Truth-telling in Oncology: Egyptian Patients' Attitudes and Preferences.

OBJECTIVE: Truth-telling in oncology is a major challenge, particularly in the absence of disclosure protocols in Egypt and the lack of Egyptian studies examining patients' preferences regarding cancer disclosure. This study aimed to reveal the preferences of patients seeking care at the National Cancer Institute - Cairo University regarding disclosing cancer diagnosis and the type and amount of information to be told. METHODS: This cross-sectional study was conducted on 200 patients selected consecutively from those attending the outpatient clinics of the National Cancer Institute - Cairo University. Face-to-face interviews were performed with the patients according to a structured questionnaire. The questionnaire consisted of five parts: socio-demographic characteristics, knowledge about cancer disease, attitudes towards cancer disease, experience during the disclosure of the diagnosis, and preferences regarding disclosure of cancer diagnosis. RESULTS: Most patients (89.5%) preferred to know the diagnosis. Of them, 94.4% wished to know from the physician. No agreement was found between most patients' preferences and physicians' practice. On multivariate logistic regression analysis, patients' education was the only significant predictor of the preference to know the diagnosis (OR = 5.298, 95% CI = 1.258 - 22.301, P = 0.023). CONCLUSION: Patients have a great desire to know the diagnosis and other information related to treatment and prognosis.

Pitfalls in scientific research: critical appraisal of articles published in one of the international journals in Egypt.

BACKGROUND: To identify and report flaws of Internet-published articles in the Journal of the Egyptian National Cancer Institute (JENCI), Cairo University, through a retrospective documentary study on articles published during the period from 2011 to 2016. All sections were reviewed against a collective checklist. Articles were grouped by publication year into 2 intervals: early (from 2011 to 2013) and recent (from 2014 to 2016) to identify changes in study characteristics over time. RESULTS: The study included 139 original articles. Half of the titles represented aim and 9.4% represented study design. Abstracts were concise, clear, with structured writing format in 98.6%, 93.5%, and 35.3%, respectively. Most introductions included the study aim, while 41% had a rationale. Study timing was reported in 59.0%, while the study design was reported in 25.9%. Inclusion and exclusion criteria were clearly reported in 43.1% and 40.1%, respectively. Statistical methods were mentioned in 80.6%, complete in 30.4%, and appropriate in 85.7%. Four studies reported sample size estimation. Only 52.5% and 58.3% of results were exhaustive and answer the research question, respectively. Incorrect statistical calculations occurred in 41.0%, inappropriate statistical tests or descriptive parameter selection in 26.6%, while inappropriate test application occurred in 49.1%. About 60% of discussions did not completely cover results, 31.7% fully justified the findings, 56.1% followed a logical flow, and 36.7% had contradiction within the text. Conclusions were mostly linked to aim, imprecise, and extrapolating beyond results. On comparing both periods, only a significant less misuse of statistical terms, more reporting conflict of interest, more missing references for cited texts in the recent period, and more participation of NCI over other institutes in the early period were found. CONCLUSION: Articles published in JENCI (from 2011 to 2016) had many methodological and reporting defects and some points of strength. Using the collective checklist developed by this study, continuous training of researchers, involving epidemiologists throughout the whole research process, and applying strict journal reporting and publication rules should be encouraged.

Cancer incidence in egypt: results of the national population-based cancer registry program.

Background. This paper aims to present cancer incidence rates at national and regional level of Egypt, based upon results of National Cancer Registry Program (NCRP). Methods. NCRP stratified Egypt into 3 geographical strata: lower, middle, and upper. One governorate represented each region. Abstractors collected data from medical records of cancer centers, national tertiary care institutions, Health Insurance Organization, Government-Subsidized Treatment Program, and death records. Data entry was online. Incidence rates were calculated at a regional and a national level. Future projection up to 2050 was also calculated. Results. Age-standardized incidence rates per 100,000 were 166.6 (both sexes), 175.9 (males), and 157.0 (females). Commonest sites were liver (23.8%), breast (15.4%), and bladder (6.9%) (both sexes): liver (33.6%) and bladder (10.7%) among men, and breast (32.0%) and liver (13.5%) among women. By 2050, a 3-fold increase in incident cancer relative to 2013 was estimated. Conclusion. These data are the only available cancer rates at national and regional levels of Egypt. The pattern of cancer indicated the increased burden of liver cancer. Breast cancer occupied the second rank. Study of rates of individual sites of cancer might help in giving clues for preventive programs.

Age at diagnosis in women with non-metastatic breast cancer: Is it related to prognosis?

OBJECTIVE: Primary objective was to verify whether breast cancer patients aged less than 40 years at diagnosis have poorer prognosis than older patients. Secondary to assess prognostic factors influencing disease free survival. METHODS: 941 women were diagnosed with non-metastatic breast cancer at NCI, Cairo in 2003. Epidemiologic, clinico-pathological characteristics, treatment modalities and disease free survival were compared among the two age groups. Prognostic factors were evaluated for association with disease-free survival. RESULTS: One hundred-eighty-one patients (19.2%) were younger than 40 years and 760 (80.8%) were older. Older women presented with higher rates of comorbidities and younger women presented with more hormone non-responsive tumors. Young women presented with larger tumors pT4=13.8% compared to 8.6% in older women, yet not significant. Young women were treated with more conservative surgery, more adjuvant chemotherapy and radiotherapy while older women with more radical mastectomies and more hormonal treatment. Recurrence rates were significantly higher among young women 44.2% compared to 34.5% in older women. Five year disease free survival in young women was 38.9% ± 4.6% compared to 48.6% ± 2.5% with adjusted hazard ratio of 1.22 95% CI (0.91-1.64), p=0.19. Multivariate analyses identified positive axillary lymph nodes (pN2-pN3), larger tumor size (pT3-pT4), hypertension, lobular carcinoma type and lack of adjuvant systemic treatment as independent factors associated with poor DFS. CONCLUSION: Young women were not found to have poorer prognosis, yet they presented with more ER negative tumors. Most of women presented with advanced stage and young women had higher recurrence rates.