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Introduction: We aimed to calculate the Population Attributable Fraction (PAF) of cancers due to tobacco use in the Eastern Mediterranean Region (EMRO), where water-pipe smoking is prevalent but its effect was not considered in previous studies.Aims and Methods: We applied Levin's formula to estimate PAFs of cancers due to tobacco use (defined as all type tobacco including both cigarette and water-pipe). We also calculated PAF of water-pipe smoking separately. Exposure prevalence data were retrieved from representative national and subnational surveys. Data on cancer incidence and death were also and cancer cases were obtained GLOBOCAN 2020. We also obtained associated relative risks from published meta-analyses.Results: Of the total 715 658 incident adult cancer cases that were reported in 2020 in EMRO, 14.6% (n = 104 800) was attributable to tobacco smoking (26.9% [n = 92 753]) in men versus 3.3% (n = 12 048) in women. Further, 1.0% of incident adult cancers were attributable to current water-pipe use (n = 6825) (1.7% [n = 5568]) in men versus 0.4% (n = 1257 in women).Conclusions: PAFs of cancers due to tobacco smoking in EMRO were higher in our study than previous reports. This could be due to the neglected role of water-pipe in previous studies that is a common tobacco smoking method in EMRO. The proportion of cancers attributable to water-pipe smoking in EMRO might be underestimated due to lack of research on the risk of cancers associated with water-pipe smoking and also less developed cancer registries in EMRO.Implications: In this study, we found higher PAFs for cancers due to tobacco smoking in the Eastern Mediterranean (EMR) region than previous reports. This difference could be due to ignoring the role of water-pipe smoking in previous studies. In 2020, 1% of incident cancers and 1.3% of cancer-related deaths in EMRO were attributable to water-pipe smoking. We also found a big difference in PAFs of cancers due to tobacco and water-pipe smoking across EMRO countries, with Tunisia, Lebanon, and Jordan having the highest, and Djibouti, Sudan, and Somalia having the lowest proportions of cancers attributable to tobacco and water-pipe smoking. [ABSTRACT FROM AUTHOR]

Objective The current study aimed to investigate the temporal trend of in-hospital and intensive care unit (ICU) mortality of coronavirus disease 2019 (COVID-19) patients over 6 months in the spring and summer of 2021 in Iran. Design We performed an observational retrospective cohort study. Setting Qazvin Province- Iran during 6 month from April to September 2021. Participants All 14355 patients who were hospitalized with confirmed COVID-19 in hospitals of Qazvin Province. Intervention No intervention. Main outcome measures The trends of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease. Results The overall in-hospital mortality, early mortality and ICU mortality were 8.8%, 3.2% and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU mortality = 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (Odds ratio = 1.3, 95% confidence interval = 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P -value < 0.001). Conclusions We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of severe acute respiratory syndrome coronavirus 2 infection in Iran. The lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit. [ABSTRACT FROM AUTHOR]

Background: Sleep disorder is one of the main complaints of patients with cancer that could affect their quality of life and clinical outcomes. We aimed to investigate major contributors of poor quality sleep in patients with cancer that underwent treatment. Methods: We performed a cross-sectional study on 250 patients with cancer referred to the oncology department of Shohaday-eHaftome-Tir Hospital, Tehran, Iran. Sleep quality as the main outcome of the study was evaluated using the Persian version of the self-report PSQI questionnaire. Global PSQI score >5 was categorized as the poor quality sleep. We also collected demographic and clinical data and physical performance status based on ECOG scale which grading is from 0:Fully active to 12:Death. Collecting the data regarding each patient was performed through medical records and face-to-face interviews. Results: Mean age (±SD) of the study participants was 52.8 (±11.9) and 177 (70.8%) patients were female. The overall proportion of poor quality sleep was 66.8%. Sleep disorders were observed more frequent in patients with partial (OR=2.0, 95% CI=1.0, 3.8) and complete (OR=7.4, 95% CI=1.5, 36.4) physical dysfunction (p-value<0.05). There was also a strong association between a history of sleep disorder and cancer-related insomnia (OR=4.4, 95% CI=1.9, 10.1). No association was found between age, marital status, metastasis status, and cancer location with poor quality sleep. Conclusion: Poor sleep quality had a high prevalence among our patients. Patients with physical functional impairment and those with psychiatric disorders (mood disorder) and pre-existing insomnia were the main groups of patients with a higher likelihood of cancer-related insomnia. [ABSTRACT FROM AUTHOR]

Background: Iran is a high-risk area with a poor prognosis for esophageal cancer. We conducted the present study to evaluate the survival rate of esophageal cancer after the introduction of neo-adjuvant chemo-radiation at the Cancer Institute of Iran. Method: We performed a retrospective cohort study and abstracted the data of 421 patients who referred to the Cancer Institute of Iran between 2007 and 2011. Life table and Kaplan-Meier approaches were applied to estimate 1-, 3-, and 5-year survival rates and corresponding 95% confidence intervals (CI). Multiple Cox regression model was recruited for investigating the association between 5-year survival rate and prognostic factors. Results: We found that 1-, 3-, and 5-year survival rates were 66.7%, 28.2, and 20.9%, respectively. The hazard ratio (HR) was significantly higher among the patients who has received definitive chemo-radiation therapy (Hazard ratio (HR) = 2.2, 95% confidence interval (CI): 1.1, 4.2), surgery (HR= 2.0 95% CI: 1.0, 3.7), and palliative care (HR= 4.2, 95% CI: 2.1, 1.8) compared with those who received neo-adjuvant chemo-radiation and surgery. We also found that the 5-year survival rate was doubled in the current study conducted between 2007 and 2011 (20.9%) compared with the previous one conducted between 1997 and 2006 (10.0%). Additionally, a considerable improvement was observed in 1- and 3-year survival rate of esophageal cancer at the Cancer Institute of Iran. Conclusion: Following the administration of neo-adjuvant chemo-radiation therapy, the prognosis of esophageal cancer has improved significantly at the Cancer Institute of Iran during the last decade. More data from other cancer centers and provinces of Iran are required. [ABSTRACT FROM AUTHOR]

Background: The impact of socioeconomic status on cancer survival has already been proven. Early diagnosis of cancer is one of the main reason of this improved survival among high socioeconomic status (SES) people. High SES people are more likely to take part in cancer screening programs for several reason and it seems that diagnosis of cancer is earlier among these people. Despite growing evidence on inequal in cancer survival, diagnosis, and treatment over the past decades there is a lack of evidence on volume and direction of socioeconomic inequality regarding early diagnosis of cancer in Iran. Objectives: To assess socioeconomic inequality in colorectal cancer stage at diagnosis time in Qazvin city, Iran during 2014 - 2016. Methods: A cross-sectional study was conducted on 200 patients who were diagnosed with colorectal cancer (CRC) at the Vellayat hospital of the Qazvin city. The Principal Component Analysis (PCA) approach was used to combine household assets as a proxy of SES. Cancer staging information was extracted from the patient's medical records and then a pathology specialist performed cancer staging. Descriptive statistics and a multiple logistic regression model were used to illustrate an association between CRC late diagnosis and socioeconomic status adjusted for age, sex, and residence of the area. We applied the standardized Concentration Index as a measure of socioeconomic inequality in CRC late diagnosis. Results: The overall percentage of late CRC diagnosis was 40.5% (95% confidence interval (CI) 33.8, 47.5), which was slightly higher among women (47.1%, 95% CI 36.8, 57.6) than men (35.4%, 95% CI, 27.0, 44.7). Logistic regression results spotted an association between SES and the late diagnosis of CRC. In Iranian women, CRC tended to be diagnosed at more advanced stages among the third (Odds Ratio (OR) = 7.68), forth (Low) (OR = 17.86) and fifth (Lowest) (OR = 25.60) SES quintiles, while in men it was only significant for the fifth quintiles (OR = 4.17). Furthermore, the concentration index implied that late CRC diagnosis is concentrated among deprived subgroups in Qazvin city, and it was statistically significant (Overall concentration index = -0.33, 95% CI -0.38, -0.28). It was estimated at -0.35 and -0.29 in Iranian women and men, respectively. Conclusions: According to this survey, CRC tends to be diagnosed at more advanced stages among low socioeconomic status groups, and the observed discrimination is more severe in Iranian women. [ABSTRACT FROM AUTHOR]

Aim: We aimed to compare pelvic lymph nodes coverage in Digital Reconstructed Radiography (DRR) based on bony landmarks and 3D planning based on contouring in external beam radiation of cervical cancer patients. Material and Methods: The study was carried out on 43 cervical cancer patients who were referred to Cancer Institute of Iran. We used RT Dose Plan software available in our department to define the treatment plan and field sizes. Images of patients were transported to RT dose plan software for planning. The Box treatment field (4 perpendicular fields) with or without additional brachytherapy was considered. The Dose Volume Histogram (DVH) and isodose curves were surveyed for acceptable tumour coverage. The study participants were assigned to two types of planning including planning based on anatomical markers (Conventional, DRR) and planning by considering the actual position of lymph nodes based on CT simulation images (CT). Results: The mean age of participants was 51 years. In the AP/PA field, the mean difference of superior, right, and left lateral borders was -2.31, -0.29, and -0.029, respectively. On the other hand, the mean difference of inferior border was estimated 1.87. Further, in the lateral field, the mean difference of DDR and CT approaches for anterior and posterior borders was 0.89 and 0.164, respectively. Conclusion: It seems CT simulation and use of contouring provide a better vision to pelvic lymph nodes and leads to wider coverage through reducing the possibility of ignoring treated areas. Nevertheless, more studies are required. [ABSTRACT FROM AUTHOR]

Background: We studied the number of lymph nodes (LN) assessed in gastric cancer, and evaluated the association between different factors and a lower number of LN assessed. Methods: We conducted a retrospective study in three hospitals in Tehran city, I.R. Of Iran. We used patient medical and pathological reports to obtaine personal and clinical information. We studied the association of being on the N3 stage with the number of assessed lymph nodes (NALN), gender, tumor size, T stage, hospital, tumor site, histopathological diagnosis, tumor grade and age at diagnosis. In addition, we estimated the association between NALN and different clinical variables. A logistic regression model estimated the crude and adjusted odds ratios (OR) and corresponding 95% confidence intervals (95% CI). Results: The average number of NALN was 10.48 (±6.9). We found that the probability of being diagnosed as stage N3 was significantly lower in patients who had less than 15 LN assessed in their pathology reports compared to those who had more than 15 LN assessed (OR=0.2; 95% CI 0.1-0.4). The hospital and tumor size were significantly associated with NALN. Conclusion: Lower NALN led to stage migration and underestimation of the real tumor stage in GC patients. The LN assessments were lower than those recommended by the American Joint Cancer Clinician Association in all the three hospitals included in this study. Developing national guidelines, training surgeons and pathologists, conducting regular monitoring and evaluating the data are necessary to increase NALN and thus improve the staging of GC patients. [ABSTRACT FROM AUTHOR]

Introduction: Adenoid cystic carcinoma (ACC) of the breast is a rare tumor, especially observed in males. Case Presentation: We presented a 42-year-old man, initially diagnosed with small cell carcinoma (SCC) by core needle biopsy. He underwent breast modified radical mastectomy (MRM) and axillary lymph node dissection; his final histopathological diagnosis was ACC. After surgery, although the patient was recommended to have post-operative chemo-radiotherapy, he did not comply. The patient is on follow-up for more than a year with no recurrence until now. Conclusions: ACC of the breast is a rare malignancy with excellent prognosis and favorable tumor biology. It could be mistaken with triple negative breast cancer, ductal carcinoma in situ (DCIC), and small cell carcinoma. [ABSTRACT FROM AUTHOR]

Background: Glioblastoma Multiform has been a common and fatal brain tumor. In this regard, there was ambiguity around patient survival rates in Iran que to data insufficiency. In this study, we have analyzed the overall and progression free survival in GBM patients at Milad Tehran hospital. Methods: In this retrospective study, wehave considered survival, clinical characteristics and prognostic factors in 123 primaryGBM patients who underwent surgical procedure (Biopsy or Resection) between February 2010 and June 2015 at Milad hospital, Tehran, Iran. All patients have pathologically proven as primary GBM. The overall survival and progression free survival has calculated using the Kaplan-Meier method. The Cox proportional hazards model has used for univariate analysis of prognostic factors. Age, gender, first symptom of the disease, tumor location and size, treatment protocol, and surgery have considered in the Cox model as prognostic factor. Results: One hundred and one patients have been studied. The mean age of the patients was 52.12 + 1.64, 67% of the patients were male, and 20% of the patients has not included in adjuvant therapy due to the patients low performance status after surgery. Patient median survival time was approximately 10.1 (6.3 - 11.8); 80% of the patient survive more than a month; and 57% of the patient has survived for six month, and one year survival of the patients was about 37%. Median progression free survival time was about 6.3 month, one-month progression free survival was 70%, and six months and one year progression free survival rates were 50% and 26%, respectively. Patients higher than 50 years have shown significant, 2 times more chance of death (HR = 2.00 CI 95% (1.3 - 3.2)) or disease progression (HR 1.94 CI 95% (1.3 - 3.2)). Correspondingly, patients who has not included in adjuvant therapy had 3.9 CI 95% (2.3 - 6.8) more hazard of death and 2.8 CI 95% (1.6 - 4.8) more chances of disease progression than who included in adjuvant therapy with TMZ and radiotherapy. Gender, symptom, tumor location or surgery type have not significantly affected patient prognosis. Conclusions: GBM patient's survival would be quite poor. Nevertheless, this result was similar to the other reports from other centers and countries. [ABSTRACT FROM AUTHOR]

Background: Allocation of the new (expensive) drugs for difficult refractory diseases and financial protection of the patients is an important challenge in the national health systems worldwide especially in developing countries. Trastuzumab (Herceptin) as one of the effective but expensive drugs, put major financial burden for the Iranian patients and government. So the Ministry of Health and Medical Education (MOHME), decided to implement a national program for appropriate management of breast cancer and regulation of Trastuzumab in I.R of Iran (NPMBCT). In this policy brief we evaluated this issue and provided necessary recommendations. Methods: We designed a conceptual model consisting of the goals, main and supporting processes for management of Trastuzumab in the national program. Five macro-processes selected as the main concerns. Then an expert panel including different scientific disciplines discussed the different aspects of the issue and provided the necessary recommendations. We determined the link between the suggested recommendations and the objectives of the program. Results: Based on the five selected main processes, the experts provided 10 recommendations including: 1) balance in the resource allocation, 2) appropriate modeling for the subsides allocation, 3) avoiding "poor subsidize the rich" phenomenon, 4) development and updating the clinical guidelines, 5) cost-effectiveness analysis on accepted guideline, 6) Quality improvement of diagnostic tests, 7) standardization of the laboratory kits, 8) brand management and lowering the drug cost, 9) improving the patient registry system by ICT infra-structure, 10) development of expert systems to empower the diagnostic laboratories. Conclusion: Given these recommendations, the NPMBCT program will be a successful model for the appropriate management of the expensive drugs and treatment of breast cancer in I.R. of Iran and other developing countries. [ABSTRACT FROM AUTHOR]

Introduction: Little data is available on the prognosis of esophageal cancer (EC) in Iran. We studied the short- and long-term survival of EC patients treated at the Cancer Institute of Iran. Methods: 619 patients were followed who had been operated in the years 1997-2006. The 1-month to 5-year survival rates of EC and hazard ratios (HR) for different prognostic factors were estimated. Results: Median survival was 11.5 months and 5-year survival was 10%. Patients at the advanced stage had a 2.1-fold higher risk of mortality compared to the early stage (95% CI 1.2-3.4). One-month mortality decreased from 12.2 in 1997-1999 to 9.1% in 2003-2006. In the first month, patients who were diagnosed in 2003-2006 had a significantly (60%) lower HR compared to 1997-1999 (HR = 0.4, 95% CI 0.1-0.9). In addition, patients with cardiopulmonary complications had an 11.7-fold higher HR compared to patients without complications (95% CI 4.7-29.3). Conclusions: The 5-year survival rate for operated EC patients was considerably low in Iran. Cardiopulmonary complications were the strong prognostic factors for first-month mortality. We suggest improving the pre- and postoperative care of EC to control these complications. Regular monitoring of patient survival is recommended to evaluate the effect of this intervention. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country. Methods: We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards. Results: We registered 13 086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients. Conclusion: The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran. [ABSTRACT FROM AUTHOR]