RESUMO
Objective Epithelial ovarian cancer (EOC) is common among ovarian cancers. The majority of existing literature shows combined data of stage III and stage IV. Therefore, we aimed to look for whether achieving complete radiological and biochemical response after initial treatment of stage IV epithelial ovarian cancer as a predictor of long-term survival in the Pakistani population. Methods A cross-sectional study was conducted of patients with stage IV epithelial ovarian cancer diagnosed and treated from 2006-2013 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. Overall survival was defined as the number of months between patients' diagnosis at the hospital and any cause of death or last follow-up date. Kaplan Meier curve was used to report the overall survival. The log-rank test was used to distinguish the survival difference in complete and no complete response. P-value <0.05 was considered statistically significant. Result A total of fifty patients of stage IV epithelial ovarian carcinoma, with a mean age of 53 ± 2 received neoadjuvant chemotherapy and suitable patients underwent interval-debulking surgery. Among these fifty patients, twenty-one (42%) patients who achieved complete radiological and biochemical response had a median survival of greater than five years. Patients without co-morbidities (46%) and having good performance status (52%) showed better results of the treatment. Patients' tolerance to chemotherapy with good response and fit enough to undergo interval-debulking surgery, achieving complete radiological and biochemical response after initial induction therapy were significantly associated with long-term survival (P<0.05). Conclusion Outcomes of patients who present with stage IV EOC remains dismal. Patients who achieved complete radiological and biochemical response after neoadjuvant chemotherapy and interval-debulking surgery was significantly associated with long-term survival.
RESUMO
BACKGROUND: Punjab is the most populous province of Pakistan, with only 12 countries in the world succeeding it in terms of population. AIMS: This review article has the objective of providing novel statistics regarding available cancer therapeutics in Punjab across four different sectors-including government, semi-private, trust and private sectors. METHODS AND RESULTS: Keywords such as "cancer treatment," "facilities," "Pakistan," were used to search Pubmed Database. 36 results were generated: after sifting based on a personal reference list as well as for relevance, 16 articles were finally reviewed. Novel statistics regarding current state of access to cancer facilities were drawn from personal references as well as from studies conducted in other LMICs. There is a gross deficit of oncological services in Punjab, with the ratio of medical oncologists to population being 0.027 per 100, 000, and every oncologist checking 1300-1500 patients annually. Only 21.4% of the population has access to radiotherapy facilities. Major problems include lack of healthcare professional awareness; poor infrastructure including drug access, radiotherapy, and cancer pain management facilities; lack of planning; and lack of educational and research programs. CONCLUSIONS: Improving education & training, developing infrastructure based on public-private-partnership models, building cancer registries and organizing national cancer screening programs, as well as encouraging basic health education and research in oncology, are measures that can ensure Punjab's healthcare delivery system becomes capable of handling increasing incident burden of cancer.
