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Background: Symptoms and their severity are among the main causes of suffering in patients with advanced cancer. Although knowledge of symptom prevalence is important for clinical practice, little is known about the frequency of symptoms in advanced cancer patients. Aims: To identify the most frequent cancer-related symptoms in a palliative care unit in the Islamic Republic of Iran. Methods: A cross-sectional study was conducted on patients with advanced cancer admitted to the Palliative Care Unit at Imam Khomeini Hospital, Tehran, between March 2019 and March 2020. We collected data from 387 patients’ records, including age, sex, cancer type, reported symptoms, and pain intensity. Pain intensity was measured using a numeric rating scale of no pain (0), mild (1 or 2), moderate (3–6), and severe (7–10). Results: Gastric (16.02%), breast (13.95%), colon (11.60%), ovarian (8.79%), and lung (5.94%) were the most frequent cancers. Patients reported 2582 symptoms. The most frequent symptoms were pain (91.2%), anorexia (86.7%), oral thrush (69.3%), nausea (55.6%), constipation (53.7%), fatigue (45.5%), and vomiting (40.1%). Based on pain intensity measurement, 72.2% of patients reported severe, 17.0% moderate, and 10.8% mild pain. Pain intensity and symptom frequency did not differ significantly by age, sex, and type of cancer. Conclusion: Cancer patients reported multiple symptoms. In the Islamic Republic of Iran, with limited palliative care services, these findings can guide palliative care centre doctors and nurses in symptom management

Background Gynecological cancers (GCs) are an important cause of morbidity and mortality among women worldwide. The incidence of cancer is increasing in Iran, and according to statistics, it has become the most important cause of mortality. This study aimed to assess the economic burden of GCs, including cervical, ovarian, and endometrial cancers, in Iran in 2014. Methods We used a prevalence-based cost of illness methodology to investigate the annual healthcare cost of GCs and to determine the productivity loss. The productivity loss was estimated, using the human capital approach. We obtained our data from a referral hospital for the year 2014; we also used expert opinion and occupational and statistical data. To estimate direct medical cost, we used bottom-up approach and we estimated the average cost of each procedure, multiplied by the number of patients receiving the procedure. Results The total cost of GCs in Iran was estimated at $51 million in 2014. The direct costs were $32 million, and indirect costs were $19 million of the total annual cost. The total cost of ovarian cancer was the highest among 3 cancers. Conclusions Knowing that the cost of GCs has a significant impact on the burden of disease and imposes an economic burden on the country could force policy makers to allocate their resource in the prevention programs and new approach in patient's management. This could lead to diagnose more GCs in the early stages, reduce mortality, and increase the quality of life.

Objectives: The present study aims to determine the attitudes of care providers including obstetricians, paediatricians and midwives working in perinatal, obstetric and neonatal intensive care unit (NICU) wards of the selected teaching hospitals in Tehran in 2019. In addition, the challenges of providing palliative care from the perspective of these individuals have been examined. Materials and Methods: In this descriptive study, the research population was selected through convenience sampling based on the inclusion criteria. To assess care providers’ attitude toward the perinatal palliative care and the challenges of its implementation, in addition to the questionnaire of demographic characteristics, a researcher-made questionnaire was also used. Results: Most of the care providers (90.5%) believed that parents should be involved in decision-making to select the treatment type. Most of the care providers (90%) believed that the lack of prepared infrastructures is one of the major challenges in providing these types of care. Conclusion: Care providers have almost positive attitudes toward the various dimensions of providing perinatal palliative care, but it has not been properly implemented yet due to the insufficient knowledge of this type of care, the lack of required infrastructures (appropriate conditions in NICUs to provide this type of care, the sufficient number of staff and experts in this field), as well as the health authorities’ neglecting this type of care.

Aim: In this study our aim was to elucidate whether advanced cancer patients benefit from antibiotic treatment in the last days of life in addition to reviewing the relevant costs and effects.Materials and methods: We reviewed medical records from 100 end-stage cancer patients that treated with antibiotics during the hospitalization in Imam Khomeini hospital. Patient's medical records were analyzed retrospectively for cause and periodicity of infections, fever, increase in acute phase proteins, cultures, type and cost of antibiotic. Results: Microorganisms were found in only 29 patients (29%) and the most microorganism among the patients was E.coli (6%). About 78% of the patients had clinical symptoms. The highest dose of antibiotics was related to Ceftriaxone (40.2%) and in the second place was Metronidazole (34.7%) and the lowest dose was related to Levofloxacin, Gentamycine and Colistine (1.4%). Fifty-one patients (71%) did not have any side effects due to antibiotics. The most common side effect of antibiotics among patients was skin rash (12.5%). The average estimated cost for antibiotic use was 7935540 Rials (24.4 dollars).Conclusion: Regardless of not prescribing antibiotics or the type of antibiotics used, it was ineffective in treating advanced cancer patients. The cost of using antibiotics during hospitalization is very high, and physicians should consider the risk of developing resistant hospital strains. Antibiotic side effects also occur in patients, causing more harm to the patient at the end of life.

Objective The COVID-19 pandemic has dramatically affected healthcare services around Asia. The Asian National Cancer Centres Alliance and the Asia-Pacific Organisation for Cancer Prevention collaborated to assess the mid- and long- term impact of COVID-19 to cancer care in Asia. Methods The two entities organised a combined symposium and post-meeting interactions among representatives of major cancer centres from seventeen Asian countries to outlining major challenges and countermeasures. Results Participating stakeholders distilled five big questions. 1) "Will there be an explosion of late-stage cancers after the pandemic?" To address and recover from perceived delayed prevention, screening, treatment and care challenges, collaboration of key stakeholders in the region and alignment in cancer care management, policy intervention and cancer registry initiatives would be of essential value. 2) "Operations and Finance" The pandemic has resulted in significant material and financial casualties. Flagged acute challenges (shortages of supplies, imposition of lockdown) as well as longer-standing reduction of financial revenue, manpower, international collaboration, and training should also be addressed. 3) "Will telemedicine and technological innovations revolutionize cancer care?" Deploying and implementing telemedicine such as teleconsultation and virtual tumour boards were considered invaluable. These innovations could become a new regular practice, leading to expansion of tele-collaboration through collaboration of institutions in the region. 4) "Will virtual conferences continue after the pandemic?" Virtual conferences during the pandemic have opened new doors for knowledge sharing, especially for representatives of low- and middle-income countries in the region, while saving time and costs of travel. 5) "How do we prepare for the next pandemic or international emergency?" Roadmaps for action to improve access to appropriate patient care and research were identified and scrutinised. Conclusion Through addressing these five big questions, focused collaboration among members and with international organisations such as City Cancer Challenge will allow enhanced preparedness for future international emergencies. .

Objective: To describe how the Asian National Cancer Centers Alliance (ANCCA) members preserve high standards of care for cancer patients while battling the COVID-19 pandemic and to propose new strategies in the Asian Cancer Centers’ preparedness to future pandemics. Methods: A 41-question-based survey was developed using an online survey tool and conducted among 15 major Asian National Cancer Centers, including 13 ANCCA members. Direct interviews of several specialists were conducted subsequently to obtain additional answers to key questions that emerged during the survey analysis. Result: Institution/country-specific results provided a strong insight on the diverse ways of managing the pandemic around Asia, while maintaining well-balanced cancer care. Pragmatic strategies were put in place in each NCC hospital, including zoning and intensive triage depending on the pandemic impact. Distancing strategies and telemedicine were implemented in different capacity depending on the national healthcare system. In addition, there was a diverse impact on the manpower and financial aspect of cancer care across surveyed NCCs relating to magnitude of the pandemic impact on the country. Conclusion: The priorities nevertheless remain on maintaining cancer care delivery while protecting both patients and health care workers from the risk of COVID-19 infection. The role of a think-tank such as ANCCA to help share experiences in a timely manner can enhance preparedness in future pandemic scenarios.

Background: The integration of paediatric palliative care into the Iranian health system is essential. Aims: The aim of this study was to identify the challenges of palliative care in the paediatric intensive care unit during COVID-19 through the experiences of healthcare providers. Methods: A qualitative study with content analysis approach was conducted. Fifteen physicians and nurses were selected by purposeful sampling. The semi-structured, in-depth interviews were applied in the data collection. Findings: Ten main categories were extracted from data analysis, including ‘caring in COVID-19’, ‘communication and family centre care’, ‘breaking bad news’, palliative care training’, ‘pain and symptom management’, ‘support of the child, family and clinical team’, ‘physical environment’, ‘guidelines’, ‘specialised staff’ and ‘home based palliative care’. Conclusion: Palliative care in the PICU faces several challenges, especially during COVID-19, but the clinical team are making every attempt to improve the comprehensive care of children and their families. Telehealth is important in COVID-19, and education is also a key component to improve palliative care in the PICU in Iran.

With or without COVID-19, “palliative care” is about basics. 1) Good control of symptoms due either to the disease or treatment, 2) Good decisions, especially when it becomes clear that control of the disease is no longer possible, with trying to help the patient do what means most to them, 3) Patient/family support in every phase of the illness from diagnosis throughout all phases of care until the moment of death, and 4) Care of bereaved person. Palliative care, the care of patients (adults or children) with probably fatal illnesses, whether they are still having anti disease therapy or not must occur in many places, many wards, clinics, at home, and even virtual. The COVID-19 crisis has a serious impact on patients’ care, but with respect for every person, and a great deal of education, training and support of staff, we would overcome it successfully.

Background: The growing prevalence of chronic diseases in children has increased their need for palliative care. We aimed to compare pediatric palliative care and home care training in Iran and in the selected countries. Materials and Methods: This comparative study was conducted based on the classifications of palliative care for children and using databases such as Scopus, Science Direct, Ovid, ProQuest and Medline, websites affiliated with communities and associated with palliative care and home care services and according to the framework of World Health Organization’s Public Health Road Map. The selected countries consist of England, Canada, Australia and South Africa, where home care services are provided for children in addition to palliative care. Results There is a pediatric palliative care training program for doctors in the selected countries. Home care is part of these programs in these countries. Despite the lack of an independent nursing course in postgraduate education in England, Canada, and Australia, community health nurses are responsible for providing care responsible to provide care for children with life-threatening diseases in the community and at home. In South Africa, a home-based palliative care training and support package for children was designed for community care workers. In Iran, pediatric palliative care is in the early stages and home care is evolving as a need. Conclusion Education is the most important factor for integrating home care and pediatric palliative care into the health system. In countries with advanced pediatric palliative care, the knowledge and skills of care providers have been considered. In Iran, revising medical and nursing curriculums and the integration of palliative care and home care programs into the curriculum are essential.

Objectives Children in the intensive care unit experience a high level of pain and anxiety. This study aimed to reveal the health care providers experience of non-pharmacological pain and anxiety management and its barriers in the pediatric intensive care unit. Methods This qualitative-descriptive study was conducted with thirteen nurses and five physicians in the pediatric intensive care unit in Iran. Individual, in-depth and semi-structured interviews were conducted, which were analyzed by conventional content analysis. Results Five main categories were identified from data analysis: 1) The importance of parents' presence, 2) Disturbance in the presence of parents and communication during the COVID-19 pandemic, 3) Choosing non-pharmacological approaches according to the child's interests and conditions, 4) Building trust in the child through non-pharmacological interventions 5) Barriers to non-pharmacological pain and anxiety management in the pediatric intensive care unit. Conclusion Health care providers implement some non-pharmacological methods to manage pain and anxiety in the pediatric intensive care unit. Facilitating the open presence of parents, using innovative methods to communicate with children, and training and psychological support for nurses and parents, especially during the COVID-19 pandemic are recommended.

Background: Polypharmacy is defined as the concurrent use of more than four or five medications by an individual. The prevalence of this condition has increased due to the ageing population and the related illnesses. Use of multiple medications would increase the risk of side-effects, drug interactions, and medical costs. The present study aimed to determine the frequency of polypharmacy in the advanced cancer patients. Methods: In this cross-sectional study, 92 patients with advanced cancer were selected through convenience sampling from the inpatients and outpatients who referred to the Palliative Care Unit of Imam Khomeini Hospital (Tehran) in 2017. An examining physician completed a researcher-made checklist for all the subjects based on the patients’ biography and medical records. Statistical analysis was performed by using SPSS software (version 19.0) through descriptive and analytical tests at the significance level of p

This study presents the high-velocity impact performance of a composite material composed of woven Kevlar fabric impregnated with a colloidal shear thickening fluids (STFs). Although the precise role of the STF in the high-velocity defeat, process is not exactly known but it is suspected to be due to the increased frictional interaction between yarns in impregnated fabrics. In order to explore the mechanism of this enhanced energy absorption, high-velocity impact test was conducted on neat, impregnated fabric and also on pure STF without fabric. A finite element model has been carried out to consider the effect of STF impregnation on the ballistic performance. For this purpose, fabric was modeled using LS-DYNA by employing the experimental results of yarn pull-out tests to characterize the frictional behavior of the STF impregnated fabric. The simulation result is a proof that the increased performance for STF impregnated Kevlar fabric is due to the increased friction.

Context: Peaceful death is a primary goal in the philosophy of palliative care. However, there are some distressing situations that can cause this unachievable that are termed “dying process crises”. The leading causes are interrelated to cultural and religious backgrounds of different societies. Objectives: The main causes of end of life crises are sought from integration of viewpoints of health care providers and extracted results are discussed as priorities for a future implication on a cancer end of life framework. Data Sources: A literature search for was performed published English qualitative studies that measured challenges or crises of end of life care in dying patients in perspective of health care providers by interview-based content analysis approaches from January 2008 to March 2018 via PubMed, MedLine, Google Scholar, ScienceDirect, and PsycINFO databases. Study Selection: Studies related to death in acute or non-hospital settings, hastened death, and structural or modeled studies were excluded. At the end, 8 articles were entered in the Meta-synthesis of qualitative studies. Data Extraction: The selected articles were repeatedly read and related themes to research question were extracted. Then, overarching themes were synthesized among descriptive themes of each article. Results: The identified overarching themes were poorly controlled symptoms, unexpected death, time and facility constrains, lack of education or knowledge, weak coping skills, communication barriers, family conflicts, and systematic issues. By discussion on the cultural aspects and isolated palliative care framework of Iran, important priorities to prevent death crises were symptom management and appropriate communication skills. Conclusions: Regarding the themes in priority, planning educational programs for family meetings directed to the Iranian cultural and religious context, besides developing high quality cancer palliative services, are in a real necessity.

Introduction: Posttraumatic growth is defined as subjective positive psychological changes following the struggle with highly challenging life events. Objective: The aim of current study was to determine dimensions of posttraumatic growth in patients with cancer. Methods: This is cross-sectional descriptive study. Study population included all cancer patients of two main referral hospitals in Tehran and samples consisted of 402 patients who had the entrance criteria were chosen by convenience method. Instruments used included demographic characteristics questionnaire and Posttraumatic Growth Inventory. For data analysis, descriptive and analytical statistical tests (T-test and Variance analysis) were used. Results: Mean age of samples was 46/7 ± 14 and 60% were female, 38/5% had metastatic cancer. The mean Posttraumatic Growth Inventory (PTGI) score of the participants was 68/68 ± 14/68. Among dimensions of post trauma, the dimension of "spiritual changes" and "communication with others" had the highest score (7/63±2/13 and 25/03±4/9 respectively). From different variables age (r= 0/193 P

Introduction: The first hospital palliative care unit (HPCU) in Iran (FARS-HPCU) has been established in 2008 in the Cancer Institute, which is the largest referral cancer center in the country. We attempted to assess the performance of the HPCU based on a comprehensive conceptual framework. The main aim of this study was to develop a conceptual framework for assessment of the HPCU performances through designing a value chain in line with the goals and the main processes (core and support). Materials and Methods: We collected data from a variety of sources, including international guidelines, international best practices, and expert opinions in the country and compared them with national policies and priorities. We also took into consideration the trend of the HPCU development in the Cancer Institute of Iran. Through benchmarking the gap area with the performance standards, some recommendations for better outcome are proposed. Results: The framework for performance assessment consisted of 154 process indicators (PIs), based on which the main stakeholders of the HPCU (including staff, patients, and families) offered their scoring. The outcome revealed the state of the processes as well as the gaps. Conclusion: Despite a significant improvement in many processes and indicators, more development in the comprehensive and integrative aspects of FARS-HPCU performance is required. Consideration of all supportive and palliative requirements of the patients through interdisciplinary and collaborative approaches is recommended.

Background: Palliative care is an important part of effective cancer care Objectives: The purpose of our study was to explore the lived experiences of nurses providing psychological palliative care for cancer patients in Iran. Methods: A hermeneutic phenomenological study was performed. We interviewed 11 oncology nurses to understand their lived experiences in cancer wards about psychological palliative care. We employed a seven-stage process of data analysis. Results: One constitutive pattern ‘palliative care as the driving force for providing psychological comfort to patients with cancer’ and three associated themes, namely ‘stress management’, ‘empathetic behavior’, and ‘all-embracing outlook’, were identified. Conclusions: The findings present better understanding of the lived experiences of oncology nurses in Iran regarding the phenomena under study.

Objective Invasive cervical cancer (ICC) is the fourth most common cancer among women worldwide. Cervical screening programs have reduced the incidence and mortality rates of ICC. We studied the cost-effectiveness of different cervical screening strategies in the Islamic Republic of Iran, a Muslim country with a low incidence rate of ICC. Methods We constructed an 11-state Markov model, in which the parameters included regression and progression probabilities, test characteristics, costs, and utilities; these were extracted from primary data and the literature. Our strategies included Pap smear screening and human papillomavirus (HPV) DNA testing plus Pap smear triaging with different starting ages and screening intervals. Model outcomes included lifetime costs, life years gained, quality-adjusted life years (QALY), and incremental cost-effectiveness ratios (ICERs). One-way sensitivity analysis was performed to examine the stability of the results. Results We found that the prevented mortalities for the 11 strategies compared with no screening varied from 26% to 64%. The most cost-effective strategy was HPV screening, starting at age 35 years and repeated every 10 years. The ICER of this strategy was $8,875 per QALY compared with no screening. We found that screening at 5-year intervals was also cost-effective based on GDP per capita in Iran. Conclusion We recommend organized cervical screening with HPV DNA testing for women in Iran, beginning at age 35 and repeated every 10 or 5 years. The results of this study could be generalized to other countries with low incidence rates of cervical cancer.

A total of 300 male broilers (Ross 308) were exposed to cool conditions at high altitudes to study the effects of dietary Arg supplementation on performance and physiological and zootechnical variables. A corn-soybean meal (SBM) and a corn-canola meal (CM) diet were formulated for the starting (1 to 3 wk of age) and growing (3 to 6 wk of age) stages according to NRC recommendations. Two additional diets were prepared by supplementing 0.2 and 0.4% l-Arg to the corn-CM diet. Substitution of CM for SBM caused a significant (P < 0.05) reduction in weight gain and feed intake and resulted in impaired feed:gain. Supplementing Arg in the CM diet restored the feed and weight losses to a significant extent so that a significant difference was found between CM diet and CM + 0.4% Arg in terms of weight gain for the growing (3 to 6 wk) stage and the entire study (1 to 6 wk; P < 0.05). Total plasma nitric oxide (NO) concentration analyzed by nitrate plus nitrite assay was measured in the treatment groups. A significant (P < 0.05) decrease in plasma NO level was observed by substituting CM for SBM in the diet. Supplementing the CM diet with Arg increased the plasma NO level above that of SBM group. Carcass and breast yields were significantly decreased (P < 0.05) as a result of substituting CM for SBM. The substitution of CM for SBM, however, significantly (P < 0.05) increased the proportions of thighs and heart. The right ventricular weight:total ventricular weight ratio and ascites mortality showed a significant (P < 0.05) increase when SBM was replaced by CM in the diet. Fortification of the CM diet with Arg eliminated the significant difference in the right-to-total ventricular weight ratios when compared with the SBM diet. In conclusion, feeding CM to broiler chickens raised at high altitude caused reduced growth performance and predisposed the birds to pulmonary hypertension and ascites, which were partly restored by Arg supplementation.

A descriptive study for evaluating the variables which influence the quality of life was performed in women with gynecologic cancer undergoing various kinds of treatment.The study was based on a chart review of 104 women with gynecologic cancer and analyses of their compiled FACT-G (V4); (Functional Assessment of Cancer Therapy-General) questionnaires. Patients were assessed before and 3 months after treatment.The relationship of a number of biomedical variables with quality of life outcomes was tested.The mean age of patients was 50.13 years. The most involved organ was ovary (42.3%).The mean of socio-familial, emotional, functional well-being and overall quality of life 3 months after the treatment were greater than previously. The mean of physical well-being after 3 months of treatment was lower than before that (p0.05). There were no statistical difference between the mean of overall quality of life before treatment and that 3 months after treatment for variables such as marital status, qualification, job, parity, co-morbidity diseases, organ involved, and stage of cancer (p0.05).More studies must utilize quality of life as a primary endpoint. As gynecologic cancers are usually discovered in late stages, strategies for supportive care need to focus on symptom management.

The knowledge and attitudes of health care professionals with regard to pain and its impact on the patient are among identified barriers that prevent health care professionals from providing effective treatment for pain. The purpose of the present study was to evaluate knowledge about and attitudes towards cancer pain and its management in Iranian physicians with patient care responsibilities.We surveyed 122 physicians in six university hospitals in Tehran. Fifty-five (45.1%) questionnaires were completed.The majority of physicians (76%) recognized the importance of pain management priority and about one half of the physicians acknowledged the problem of inadequate pain management in their settings. Most cited inability to access professionals who practice specialized methods in this field, and inadequate staff knowledge of pain management as barriers to good pain management. A large majority of them expressed dissatisfaction with their training for pain management in medical school and in residency. Furthermore a considerable widespread knowledge deficit among all medical subspecialties and all levels of experience was noted which was significantly more profound in the non-oncologists group and only correlated poorly with number of total treated patients in past 6 months.The most significant barrier to the effective management of pain in cancer patients in Iran is deficit in knowledge as identified in this survey. A combination of an active continuing education program on both the international guidelines with routine professional education and dissemination of guidelines is needed to bring about significant improvement in cancer pain control.

Background: cancer patients require palliative care. Aim: the purpose of this study was to explore the experiences of nurses, who provide palliative care for cancer patients, within the context of Iranian culture. Methods: we conducted a hermeneutic phenomenological study. Semi structured in-depth interviews with 10 nurses were audio taped and transcribed. The transcriptions were then analyzed by Van Manen’s method. Results: one of the most important themes that emerged was “human relationships”, which also contained the subthemes of “comprehensive acceptance” and “psychological support”. Conclusions: the results provide deep understanding of human relationships in palliative care of cancer patients in Iran.