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Objectives The study objectives were to (1) describe the characteristics of the pharmacy professionals and (2) explore the association between job satisfaction and factors, such as work control, work stress, workload and organization and professional commitments. Methods This study was a cross-sectional design. The survey items were mainly adapted from the US National Pharmacist Workforce Survey. An electronic (Qualtrics) questionnaire was posted on pharmacist social media in several Arab countries. The survey link was posted from 22 March 2021 to 1 May 2021. The multiple linear regression measured the association between 12 independent variables and pharmacist job satisfaction. Key findings A total of 2137 usable surveys were received from pharmacists (54.7% female) working in 18 Arabic countries. The job satisfaction rate varied among countries in the Arab world. The fields with the highest satisfaction average included pharmaceutical marketing, academia and the pharmaceutical industry. At the same time, pharmacists working in community pharmacy and Ministry of Health/administrative positions had the lowest satisfaction rates. Overall, pharmacist satisfaction was average (3.1 out of 5). The pharmacists had the lowest satisfaction averages with income and job expectations. The pharmacists with bachelor’s degrees had significantly lower satisfaction than pharmacists with postgraduate degrees. Male pharmacists had significantly higher job satisfaction compared with female pharmacists. Workload and the feelings of organization and professional commitments had significant positive associations with job satisfaction. Conclusions The pharmacy profession in Arabic countries faced several challenges that negatively impacted job satisfaction. Improving work environment, professional management, income and organization loyalty is necessary to enhance pharmacist job satisfaction.

Introduction: Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors are indicated in the first-line treatment of hormonal receptor positive and HER-2 negative (HR+/HER2- negative) metastatic breast cancer (MBC). Although phase III randomized controlled trials (RCTs) proved their clinical efficacy, they can increase healthcare expenditure. To date, there are no observational studies to validate the clinical findings of the existed RCTs. In addition, only a few pharmacoeconomic evaluations were published regarding the two common CDK4/6 inhibiting agents, palbociclib and ribociclib to evaluate their financial burden. Objectives: To evaluate the clinical efficacy of palbociclib and ribociclib in the local settings in Qatar. Moreover, to conduct a thorough pharmacoeconomic analysis for the two medications and compare them in terms of their cost-effectiveness and cost-utility. Methodology: A retrospective observational study on HR+/HER-2 negative stage IV breast cancer patients receiving palbociclib or ribociclib in Qatar was conducted, followed by a comparative pharmacoeconomic analysis. The primary outcomes were progression-free survival (PFS) and overall-survival (OS). Safety profiles of both medications were also evaluated. Clinical data of all MBC in Qatar were collected from the National Center for Cancer Care and Research (NCCCR) from January 2017 to December 2019 using Cerner ® system. To evaluate the long-term costs-effectiveness, a 10-year within-cycle corrected Markov’s model was developed. The Markov’s model consisted of three main health states: progression-free (PFS), progressed disease (PD), and death. Incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were generated and compared to a three gross-domestic-product (3 GDP) per capita. Model costs were obtained from the department of accounting and finance in the NCCCR, transition probabilities were calculated from individual patient data obtained in the clinical phase, and utilities were summarized from the published literature. Deterministic and probabilistic sensitivity analyses were carried out. Modeling was conducted via TreeAge Pro ® software. Results: There was no statistically significant difference between palbociclib and ribociclib in PFS; median PFS time was 17.85 versus 13.55 months respectively; p> 0.05. Similarly, there was no statistically significant difference in OS (29.82 versus 31.72 months; p>0.05). For the pharmacoeconomic analysis, ribociclib dominated palbociclib in yielding an ICER of - 83,090.88 QAR per life-year gained, and ICUR of -31,868.06 QAR per quality-adjusted life-year gained. The results remained robust in all cases of the deterministic sensitivity analyses suggesting ribociclib is more cost-effective than palbociclib. Taking all combined uncertainties into account, the overall confidence in the base-case conclusion was around 60%. Conclusions: Both treatment strategies have similar efficacy and safety profiles. Nonetheless, ribociclib is a more cost-effective option than palbociclib based on the base-case results and based on the addressed uncertainties related to the model inputs. Citation Format: Nour Hisham Al-Ziftawi, Shereen Elazzazy, Mohammed Fasihul Alam, Asrul Akmal Shafie, Anas Hamad, Salha Bujassoum, Mohamed Izham Ibrahim. Clinical and pharmacoeconomic analyses of CDK4/6 inhibitors use in stage IV breast cancer females in the state of Qatar: A comparative retrospective observational study with cost effectiveness and cost utility analyses [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-16-03.

Home cancer care research (HCCR) has accelerated, as considerable attention has been placed on reducing cancer-related health costs and enhancing cancer patients’ quality of life. Understanding the current status of HCCR can help guide future research and support informed decision-making about new home cancer care (HCC) programs. However, most current studies mainly detail the research status of certain components, while failing to explore the knowledge domain of this research field as a whole, thereby limiting the overall understanding of home cancer care. We carried out bibliometric and visualization analyses of Scopus-indexed papers related to home cancer care published between 1990–2021, and used VOSviewer scientometric software to investigate the status and provide a structural overview of the knowledge domain of HCCR (social, intellectual, and conceptual structures). Our findings demonstrate that over the last three decades, the research on home cancer care has been increasing, with a constantly expanding stream of new papers built on a solid knowledge base and applied to a wide range of research themes. This research was funded by National Priorities Research Program-Standard (NPRP-S) Twelfth (12th) Cycle grant# NPRP12S-0219-190108, from the Qatar National Research Fund.

Background In line with global trends, cancer incidence and mortality may have decreased for specific types of cancer in Qatar. However, the cancer-related burden on patients, healthcare systems, and the economy is expected to expand; thus, cancer remains a significant public healthcare issue in Qatar. Qatar’s free access to cancer care represents a considerable economic burden. Ensuring the best utilization of financial resources in the healthcare sector is important to provide unified and fair access to cancer care for all patients. Experts from the Qatar Oncology Health Economics Expert Panel (Q-OHEP) aimed to establish a consistent and robust base for evaluating oncology/hematology medications; involve patients’ insights to accelerate access to cutting-edge medications; increase the value of cancer care; and reach a consensus for using cost-effective strategies and efficient methodologies in cancer treatment. Methods The Q-OHEP convened on 30 November 2021 for a 3-hour meeting to discuss cancer management, therapeutics, and health economics in Qatar, focusing on four domains: (1) regulatory, (2) procurement, (3) treatment, and (4) patients. Discussions, guided by a moderator, focused on a list of suggested open-ended questions. Results Some of the salient recommendations included the development of a formal, fast-track, preliminary approval pathway for drugs needed by patients with severe disease or in critical condition; and encouraging and promoting the conduct of local clinical trials and real-world observational studies using existing registry data. The Q-OHEP also recommended implementing a forecast system using treatment center data based on the supply/demand of formulary oncology drugs to detect treatment patterns, estimate needs, expedite procurement, and prevent shortages/delays. Furthermore, the panel discussed the needs to define value concerning cancer treatment in Qatar, implement value-based models for reimbursement decision-making such as health technology assessment and multiple-criteria decision analysis, and promote patient education and involvement/feedback in developing and implementing cancer management guidelines. Conclusion Herein, we summarize the first Q-OHEP consensus recommendations, which aim to provide a solid basis for evaluating, registering, and approving new cancer medications to accelerate patient access to novel cancer treatments in Qatar; promote/facilitate the adoption and collection of patient-reported outcomes; and implement value-based cancer care in Qatar.

Outpatient Chemotherapy Appointment (OCA) planning and scheduling is a process of distributing appointments to available days and times to be handled by various resources through a multi-stage process. Proper OCAs planning and scheduling results in minimizing the length of stay of patients and staff overtime. The integrated consideration of the available capacity, resources planning, scheduling policy, drug preparation requirements, and resources-to-patients assignment can improve the Outpatient Chemotherapy Process’s (OCP’s) overall performance due to interdependencies. However, developing a comprehensive and stochastic decision support system in the OCP environment is complex. Thus, the multi-stages of OCP, stochastic durations, probability of uncertain events occurrence, patterns of patient arrivals, acuity levels of nurses, demand variety, and complex patient pathways are rarely addressed together. Therefore, this paper proposes a clustering and stochastic optimization methodology to handle the various challenges of OCA planning and scheduling. A Stochastic Discrete Simulation-Based Multi-Objective Optimization (SDSMO) model is developed and linked to clustering algorithms using an iterative sequential approach. The experimental results indicate the positive effect of clustering similar appointments on the performance measures and the computational time. The developed cluster-based stochastic optimization approaches showed superior performance compared with baseline and sequencing heuristics using data from a real Outpatient Chemotherapy Center (OCC).

Eltrombopag olamine (ELT) is a synthetic nonpeptide with a low molecular weight that has been investigated in various phase-3 studies and shown to be efficacious at a typical dose of 50 mg. Varied ethnic groups have reported different responses to ELT.The aim is to examine the efficacy of ELT in Asian and Arab patients with immune thrombocytopenia (ITP) from the Indian subcontinent by starting with (12.5 mg, as a minimum dose) and gradually increasing to a maximum dose of 50 mg.Between January 2015 and January 2019, we reviewed the electronic health records of non-Arab Asian (n = 17) versus Arab (n = 41) patients who were ≥18 years old, residing in Qatar, and with confirmed diagnoses with chronic ITP and under active treatment with a platelet count of 30,000/L, and bleeding symptoms. Following receiving ELT for three months or longer at various dosages, patients' response was examined.After three months of ELT therapy, the response rate (platelet count of 50,000/L) was equivalent in non-Arab (88.2%) versus Arab (87.5%) patients. However, to achieve an adequate response, 26% of Arab patients required a lower dose of 12.5 or 25 mg, and 41.5% required a higher dose of 50 mg. In adult chronic ITP patients, ELT is typically well-tolerated and delivers the desired outcomes. In 67.5% of Arab patients, smaller dosages of ELT (12.5-50 mg) were helpful in sustaining acceptable PLT levels. This helps patients get the most benefit at the lowest feasible dose, reducing toxicity and expense.

Immune checkpoint blockade (ICB)-based therapy is revolutionizing cancer treatment by fostering successful immune surveillance and effector cell responses against various types of cancers. However, patients with HER2+ cancers are yet to benefit from this therapeutic strategy. Precisely, several questions regarding the right combination of drugs, drug modality, and effective dose recommendations pertaining to the use of ICB-based therapy for HER2+ patients remain unanswered. In this study, we use a mathematical modeling-based approach to quantify the growth inhibition of HER2+ breast cancer (BC) cell colonies (ZR75) when treated with anti-HER2; trastuzumab (TZ) and anti-PD-1/PD-L1 (BMS-202) agents. Our data show that a combination therapy of TZ and BMS-202 can significantly reduce the viability of ZR75 cells and trigger several morphological changes. The combination decreased the cell’s invasiveness along with altering several key pathways, such as Akt/mTor and ErbB2 compared to monotherapy. In addition, BMS-202 causes dose-dependent growth inhibition of HER2+ BC cell colonies alone, while this effect is significantly improved when used in combination with TZ. Based on the in-vitro monoculture experiments conducted, we argue that BMS-202 can cause tumor growth suppression not only by mediating immune response but also by interfering with the growth signaling pathways of HER2+ BC. Nevertheless, further studies are imperative to substantiate this argument and to uncover the potential crosstalk between PD-1/PD-L1 inhibitors and HER2 growth signaling pathways in breast cancer.

Background The economic benefit of the clinical pharmacist's role in ensuring the optimum use of medicines is potentially considerable, particularly when it comes to cancer management. We sought to evaluate the overall economic impact of clinical pharmacist interventions in the main cancer setting in Qatar. Methods The total economic benefit of the clinical pharmacy interventions were analyzed from the public hospital perspective. Patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care and Research, Qatar. The total benefit from interventions was the total cost avoidance due to preventable adverse drug events plus any cost savings associated with therapeutic-based resource use. Sensitivity analyses confirmed the results’ robustness and increased generalizability. Results A total of 1352 interventions based on 281 patients were analyzed. The majority of the drug-related problems were related to the appropriateness of therapy, followed by dosing and administration. The total population benefit over the 3-months study period was QAR 4,879,185 (USD 1,336,763), constituting cost avoidance of QAR 4,234,012 (USD 1,160,003) and negative resource-use cost savings of −QAR 645,174 (−USD 176,760). Projected annual overall benefit was QAR 14,355,354 (USD 3,932,974). The increase in resource use with therapies was mostly because of the addition of other medications. Cost avoidance was mostly driven by recommending additional medications and discontinuation of medications. The uncertainty analysis demonstrated the robustness of outcomes. Conclusions The clinical pharmacist intervention increased resource use and its cost. In overall, however, taking avoided cost of adverse drug events in consideration, it is an economically beneficial practice in the National Center for Cancer Care and Research setting, associated with adverse drug events prevention and substantial economic benefits.

Background: Clinical pharmacists play a key role in ensuring the optimum use of cancer medicines. Yet, the economic benefit of this role has never been assessed in Qatar. Aim: To evaluate the overall economic impact of clinical pharmacist interventions in the main cancer care setting in Qatar. Methods: From the public healthcare perspective, this was an analysis of the total economic benefit and a cost-benefit analysis of the clinical pharmacy interventions. As a study sample size, patient records in March 2018, July/August 2018, and January 2019 were retrospectively reviewed at the National Center for Cancer Care & Research (NCCCR), Qatar. The total benefit from interventions was the total of the cost avoidance due to preventable adverse drug events (ADEs) plus the cost savings associated with therapeutic interventions. The interventions cost was based on salary and increased cost due to therapeutic interventions. The cost-benefit analysis results were presented via net benefit and benefit‐to‐cost ratio measures. Results : Total of 1,352 interventions occurred during the 3-month follow-up period. The total benefit was QAR 196,010,360 (USD53,834,206), constituting cost avoidance of QAR 194,764,534 (USD 53,492,040) and cost savings of QAR 1,245,826 (USD 342,166), mostly due to recommending additional medications and the medication dose reduction. The benefit-to-cost ratio was 174:1 and the annual net benefit was QAR 779,539,440 (USD 214,100,351). Sensitivity analyses confirmed the robustness of results. Conclusion: The clinical pharmacist intervention is a cost-beneficial practice in the NCCCR setting, associated with ADEs prevention and substantial economic benefits, including relative to the interventions cost.

Palbociclib and ribociclib are indicated in the first-line treatment of hormonal-receptor-positive HER-2 negative (HR+/HER-2 negative) advanced breast cancer. Despite their clinical benefit, they can increase healthcare expenditure. Yet, there are no comparative pharmacoeconomic evaluations for them in developing countries, the Middle East, or Gulf countries. This study compared the cost-effectiveness of palbociclib and ribociclib in Qatar. A 10-year within-cycle-corrected Markov’s model was developed using TreeAge Pro® software. The model consisted of three main health states: progression-free (PFS), progressed-disease (PD), and death. Costs were obtained from the actual hospital settings, transition probabilities were calculated from individual-patient data, and utilities were summarized from the published literature. The incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR) were calculated and compared to three gross-domestic-products per capita. Deterministic and probabilistic sensitivity analyses were performed. Ribociclib dominated palbociclib in terms of costs, life-years gained, and quality-adjusted life-years gained. The conclusions remained robust in the different cases of the deterministic sensitivity analyses. Taking all combined uncertainties into account, the confidence in the base-case conclusion was approximately 60%. Therefore, in HR+/HER-2 negative stage IV breast cancer patients, the use of ribociclib is considered cost-saving compared to palbociclib.

Background There is a paucity of studies about the readiness of community pharmacists to manage the safe and effective use of oral anticancer medicines (OAMs) in developing settings. Objectives Using the readiness component (knowledge and willingness) of the situational theory of leadership, the study assessed community pharmacists’ readiness to manage the safe and effective use of OAMs in Qatar, and also identified its significant predictors. Methods A cross-sectional assessment of 252 community pharmacists was conducted with a pre-tested 48-item questionnaire. Readiness was assessed with a 5-point Likert-type scale and the maximum obtainable score was 70. The mean was used as the cut-off point to categorize willingness and knowledge as either high (≥ mean) or low (< mean). Independent t-test, one-way analysis of variance and multiple linear regression was used for data analyses. Results The mean SD score for the readiness of community pharmacists was 39.3 ± 11.2 (min = 11, max = 70). Only a minority of the respondents expressed an excellent understanding of the chemotherapy cycles (19.6%; 45/230), and familiarity with targeted anticancer therapy (14.3%; 33/230), side effects (22.2%; 51/230), and dosing of OAMs (14.4%; 33/230). Employment status, number of OAMs prescriptions dispensed per month and adequacy of the contents related to OAMs in undergraduate training were the significant predictors of readiness ( R2 = 0.558, (F (11, 209) = 3.559, p = 0.0001). Conclusions Community pharmacists’ readiness appear inadequate especially regarding its dosing, side effects, handling, and disposal of OAMs. These inadequacies probably underline community pharmacists’ low familiarity and comfortability with dispensing and educating patients on the effective and safe use of OAMs.

Background: Thromboprophylaxis of ambulatory cancer patients is considered controversial. However, some guidelines suggest conducting VTE risk assessment using the Khorana risk assessment scoring model. This study aims to assess the incidence of Deep Vein Thrombosis (DVT) and related cancer types, focusing on the incidence of DVT in ambulatory patients actively on chemotherapy, with Khorana risk score (KRS). Methods: The Doppler ultrasound reports over 12-month period were reviewed. A total of 205 patients were included in the study. Patients with DVT were screened for the relevant biomarkers in KRS model and any other additional risk factors. Furthermore, a comparison between ambulatory patients who developed DVT and those who did not, was carried on determining the KRS association with incidence. Results: The incidence of DVT in ambulatory cancer patients was higher than the inpatient setting (23% vs. 8%). Breast cancer was the most common malignancy associated with DVT (30%) followed by colon cancer (17%). Chemotherapy increased the incidence of DVT in ambulatory patients (29% vs. 13%). Patients with KRS of ≥2 were more likely to develop DVT (37.5%). Conclusion: This study highlights the importance of conducting a thorough DVT risk assessment for ambulatory cancer patients on chemotherapy and the need to look for KRS to reconsider additional risk factors.

Background: Microsatellite instability-high (MSI-H) is shown to predict response to the immune checkpoint inhibitors (ICPi). Recently, the FDA granted an accelerated approval for the use of pembrolizumab in any solid tumor and nivolumab in metastatic colorectal cancer in patients with MSI-H. However, the immune-related adverse events (irAEs) exhibit a unique heterogeneous spectrum than conventional chemotherapy adverse drug reactions (ADRs). Underestimating the irAEs could be potentially lethal. Objectives: To evaluate the irAEs; their management, and outcome in MSI-H patients treated with ICPi at the National Center for Cancer Care and Research (NCCCR) in Qatar. Methods: All patients with MSI-H and treated with ICPi at the NCCCR between January 2015 and June 2018 were reviewed retrospectively. Radiologic assessment of irAEs and Naranjo score were used to estimate and confirm the probability of ADRs. Patient demographics, immunotherapy treatment, reported irAEs, and their management were collected. Results: Of the total cohort of patients receiving ICPIs; 9 patients with MSI-H were identified; all received pembrolizumab. 45% (n=4) of the patients were still actively on treatment; 22% (n=2) received only 1 dose then passed away; 22 % (n=2) discontinued because of disease progression; and 11% (n=1) of the patients received 2 cycles as neoadjuvant treatment. To the best of our knowledge, this is the biggest cohort of cancer patients with MSI-H in the Middle East. Calculated Naranjo score was 7 in 45% of the patients (n=4) and 5 in 22 % of patient (n=2), which indicates a probable ADR. 34% of the patients (n=3) did not experience ADRs till the date of data cutoff. 8 irAEs were seen in 67% (n=6) of the patients (Table 1). Based on laboratory or radiologic confirmation, 87.5% (n=7) were irAEs and 12.5% (n=1) was not related to pembrolizumab. Laboratory findings confirmed 25% of the ADRs and radiologic findings confirmed 75% of the ADRs. Of those who developed irARs, 3 patients required a hold of treatment, 1 needed monitoring, and 2 required pharmacologic interventions. There was one patient who received empirical pharmacologic intervention at which evaluation showed no relation to immunotherapy. Conclusion: irAEs can sometimes be unpredictable, rare, and often missed. Frequent monitoring and early management of these suspected or confirmed adverse effects is life saving and should be done in a multidisciplinary approach.

Background: Studies showed that 40%–50% of patients with cancer pain receive insufficient analgesia due to different factors (Beyeler et al, Support Care Cancer 2008; Salminen et al, Support Cancer Care 2008), beside the challenges to accurately assess pain, which might affect drug selection and pain control (Stewart, Ulster Med J 2014). In NCCCR, the treating primary physicians (PP) may prescribe analgesics to their patients or refer them to the Pain Management Team (PMT), based on evaluation or as requested by patients. This study will address the clinical concerns of PP, which may lead to refer the patients to PMT, moreover the clinical judgement of PMT on the referred cases whether they need to be refereed or not. Objectives: To determine the efficiency of the referral pathway to the pain clinic by PMT. Methods: PMT is going to assess the referred patient to their clinics according to pain assessment methods. Patients will be evaluated whether they have been appropriately referred or not, any unnecessary referral will be documented based on the following;• If the patient was referred by hematologist or oncologist• If the patient required specialized treatment• If the patient required urgent treatment/prescription or advanced pain management techniques• If the patient required further consultation by pain management• If the patient could be managed by PP Results: 195 patients were newly referred to the pain clinic during the period from March 8, 2018 to August 31, 2018. 12% (23/195) were deemed as unnecessary referrals based on PMT assessment; 43% (10/23) of them were hematology patients, while 57% (13/23) were oncology. The majority was for breast cancer and sickle cell disease patients with 35% for each. According to the PMT assessment, 61% (14/23) patients (95% CI, 40.79%–77.84%) considered unnecessary referrals due to improper basic pain assessment and management by PP, while 30% (7/23) patients (95%CI, 15.60%–50.87%) asked for refill medications. Conclusion: There is 12% unnecessary referrals to PMT, which need further improvement in the referral pathway, via the development of a definite referral criteria to PMT. PP should be encouraged to provide basic pain treatment and to consider multidisciplinary management with appropriate coordination for better improvements in patients’ quality of life.

Background: Up to 70% of cancer patients experience pain during the course of illness (Fallon, Support Care Cancer 2008). Studies showed that 40%–50% of patients with cancer pain receive insufficient analgesia due to different factors. Physicians are facing different challenges to accurately assess pain which might affect drug selection and pain control (Beyeler et al, Support Care Cancer 2008; Salminen et al, Support Cancer Care 2008; Stewart, Ulster Med J 2014). In NCCCR, treating physicians may prescribe analgesics to their patients or refer them to the Pain Management Service (PMS) based on their evaluation or as requested by patients. This study explored the factors which might lead to undertreatment of cancer pain in Qatar. In addition, focused on cancer patients’ pain management satisfaction and PMS awareness. Objectives: To assess the existing PMS at NCCCR from patients' perspective. Methods: In this study, we evaluated patients’ pain management perception via a validated written (Arabic and English) questionnaire (SF-MPQ-2; available at https://eprovide.mapi-trust.org/instruments/short-form-mcgill-pain-questionnaire#DESCRIPTIVE_INFORMATION; Gauthier et al, J Pain 2014) and a structured interview by outpatient pharmacists at a single point of time, to assess patients` awareness towards the PMS, if they are receiving pain medications or not, if they are experiencing any pain regardless on pain medications or not, pain severity, and patients’ level of satisfaction towards their medications. A sample of 400 patients was randomly selected amongst the total cancer population visiting NCCCR Pharmacy over a specific period of time. Participants were consented and interviewed. Results: 400 patients agreed to participate; the median age was 50. Male to female ratio was 3 to 7. Data showed that 61% (245/400) of participants were not aware of the existence of the PMS. Only 20% (78/400) were aware and followed by PMS, with a satisfaction rate of 76% (59/78). Although 69% (276/400) of the patients were on pain medications, only 70% (191/276) were satisfied with their current medications. However from the satisfied patients, 57% (109/191) rated their pain as 4–10 at the time of interview (ATI). In the 31% (124/400) that were not taking any pain medications; 77% (96/124) didn’t know about the PMS, and 44% (55/124) had 4–10 pain severity (ATI). Conclusion: These findings provide clear evidence that factors leading to undertreating of cancer pain in Qatar might be unawareness of the PMS existence, pain treatment by unspecialized physicians, and patients’ reluctance to express their pain. Thus, raising patients’ awareness and standardizing the referral criteria can improve pain control and quality of life amongst cancer patients.

Employee engagement is a concept that is capable of predicting various employee outcomes. It could directly influence the success of any organization and its overall financial performance. The present study was undertaken to determine the relationship between Psychological and Social capitals and employee engagement. Data for the study was collected randomly from 395 respondents. Structural equation modeling was used to analyze the collected data. The data was found to be powerfully fitting, with all the indices having values above the thump's identified rules. The results indicated positive relationships between the constructs. The results of the study have multiple theoretical and practical implications.

Background: The economic outcome research of approved tyrosine kinase inhibitors for treating the chronic phase of chronic myeloid leukemia in developing is scarce. The aim of this study was to assess the cost-effectiveness of dasatinib and nilotinib for newly diagnosed chronic myeloid leukemia patients. Methods: A decision tree model was developed linking clinical effectiveness (defined as major molecular response) and/or complete cytogenetic response, utility, and cost data over a 12-month period. Patients are recruited from Qatar Cancer Registry. The probability of primary clinical outcome is calculated from DASISION (dasatinib) and ENESTnd (nilotinib) trials. Direct healthcare costs were derived from the national healthcare payer system, whereas adverse effects data were derived from local incident reporting system. Results: In the first-line treatments of chronic myeloid leukemia patients, nilotinib has greater major molecular response (39% nilotinib vs 12% dasatinib) and complete cytogenetic response (24% nilotinib vs 16% dastinib) response outcomes, and more adverse effects than dasatinib (13.3% vs 4%). Moreover, nilotinib is more cost-effective with annual costs (USD63,589.59) and after 12 months of follow-up. Despite the lower acquisition annual cost of dasatinib (USD59,486.30), the incremental cost-effectiveness ratio of nilotinib (vs dasatinib) per major molecular response/complete cytogenetic response achieved was USD15,481.10 per year. There were no cases in both arms that progressed to accelerated or blast phase. At a threshold of 3 times gross domestic product per capita of Qatar and according to World Health Organization recommendation, the nilotinib use is still cost-effective. Conclusion: Upfront therapy of chronic myeloid leukemia–chronic phase patients by nilotinib plan appears to be more cost-effective than dasatinib.

Background: Lymphoma: either most common non-Hodgkin (NHL) or less common Hodgkin (HL), are well-known hematological malignancies. With advancement in treatment modalities, the survival in both lymphomas especially the "poor prognosis" non-Hodgkin lymphoma has evolved in the last decades. Hence, patient's outcome may be diverse and quite complicated; with some need extended time for observation, and others having multiple chemotherapy treatments. In this review, we will focus on the clinic-epidemiological patterns of various malignant lymphoma subtypes in Qatar in recent years (2013-2017) Objective: The primary aim is to investigate and compare the overall survival (OS) for both types of lymphoma; HL and NHL at 1, 3 and 5-years of follow up in adult lymphoma patients in Qatar between January 2013 - December 2017. Other objectives include comparing between the most frequent histological varieties, clinical and epidemiological characteristics of HL and NHL lymphoma in Qatar. The secondary objectives included clinical characteristics, treatments used, treatment response, disease-free survival and overall survival. Methods: A retrospective, descriptive study of consecutive cases was carried out at NCCCR, Qatar between 2013-2017. Inclusion criteria included: ≥ 18 years of age, male or female, any clinical stage at diagnosis, who had received any chemotherapy regimen, with a known outcome. Descriptive statistics was performed for all variables, and survival was assessed using Kaplan-Meier curves. Data was abstracted by Qatar National Cancer Registry and the 2008 World Health Organization (WHO) classification of hematopoietic and lymphoid tumors is used as reference for disease staging and pathological classification. We used STATA version 13.0 (StataCorp., College Station, TX) for exploratory data analysis and descriptive statistics. Results: During the period 2013-2017, 414 men and women were diagnosed with lymphoma in the state of Qatar. The median age at diagnosis being 49 years (interquartile range IQR 36-95 years; p Conclusions: Diffuse large B-cell lymphoma constitutes the most frequent subtype for all lymphomas in Qatar. Overall, the survival was generally better for HL than NHL 67% and 60% respectively. Survival can be slightly deflated than other countries or regions especially HL, this is in part due to higher immigration rate in the country, so changes in survival over time (especially for longer periods) need to be examined alongside trends in incidence rates to interpret improvement in cancer control policies implemented. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Background :Sickle cell disease (SCD) is a hereditary disease that is caused by autosomal recessive gene fault in the beta (β) allele of the hemoglobin (Hb) gene. As a result, sickled cells are characterized by easy and abnormal hemolysis with resultant varying degrees of anemia. Globally, the incidence of SCD is estimated to reach 400,000 persons per year, and in the United States alone, for example, the prevalence estimation is approximately 100,000 patients. Possible clinical presentations of SCD may come from different pathophysiologic mechanisms: the disfiguration of the RBC with subsequent loss of function can lead to vascular occlusion and a short lifetime of these RBCs that leads to hemolysis. The most severe and serious manifestation of SCD is the recurrent acute pain, or better known as vaso-occlusive crisis (VOC). Additionally, other clinical manifestations that SCD patients may show are acute complications such as acute chest syndrome (ACS), recurrent infections, kidney necrosis, and stroke. Such complications may affect multiple organs and can result in early death. Acute pain crisis is another common complication of SCD and is usually managed with pain medications, especially opioids, This is the first study to address two of novel therapies in patients with SCD in the Middle East. Our study was comprehensive in terms of outcome mostly encountered by SCD patients which is VOC and inclusivity of interventions mostly used for its management and was focused on the target population of in one of areas of high prevalence of SCD in the world. Our analysis tracked the CHEERS guidelines and checklist for reporting. To be also complete, we used only RCT evidence in our analysis. Additionally, in considering VOC, we ensured only studies with a definition compatible with that of the principal Crizanlizumab study were analyzed. Objectives: Treatment options for preventing vaso-occlusive crises (VOC) among sickle cell disease (SCD) patients are on the rise, especially if hydroxyurea treatment has failed. This economic analysis is conducted to assess the comparative clinical effectiveness, safety and acquisition cost of L-glutamine and Crizanlizumab for older adolescent and adults (≥16 years old) SCD in Qatar, with an emphasis on treatment costs and acute pain crises. Methods: We conduct a decision tree model, where we compare the clinical and economic outcomes of two novel FDA-approved medications which are available in Qatar; L-glutamine and Crizanlizumab over a time horizon of one year in a hypothetical cohort of adult SCD patients from a Qatar healthcare perspective. The main outcome is incremental cost per SCD-related acute pain crises averted. Model clinical parameters were derived from individual drug randomized trials, published literature, whereas cost parameters from Qatar healthcare payer system. A sensitivity analysis was carried out, and the study results were robust around model inputs. Costs were converted to 2020 US dollars. Results: Study results showed that both treatment modalities' costs were the main driver of this analysis, with average annual cost of the treatments per patient being $189,014 for Crizanlizumab (5mg/Kg), $143,798 Crizanlizumab (2.5mg/Kg) and $74,323 for L-glutamine. The probability of no first time SCD-related VOC averted were 0.001/year for Glutamine, 0.26/year for Crizanlizumab (5mg/Kg) and 0.34/year for Crizanlizumab (2.5mg/Kg). Lower dose Crizanlizumab (2.5mg/Kg) dominated the higher one (5mg/Kg). The ICER of Crizanlizumab (2.5mg/Kg), when compared to L-Glutamine was $81,265 per SCD-related VOC averted. When comparing Crizanlizumab (5mg/Kg) and L-Glutamine, Crizanlizumab (5mg/Kg) showed higher efficacy, yet the Crizanlizumab ICER was at $459,620 than L-glutamine. Conclusions: Crizanlizumab (2.5mg/Kg) may be cost-effective interventions yet it is not the approved dose for preventing VOC in adolescents and adults with sickle cell disease. Crizanlizumab (5mg/Kg) was more cost effective than the approved L-glutamine per SCD vaso-occlusive crisis prevented. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Introduction: The thrombopoietin receptor agonists (TPO-RA) such as eltrombopag (ELT) have, in recent years, changed immune thrombocytopenia (ITP) treatment, showing that there is both increased platelet destruction and suboptimal platelet production in ITP. ELT is an oral drug and studies have shown that absorption can be affected by meals. Thus, for optimum absorption, patients are counseled to take the ELT on empty stomach at least 1 hour before or 2 hours after a meal and at least 2 hours before and 4 hours after calcium containing meals. However, in the Muslim world, the holy month of Ramadan, where Muslims have to fast since dawn till sunset the scheduling of drug consumption can be affected. Objective: The aim of this study is to evaluate the effect of fasting on patients with ITP receiving Eltrombopag. Methods: A mixed design study was performed in which we retrospectively analyzed and interviewed all Muslim patients (n=29) who are 18 years and older in Qatar and fasted Ramadan while receiving Eltrombopag treatment between the years of 2015 and 2019 recording clinical and biological parameters and using a standardized patient form. Fasting status was confirmed by a telephone call to each patient. Patients' responses were retrospectively evaluated before, during and after Ramadan. A significant drop in platelets was defined by either drop in platelets to < 30 000 /L or drop to ≥ half from baseline. Bleeding tendency was also evaluated as either no bleeding, minor cutaneuos and mucosal bleeding or life threatening bleeding involving major organs (i.e. central nervous system, gastrointestinal or genitourinary). Results: Twenty-nine patients were identified who matched our inclusion criteria for this study. Majority of which were Arabs (~83%) whereas the rest were of the sub-continent of India. Platelet responses were statistically significantly impacted (P-Valua: 0.005) by the fasting of the holy month of Ramadan, the mean platelet count before Ramadan was estimated at 87.78±67.75 while during Ramadan it dropped to 46.57±36.50. Wheras when compared Platelet beofr and after Ramadan showed insignificant difference (116.4±68.2 vs 132.9±91.3; P=0.389). Only 10% (3 patients) of the patients fasting Ramadan experienced bleeding episodes. 1 of which experienced minor bleeding (ecchymosis) and 2 had major bleeding episodes during Ramadan (CNS and GU bleeds). Conclusion: ELT is generally well tolerated and effectively achieves target platelet counts in adult ITP patients. However, the absorption of ELT is highly effected by food consumption and thus it is critical to adhere to the instruction given on how ELT should be consumed on an empty stomach. As has been shown due to the mis-scheduling of ELT consumption during the holy month of Ramadan. Health care providers must pay more attention to this period and provide a better tailored plan for patients in order to prevent platelet drop and pouts of bleeding that patients might experience Disclosures No relevant conflicts of interest to declare.

Background: Thrombopoietin receptor agonists stimulate platelet production . Eltrombopag olamine (ELT) is alow molecular weight, synthetic nonpeptide agent thathas been studied in multiple phase 3 trials and proved efficacy at a standard dose of 50 mg. ELT exposure has been reported to be different in different ethnic descents. In East Asian ITP patients, the area under the curve (AUC) was reported to be more than 85% those of non-East Asian descent Objectives: The objective of this study is to evaluate the efficacy of ELT in Arab and Asian ITP patients of the subcontinent of India by using a lower starting dose (12.5 mg) and maximum (50 mg) doses of ELT than the standard starting dosing of (50 mg) and maximum of (75 mg) approved in the USA and Europe. Methods A retrospective study was conducted to evaluate the role of ethnicity (Arab and East Asians) in response to ELT among ITP patients by reviewing patients' electronic medical records between Jan 2015 - Jan 2019. A total of 58 patients were identified. We examined retrospectively Arab (n = 41) and non-Arab Asian (n = 17) patients who are 18 years and older in Qatar, with previously treated chronic ITP who had a platelet count of < 30 000 /L and who presented with bleeding manifestations. Patients' responses were evaluated after receiving ELT for 3 months or more, as well as their response to different doses of ELT (100, 75, 50, 25, 12.5 or any alternating doses e.g., 50/25). Results: The response rate (platelet count of ‡ 50 000 /L) after 3 months of ELT treatment was comparable in the Arab (87.5%) and non-Arab (88.2%) patients. 26% of the Arab patients required 12.5 or 25 mg and 41.5 % required 50 mg of ELT to achieve an acceptable response. In the Non-Arab Asian group 17.6% required 25 mg and 52.9% required 50 mg of ELT to achieve acceptable response. 22% of the Arab patients and 35.3% of the Non-Arab Asians patients required 75 mg or more of ELT to achieve acceptable control. Further sub-analysis of this data showed that 70% of the Arab patients who achieved complete response were females (14/20) whereas 33.3% (3/9) were Asian females. Two-third the Arab patients who achieved clinical remission were females whereas more than Two-third were non-Arab Asian males. Conclusion: ELT is generally well tolerated and effectively achieves target platelet counts in adult ITP patients. Low doses (12.5 - 50 mg) of ELT were effective in achieving and maintaining safe platelet counts in most Arab patients. This helps in achieving the maximum benefit for the patient at the lower possible dose to prevent toxicity. Tailoring treatment guidelines to match ethnic variations will help in providing a more cost-effective approach for both the patients and the health care system. Disclosures No relevant conflicts of interest to declare.

Abstract: Objectives: Iron deficiency anemia (IDA) is a major health issues and common type of nutritional deficiency worldwide. For IDA treatment, IV iron is a useful therapy. Many intravenous (IV) iron preparations are used for treatment of iron-deficiency anemia (IDA). The purpose of this study is to evaluate the efficacy of ferric carboxymaltose (FCM) in comparison to iron sucrose (IS) in treatment of IDA adult patients; considering cost-effectiveness (CE) for IDA patients from Qatar healthcare system perspective. We evaluated both treatments considering their response outcomes at 12 months period as well their respective acquisition costs. Methods: This was a cross sectional study with retrospective data performed on 764 IDA adult patients who were treated either with FCM or IS for IDA linking clinical efficacy (defined as improvement in hemoglobin (HB), ferritin and transferrin saturation levels) utility, and CE evaluation, including Incremental Cost-Effectiveness Ratio (ICER) over a 12-months period. The response to treatment was the primary outcomes. As the clinical laboratory data were collected before and after the first injection of the medications. The cost i.e. resources consumed were also the main outcome in our study. The cost effectiveness of FCM and IS was the secondary outcome. Direct healthcare costs were derived from the national healthcare payer system. Both descriptive and differential statistics were applied for data analysis. Alpha = 0.05. Results: Patients in the IS group used significantly higher number of injections, ampoules of medication, NS 0.9% bags and visits to the IV suite compared to FCM group. There were significant changes of laboratory tests between the FCM and IS groups. Further analysis in the change of effectiveness, indicated that the changes of hemoglobin and MCH levels in the IS group were significantly higher than the FCM group. The overall cost of IS therapy was significantly slightly higher than FCM. The medication cost for FCM was approximately 6.5 times higher than IS but cheaper in terms of bed cost and nursing cost. CE ratio illustrated that FCM and IS were significantly different in terms of HB, ferritin and MCH levels. Further, ICER indicated that further justifications and decisions need to be made for FCM when using HB, iron, transferrin saturation, MCH and MCV levels as the surrogate outcomes. Conclusions: The higher cost of FCM versus IS can be offset by savings in healthcare personnel time and bed space. ICER indicated that further justifications and decisions need to be made for FCM when using HB, iron, transferrin saturation, MCH and MCV levels as the surrogate outcomes. Limitations and strengths: Limited data is available with respect to comparison of safety and adverse effects of FCM and IS. The data is reliable as it was collected and documented before and after the treatment. Patients were monitored 30 min after the infusion to ensure keen observation and maximum safety. Disclosures No relevant conflicts of interest to declare.

Background Clinical pharmacy services started in 2009 at the National Center for Cancer Care and Research, Qatar. Clinical pharmacy services was established to provide comprehensive prescription of drug management and support, and consulting services to build clinically efficient and cost-effective pharmacy program. Aim To determine perceptions and expectations of healthcare providers toward the clinical pharmacy services at the National Center for Cancer Care and Research. Methods A cross-sectional survey of healthcare providers was conducted from January to May 2018. A self-administered electronic/paper survey containing four domains assessing healthcare providers’ perceptions and expectations towards clinical pharmacy services, perceived barriers to clinical pharmacist role and suggested area for improvement was sent to 375 healthcare providers including physicians, operational pharmacists, nurses and dietitians. Results The response rate was 112/375. Most of the healthcare providers (74%) perceived the increasing interest in clinical pharmacy services. Also, they expected (1) providing consultations regarding appropriate medication choices (82%); (2) providing information about medication availability and shortages (82%); (3) assisting in the prescribing of cost-effective drugs by providing pharmacogenomics information routinely (75%) and (4) Participating actively in research activities (74%). Overall, healthcare providers have a high level of trust in the clinical pharmacists’ abilities (P

Purpose To compare the antimicrobial effect of topical anesthetics, antivirals, antibiotics, and biocides on the viability of Acanthamoeba cysts and trophozoites in vitro. Methods Amoebicidal and cysticidal assays were performed against both trophozoites and cysts of Acanthamoeba castellanii (ATCC 50370) and Acanthamoeba polyphaga (ATCC 30461). Test agents included topical ophthalmic preparations of common anesthetics, antivirals, antibiotics, and biocides. Organisms were exposed to serial two-fold dilutions of the test compounds in the wells of a microtiter plate to examine the effect on Acanthamoeba spp. In addition, the toxicity of each of the test compounds was determined against a mammalian cell line. Results Proxymetacaine, oxybuprocaine, and especially tetracaine were all toxic to the trophozoites and cysts of Acanthamoeba spp., but lidocaine was well tolerated. The presence of the benzalkonium chloride (BAC) preservative in levofloxacin caused a high level of toxicity to trophozoites and cysts. With the diamidines, the presence of BAC in the propamidine drops was responsible for the activity against Acanthamoeba spp. Hexamidine drops without BAC showed good activity against trophozoites, and the biguanides polyhexamethylene biguanide, chlorhexidine, alexidine, and octenidine all showed excellent activity against trophozoites and cysts of both species. Conclusions The antiamoebic effects of BAC, povidone iodine, and tetracaine are superior to the current diamidines and slightly inferior to the biguanides used in the treatment for Acanthamoeba keratitis. Translational Relevance Ophthalmologists should be aware that certain topical anesthetics and ophthalmic preparations containing BAC prior to specimen sampling may affect the viability of Acanthamoeba spp. in vivo, resulting in false-negative results in diagnostic tests.

Background Patellofemoral knee pain is a common cause of anterior knee pain. The Kujala anterior knee pain score is a scoring system for the clinical assessment of disease severity. The purpose of this cross-sectional study was to validate an Arabic translation of the original Kujala anterior knee pain score to assess Arabic-speaking patients with patellofemoral pain syndrome. Methods The Kujala anterior knee pain score was translated into Arabic by a group of native Arabic and native English speakers including orthopedic surgeons, residents, and a medical student. Questionnaires were filled by 127 patients visiting our outpatient department complaining of anterior knee pain diagnosed clinically and after exclusion of other pathologies. Questionnaires were re-filled at least 2 weeks later via phone contact from a member of our team. After exclusions, 97 questionnaires were analyzed for reliability using Cronbach's alpha for the scoring system's internal consistency and intraclass correlation coefficient for test-retest analysis. Results The mean score of the questionnaire before the follow-up was 62.38 (±17.78) and 64.02 (±18.47) after the follow-up. The scoring system's internal consistency measured via Cronbach's alpha was 0.824. Average ICC for the scoring system was 0.948 (CI: 0.923–0.965) and for single measures, 0.902 (CI: 0.856–0.933). Further, 94.8% of patients were contacted before initiating physiotherapy. Forty-six of the patients (47.4%) showed improvement in their scores when contacted, 44 patients (45.4%) showed a slight worsening of their scores and seven patients' (7.2%) scores were unchanged. Conclusions The Arabic translation of the Kujala anterior knee pain score is a valid, reliable, useful, and easy-to-interpret scoring system to assess Arabic-speaking patients with patellofemoral pain syndrome.

Adverse Drug Reactions (ADRs) are major global concern, adversely impacting patient safety and health outcomes. ADRs cause significant morbidity and mortality among hospitalised patients, causing greater length of hospital stay, increased healthcare costs and patient dissatisfaction to the treatments. Pharmacovigilance (PV), a process of detecting, monitoring and preventing drug-related harm, plays a vital role to ensure patient safety. ADR reporting is the cornerstone of PV. PV practices in Qatar are relatively new and are evolving rapidly. The purpose of this article is to explore the medication safety practices (notably ADR reporting) at the largest academic healthcare center in Qatar. The article further provides evidence on how information related to ADRs are generated and interpreted. Furthermore, it describes how a designated center for monitoring medication safety activities was established at the largest healthcare provider in Qatar.

Haemophilia is a disorder that affects the ability of the blood to form clots. The congenital form of the disease is the most prevalent, is inherited as X-linked recessive and it causes deficiency of clotting Factor VIII or IX. clinically it presents with joint bleeding. Its counterpart, acquired haemophilia is a rare condition that usually presents with cutaneous, soft tissue or internal bleeding. The pathophysiology of the disease is centred on the formation of auto antibodies which inactivate factor VIII. Haematologically this is reflected as a prolonged aPTT with normal PT and failure of mixing studies to correct aPTT to more than 50%. To confirm the diagnosis Bethesda assay has to be performed to detect the presence of factor inhibitors. In half of the cases it is associated with an underlying condition such as autoimmune diseases, malignancy, pregnancy or infections. The mainstay treatment is to control the bleeding with bypassing agents such as recombinant factor VIIa or Factor VIII inhibitor bypassing agent as well as eradicating the inhibitor with immunosuppressive and/or cytotoxic agents. Here we report a patient with idiopathic acquired haemophilia who presented with a thigh compartment syndrome. He was successfully treated with fasciotomy, bypassing agents and immunosuppressive therapy.