID-19 on other malignancies.
ABSTRACT
INTRODUCTION: While hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreduction surgery (CRS) has been shown to improve patient survival and disease-free progression in peritoneal carcinoma (PC) patients, the procedure relates to a high postoperative infection rate. Herein, we report the bacterial and fungal infections after CRS and HIPEC from a single institution in Saudi Arabia. PATIENTS AND METHODS: A prospective observational study was conducted on 38 patients with PC selected for CRS/HIPEC procedure between 2012 and 2015 in our centre. RESULTS: Postoperative bacterial and fungal infection within 100 days was 42.2%, bacterial infection was reported always, and fungal infection was reported in 5 (13.2%) cases. Infections from the surgical site were considered the most common infection site. Multidrug-resistant extended-spectrum beta-lactamase (ESBL) Escherichia coli was the most frequent isolate, followed by multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Lower preoperative albumin and a prolonged preoperative activated partial thromboplastin time (APTT) are associated with postoperative infections, while a prolonged preoperative hospital stay (hazard ratio (HR) = 1.064; confidence interval (CI) = 1.002-1.112; P=0.042) and more intraoperative blood loss (>10%) (HR = 3.919; 95% CI = 1.024-14.995; P=0.046) were independent risk factors for postoperative infections. Three cases died during the follow-up period; all were due to infection. DISCUSSION: The infection rate in our centre compared to previous studies of comparable patients was matching. Effective management of postoperative infections should be considered, and identified risk factors in this study can help to focus on effective prevention and treatment strategies.
ABSTRACT
INTRODUCTION: The combined approach of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has achieved encouraging outcomes for patients with PMCA with peritoneal dissemination. However, there is little evidence for the use of EPIC in addition to HIPEC in this group of patients. PATIENTS AND METHODS: This was a retrospective study of prospectively collected data of consecutive patients with PMCA who underwent CRS and perioperative intraperitoneal chemotherapy by one surgical team at St George Hospital in Sydney, Australia between Jan 1996 and Aug 2016. RESULTS: A total of 185 patients formed the cohort of this study. However, there was no significant difference in terms of hospital mortality (p = 0.632), major morbidity rate (i.e. Grade III/IV) (p = 0.444), intensive unit care stay (p = 0.638) and total hospital stay (p = 0.0.078). However, patients who received HIPEC and EPIC had a significant longer stay in high dependency unit (p < 0.001). Multivariate analysis showed combined HIPEC with EPIC is an independent prognostic factor for better overall survival (Hazard ratio (HR) = 0.42, 95% confidence interval (CI) = 0.19-0.92, P = 0.030) and disease free survival (HR = 0.66, 95%CI = 0.44-0.99, p = 0.045), adjusted for age, sex, peritoneal cancer index, completeness of cytoreduction score, CEA ≥ 6.5 mg/L, CA19-9 ≥ 24.0 U/mL and CA125 ≥ 32.0 U/mL. CONCLUSIONS: In summary, the combination of HIPEC and EPIC could potentially provide additional survival benefit for patients with PMCA with peritoneal spread as compared to HIPEC alone without increasing postoperative morbidity and mortality. More studies are warranted to further confirm the potential benefits of EPIC in PMCA and address the question of optimal drug and/or duration of EPIC.
