The pattern of comorbidities in cancer patients in Lagos, South-Western Nigeria

Symptom representations in people with multimorbidity undergoing treatment for cancer: a qualitative descriptive study

PURPOSE

The symptom representations (i.e., beliefs and attitudes) that people with cancer hold about their symptom experience can impact how they self-manage their symptoms. Having two or more chronic conditions (multimorbidity) can complicate illness representations. Little is known about symptom representations in people with cancer and multimorbidity.

METHODS

This qualitative descriptive study was conducted with a sample of adults with a diagnosis of cancer and at least one additional chronic condition. Semi-structured interviews were conducted to understand their symptom representations. Leventhal's Common-Sense Model of Illness Representations (i.e., identity, consequences, cure/control, timeline, and cause) provided the guiding framework. A qualitative thematic analysis was used to identify codes, themes, and subthemes.

RESULTS

The mean age of the participants (n = 17) was 62.1 years and primary cancer sites were gastrointestinal, thoracic, or head/neck. Five themes were identified: (1) perceiving and living with symptoms, (2) being unable to do things, (3) self-management behaviors, (4) domino theory, and (5) a side effect of conditions. These themes aligned with Leventhal's Common-Sense Model dimensions. The interaction among diagnoses and multimorbidity was identified by a minority of participants.

CONCLUSION

People with cancer and multimorbidity described symptom representations primarily in the context of cancer. Consistent with previous research, symptoms negatively impacted their lives, and their representations include an understanding of how symptoms interact. Few participants described their symptoms within the larger context of multimorbidity. Future research is needed to determine how symptom representations impact their communication patterns with providers and coping behaviors.

The prevalence and correlates of comorbidities among patients with cancer attending a tertiary care cancer center in South India: An analytical cross-sectional study

Background

Comorbidities in patients with cancer can affect treatment, and should, therefore, be prioritized and managed.

Objectives

Our primary aim was to assess the prevalence of comorbidities among patients with cancer. The secondary objective was to identify the association of comorbidities with various sociodemographic and clinical variables.

Materials and Methods

This was a cross-sectional study conducted between December 2019 and March 2020 among patients with cancer, seeking treatment at Malabar Cancer Center, in Kannur District of northern Kerala in South India. Semi-structured interviews were conducted, and comorbidities were assessed using the Charlson Comorbidity Index. The anthropometric measurements were recorded using a standardized instrument and protocol.

Results

We enrolled 242 patients in this study. There were 148 (61.2%) female patients; 106 (43.8%) were aged between 41 and 50 years. Cancers of the head-and-neck and breast accounted for the majority of cases (23.1% each, n = 56), followed by the digestive system (18.6%, n = 45) and female reproductive system (11.2%, n = 27). The most common primary cancers in the head-and-neck, digestive, and female reproductive systems were oral, colorectal, and cervical, respectively. The prevalence of comorbidities among patients with cancer was 70.2% (n = 170). Common comorbidities were hypertension (n = 82 ; 33.9%), arthritis (n = 57; 23.6%), and diabetes (n = 53; 21.6%). After controlling for potential confounders, the factors noted to be independently associated with the presence of comorbidities were advanced age, family history of comorbidity, normal weight or underweight, and cancer treatment for more than 6 months' duration.

Conclusions

The high prevalence of comorbidities among patients with cancer suggests the need for an integrated system of care and management as the comorbidities affect the overall management of cancer treatment and care.

Quality of life among cancer patients at Queen Elizabeth and Kamuzu Central Hospitals in Malawi: a cross-sectional double-center study

Introduction

Many cancer patients experience psychosocial challenges that affect quality of life during the trajectory of their disease process. We aimed at estimating quality of life among cancer patients at two major tertiary hospitals in Malawi.

Methods

The study was conducted among 398 cancer patients using semi-structured questionnaire. Quality of life was measured using EQ-5D-3L instrument.

Results

Mean age was 45 years ± 12.77. Pain (44%) was the most prevalent problem experienced by cancer patients. About 23% had worst imaginable health status on the subjective visual analogues scale. Attending cancer services at QECH (AOR= 0.29, 95% CI: 0.17-0.54, p<0.001) and having normal weight (AOR=0.25, 95% CI: 0.08-0.74, p = 0.012), were associated with improved quality of life. A history of ever taken alcohol (AOR= 2.36, 95% CI: 1.02-5.44, p = 0.045) and multiple disease comorbidities (AOR= 3.78, 95% CI: 1.08-13.12, p = 0.037) were associated with poor quality of life.

Conclusion

Loss of earning, pain, marital strife, sexual dysfunction, were among the common psychosocial challenges experienced. History of ever taken alcohol and multiple comorbidities were associated with poor quality of life. There is need to integrate psychosocial solutions for cancer patients to improve their quality of life and outcomes.

Patient's Perspective on the Impact of COVID-19 on Cancer Treatment in Nigeria

Because of the global COVID-19 pandemic, health care organizations introduced guidelines for modifications to health and cancer medical care delivery to mitigate transmission and ensure quality health outcomes. To examine the extent and impact of these modifications on oncology service disruptions in Nigeria, we surveyed oncology patients across selected public and private cancer treatment centers.

Service interruptions because of the COVID-19 pandemic—Nigerian cancer patients' experience.

Burden of chronic disease comorbidities among cancer patients at Queen Elizabeth and Kamuzu Central Hospitals in Malawi: an exploratory cross-sectional study

Introduction

chronic disease comorbidities are common among cancer patients in most parts of the world, however; there are limited data on the same for Malawi. Comorbidities worsen clinical outcomes and are associated with lower quality of life among cancer patients. We aimed at estimating chronic disease comorbidities and associated factors among cancer patients attending oncology services at the Queen Elizabeth Hospital (QECH) and Kamuzu Central Hospital (KCH) in Blantyre and Lilongwe respectively.

Methods

we conducted a cross-sectional study at QECH and KCH in Malawi from January to March 2021. Participants were recruited using simple random sampling technique at the oncology clinics and were interviewed using structured questionnaires. The College of Medicine Research and Ethics Committee (COMREC) approved the study and informed consent was obtained with each participant. Data were analyzed in Stata version 14 and summary statistics were presented as frequencies and proportions.

Results

we interviewed 398 cancer patients and the mean age was 45.4years (SD± 12.77). The common cancers were cervical (30%), Kaposi´s sarcoma (24%), breast (11%), esophageal (4%) and leukemia (4%). The prevalence of chronic disease comorbidities was 61.56% (n=398) and common conditions included: HIV and AIDS (43%), depression (9%) hypertension (8%) and anemia (9%). Chronic disease comorbidities were significantly associated with formal employment (p<0.01) and obesity (p<0.02).

Conclusion

chronic disease comorbidities were prevalent among cancer patients in the study settings in Malawi. There is a need to develop a multidisciplinary approach when managing cancer patients with emphasis on active screening for the common conditions as reported by this study.

Prevalence of multimorbidity in adults with cancer, and associated health service utilization in Ontario, Canada: a population-based retrospective cohort study

BACKGROUND

The majority of people with cancer have at least one other chronic health condition. With each additional chronic disease, the complexity of their care increases, as does the potential for negative outcomes including premature death. In this paper, we describe cancer patients' clinical complexity (i.e., multimorbidity; MMB) in order to inform strategic efforts to improve care and outcomes for people with cancer of all types and commonly occurring chronic diseases.

METHODS

We conducted a population-based, retrospective cohort study of adults diagnosed with cancer between 2003 and 2013 (N = 601,331) identified in Ontario, Canada healthcare administrative data. During a five to 15-year follow-up period (through March 2018), we identified up to 16 co-occurring conditions and patient outcomes for the cohort, including health service utilization and death.

RESULTS

MMB was extremely common, affecting more than 91% of people with cancer. Nearly one quarter (23%) of the population had five or more co-occurring conditions. While we saw no differences in MMB between sexes, MMB prevalence and level increased with age. MMB prevalence and type of co-occurring conditions also varied by cancer type. Overall, MMB was associated with higher rates of health service utilization and mortality, regardless of other patient characteristics, and specific conditions differentially impacted these rates.

CONCLUSIONS

People with cancer are likely to have at least one other chronic medical condition and the presence of MMB negatively affects health service utilization and risk of premature death. These findings can help motivate and inform health system advances to improve care quality and outcomes for people with cancer and MMB.

Major depressive disorders in outpatients with cancers at the Nigerian National Hospital

OBJECTIVE

Frequently, little attention is paid by clinicians on the psychiatric disorders that may be associated with cancers. The aim of this study was to determine the prevalence of major depressive disorders in outpatients with cancers at the Radiology Oncology Centre of the National Hospital, Abuja, Nigeria. It also sought to determine the socio-demographic and clinical factors associated with the disorder.

METHOD

A sample of 177 randomly selected outpatients with cancers was interviewed with socio-demographic questionnaire and the major depressive episode section of the Mini International NeuroPsychiatric Interview at the hospital.

RESULTS

The mean age (SD) of the participants was 48.9 (13.8) years, with females accounting for 61.6% of them. The prevalence of current major depressive disorder, past depressive episode and recurrent depressive disorder were 25.1%, 24.3% and 7.5%, respectively. The current depressive disorder was found to be significantly associated with the presence of disturbing pain and the stage of the disease.

CONCLUSION

The occurrence of depressive disorders in patients with cancers at the hospital was high. Their assessment and treatment should be prioritized to ensure complete management of the patients with cancer conditions.

Analysis of outcomes in hospitalized pregnant patients with acute myeloid leukemia

BACKGROUND

There have been significant advances in the management of acute myeloid leukemia (AML) in the past decade. However, management of AML in the pregnant patient has been challenging as most interventions are contraindicated in pregnancy. Medical termination of pregnancy is advocated over chemotherapy in the first trimester as delaying chemotherapy could often be fatal. Chemotherapy during second and third trimesters may be provided with close surveillance of fetal abnormalities. The outcomes in these patients have not been systematically studied and have been limited to case reports and case series in medical literature.

METHODS

Patients hospitalized with a diagnosis of AML were identified using the International Classification of Disease (ICD-9) codes in the National Inpatient Sample database. This database is maintained by the Agency of Healthcare Research Quality under the United States Department of Health and Human Services. It represents 20% of all hospitalizations occurring in the United States every year. Amongst these AML patients, all patients who were pregnant were identified and their demographic information was extracted. Other details related to their hospitalization, hospital size, location, region and teaching status were also determined. The association of outcomes with common medical comorbidities was studied. Pregnancy related outcomes, mode of delivery and mortality rates were calculated for the 15 year time period.

RESULTS

During the time period of 2000 to 2014, 678942 hospitalizations involved AML patients of which 5076 were noted to be from pregnant women. The hospitalization trend gradually increased over these years and was noted to be the highest in the age group of 18-34 years. The highest hospitalization rates were noted in African American and Native American patient populations. Hypertension, hyperlipidemia, chronic kidney disease and smoking were noted to be more prevalent in pregnant women with AML. A majority of these patients had a Charlson's comorbidity index of 1-3. 3.5% of patients underwent medical termination of pregnancy, 16.25% suffered from pregnancy related complications, 0.6% suffered from puerperal infection, 4% of patients had normal vaginal delivery, 2.8% of patients had caesarian section and 5.7% of patient died. The rate of mortality was the highest in Native Americans followed by Caucasians. Multiple regression showed that odds of mortality have decreased from 2000 to 2015 and that a higher Charlson's comorbidity score was an independent predictor of mortality.

CONCLUSIONS

This is the first nationwide study to document the outcomes of pregnancy in hospitalized AML patients. AML in pregnancy is rare and this study shows that the mortality has been improving over the past 15 years. Notably, vaginal delivery has been more common than caesarian section in pregnant AML patients. Native Americans have high prevalence and high mortality rates, a likely result of healthcare disparity. Pregnant AML patients with high Charlson's comorbidity score may benefit from aggressive management of their comorbidities. Further studies are required to better characterize outcomes in pregnant women with AML.

Withania somnifera (L.) Dunal: A potential therapeutic adjuvant in cancer

ETHNOPHARMACOLOGICAL RELEVANCE

Withania somnifera (L.) Dunal (WS) is one of the moststudied Rasayana botanicals used in Ayurveda practice for its immunomodulatory, anti-aging, adaptogenic, and rejuvenating effects. The botanical is being used for various clinical indications, including cancer. Several studies exploring molecular mechanisms of WS suggest its possible role in improving clinical outcomes in cancer management. Therefore, research on WS may offer new insights in rational development of therapeutic adjuvants for cancer.

AIM OF THIS REVIEW

The review aims at providing a detailed analysis of in silico, in vitro, in vivo, and clinical studies related to WS and cancer. It suggests possible role of WS in regulating molecular mechanisms associated with carcinogenesis. The review discusses potential of WS in cancer management in terms of cancer prevention, anti-cancer activity, and enhancing efficacy of cancer therapeutics.

MATERIAL AND METHODS

The present narrative review offers a critical analysis of published literature on WS studies in cancer. The reported studies were analysed in the context of pathophysiology of cancer, commonly referred as 'cancer hallmarks'. The review attempts to bridge Ayurveda knowledge with biological insights into molecular mechanisms of cancer.

RESULTS

Critical analysisof the published literature suggests an anti-cancer potential of WS with a key role in cancer prevention. The possible mechanisms for these effects are associated with the modulation of apoptotic, proliferative, and metastatic markers in cancer. WS can attenuate inflammatory responses and enzymes involved in invasion and metastatic progression of cancer.The properties of WS are likely to be mediated through withanolides, which may activate tumor suppressor proteins to restrict proliferation of cancer cells. Withanolides also regulate the genomic instability, and energy metabolism of cancer cells. The reported studies indicate the need for deeper understanding of molecular mechanisms of WS in inhibiting angiogenesis and promoting immunosurveillance. Additionally, WS can augment efficacy and safety of cancer therapeutics.

CONCLUSION

The experimentally-supported evidence of immunomodulatory, anti-cancer, adaptogenic, and regenerative attributes of WS suggest its therapeutic adjuvant potential in cancer management. The adjuvant properties of withanolides can modulate multidrug resistance and reverse chemotherapy-induced myelosuppression. These mechanisms need to be further explored in systematically designed translational and clinical studies that will pave the way for integration of WS as a therapeutic adjuvant in cancer management.