Othman NO, Alsirafy SA. "Authors’ Reply to the Letter to the Editor by Giusti et al: Olanzapine for Cachexia—Short-Term Benefit, Long-Term Questions." Journal of the National Comprehensive Cancer Network. 2025;23:e257114. AbstractWebsite
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Sharief MH, Elghazaly AA, Al Abbas AM, Al Basri RS, Alsirafy SA. "Does hematology rotation impact the interest of internal medicine residents in considering hematology as a career?" BMC Medical Education. 2024;24(1):223. AbstractWebsite

Background: The ongoing need for hematologists is not met in many parts of the world. The hematology rotation during internal medicine residency is an opportunity to attract more physicians to the hematology field. This study aimed to assess the impact of a hematology rotation on internal medicine residents' interest in considering a hematology career.

Methods: Internal medicine residents were invited to complete an anonymous questionnaire before and after a mandatory hematology rotation. Their interest in pursuing a hematology career was assessed by asking them to rate "Consider hematology as a career" on a 0 to 10 scale (0 = never, 10 = strongly agree). In addition, viewing the hematology workload as manageable, comfort in dealing with cancer and satisfaction with the hematologist lifestyle were assessed before and after the rotation.

Results: Sixty out of 62 IM residents completed the pre- and post-hematology rotation questionnaire (response rate 97%). 80% were in the age range of 25-29 years and 73% were males. Two-thirds were in the senior level (3rd and 4th year) of their residency program and 40% had a prior rotation in a hematology unit. Rating considering hematology as a career increased significantly from a median of 7 (IQR: 5-9) pre-rotation to 8.5 (IQR: 7-10) post-rotation (p = 0.0018). Subgroup analysis showed a significant increase in interest among subgroups except residents > 29 years of age, those with prior hematology rotation and junior residents (1st and 2nd year residency). The change in viewing hematology workload as manageable, comfort in dealing with cancer patients and perceiving the hematologist lifestyle as satisfactory were strongly positively correlated with the change in considering hematology as a career (p = 0.0014, < 0.0001 and < 0.0001; respectively).

Conclusions: A hematology rotation is associated with an increase in the interest of internal medicine residents in considering hematology as a career. Further research is needed to Identify factors that may make hematology rotations an effective tool in attracting residents to the hematology field.

Othman NO, Abd El-Aal HH, Elsherief WA, Farag DE, Hunter CN, Alsirafy SA. "Olanzapine for Anorexia in Patients With Incurable Cancer and Cachexia (OlAnCa): A Double-Blind, Placebo-Controlled, Randomized Clinical Trial." Journal of the National Comprehensive Cancer Network. 2025;23:385-392. AbstractWebsite

Background: Pharmacologic options for managing anorexia in cancer cachexia are limited. This trial aimed to evaluate the efficacy of olanzapine in alleviating anorexia in patients with incurable cancer and cachexia.

Methods: This double-blind, placebo-controlled, randomized trial included adult patients with incurable cancer and cachexia, scoring ≥4 on the Edmonton Symptom Assessment Scale (ESAS) anorexia item (ESAS-Anorexia) and <4 on the ESAS nausea item (ESAS-Nausea). A total of 164 patients were randomized in a 1:1 ratio to receive either placebo (n=82) or olanzapine 5 mg daily (n=82) for 4 weeks. The primary outcome was the change in ESAS-Anorexia score after 1 week. Secondary outcomes included changes in anorexia and quality of life scores, body weight, and handgrip strength after 4 weeks.

Results: In the complete case analysis of the primary outcome (n=159; 97%), median [IQR] reduction in ESAS-Anorexia score after 1 week was significantly greater in the olanzapine group (-2 [-3 to 0] vs -1 [-2 to 0]; P=.003). The significance continued at 2 weeks (-2 [-4 to -1] vs -1 [-2 to 0]; P=.039). After 4 weeks, significantly more patients in the olanzapine group experienced >5% weight gain (14% vs 0%; P=.008), and the mean [SD] improvement in Functional Assessment of Anorexia/Cachexia Therapy - Anorexia/Cachexia Subscale score was higher (+2.7 [7.4] vs -0.04 [7]; P=.043). The mean [SD] decline in handgrip strength was greater with olanzapine and was significant in per-protocol analysis (-2.8 [4.9] kg vs -0.3 [4.1] kg; P=.027). Anxiety, insomnia, and nausea (P=.016, P=.034, and P=.039, respectively) were significantly less frequent with olanzapine, whereas grade ≥3 anemia and leukopenia were more frequent (P=.018 and P=.041, respectively).

Conclusions: A short course of olanzapine 5 mg daily significantly reduces anorexia in patients with incurable cancer and cachexia. Further studies are needed to evaluate its long-term safety and efficacy in cancer cachexia.

Rosa WE, Connor S, Aggarwal G, et al. "Relieve the suffering: palliative care for the next decade." The Lancet. 2025;405:1802-1804. AbstractWebsite
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Alsirafy SA, Mousa SMA. "Palliative care journal publications by country as a metric for palliative care development level." BMJ Supportive & Palliative Care. 2024;14:e2686-e2693. AbstractWebsite

Objective There is a growing interest in developing a scientific research metric to assess the level of palliative care (PC) development in countries. This study assesses a metric based on publishing in specialised PC journals as an indicator for the level of PC development.Methods A 3-year average articles per million population per year (3y-AAMY) metric was calculated using documents published in 19 specialised PC journals indexed in Scopus database. Countries were categorised into six levels starting with level ‘0’ with no publications then levels Q1 to Q5 according to the 3y-AAMY quintiles (Q5=best performance). The relationship between the 3y-AAMY and the level of PC development in countries and opioid consumption figures was tested.Results During 2016–2018, 6610 eligible documents were published in the selected 19 journals. The median (IQR) 3y-AAMY of 191 countries was 0.0123 (0–0.237). The 3y-AAMY differed significantly among the levels of PC development, being 0 (IQR:0–0) for category 1 (no known activity) countries and 1.129 (IQR:0.286–4.625) for category 4B (advanced integration) countries (Kruskal-Wallis test p<0.000001 and Jonckheere-Terpstra trend test p<0.00001). The correlation between the 3y-AAMY and average opioid consumption was a highly significant positive one (Spearman’s ρ=0.681, p<0.0001). Furthermore, opioid consumption differed significantly between the 3y-AAMY categories being highest for Q5 countries (Kruskal-Wallis test p<0.000001 and Jonckheere-Terpstra trend test p<0.00001).Conclusion A metric based on publishing in specialised PC journals correlates significantly with the levels of PC development and opioid consumption in countries and may be used alongside other indicators for the assessment of PC development.Data used to generate the results of this study were retrieved from the Scopus database using the search strategy detailed in the methods section.

Sánchez-Cárdenas MA, Garralda E, Van Steijn D, et al. "Region-specific macroindicators on palliative care development in the Eastern Mediterranean Region: a Delphi study." East Mediterr Health J. 2022;28(8):560-568. AbstractWebsite

Background: The World Health Organization Office for the Eastern Mediterranean Region (EMR), and a recently created palliative care experts’ network from the EMR, decided to develop region-specific indicators to monitor national palliative care development.

Aims: To identify relevant and feasible macroindicators of palliative care development for the EMR.

Methods: Palliative care experts from the EMR were nominated and invited to complete a 2-round Delphi study to rate macroindicators from previous studies and propose new ones based on regional characteristics. All indicators were assessed by regional relevance (R) and feasibility (F). A content validity index (CVI) was calculated. Indicators with CVI ≥ 0.7/1, and scoring ≥ 7/9 for the average of R and F were selected.

Results: Twelve of 22 countries were represented in the study. In the first round, 11 indicators were selected and 13 new ones proposed. In the second round, 15 indicators matched R, F and CVI criteria. Top-scored indicators were: existence of a current national palliative care strategy (R = 8, F = 8, CVI = 1); ratio of specialized services (for adults and children) in the country per population (R = 8, F = 7, CVI = 1); allocation of funds for palliative care in the national health budget by the Ministry of Health or equivalent government agency (R = 8, F = 6, CVI = 1); education for prequalification doctors/nurses (R = 8, F = 8, CVI = 0.9); and availability of morphine and other strong opioids (R =8, F = 8, CVI= 0.9).

Conclusion: A baseline set of 15 region-specific indicators for measuring development of palliative care were validated by regional experts.

El-Sherif RAM, Shaban AH, Abbas FA, Alsirafy SA. "Burden, Depression and Quality of Life in Carers of Newly Diagnosed Advanced Cancer Patients in Egypt." Journal of Pain and Symptom Management. 2024;67:e403-e408. AbstractWebsite

Context The goal of palliative care (PC) is to improve the quality of life (QoL) of patients with life-limiting illnesses as well as their families. Ideally, PC is integrated early in the course of life-limiting illnesses. Less attention has been paid to the need for early PC for family caregivers (FCs) in lower-income settings. Objectives This observational cross-sectional study was conducted to explore the burden experienced by FCs of newly diagnosed incurable cancer patients in Egypt and characterize its relation to depression and QoL. Methods Ninety-five adult FCs of adult patients with newly diagnosed incurable cancer completed the 22-item Zarit Burden Interview (ZBI-22), Patient Health Questionnaire (PHQ-9), and Short Form 12 (SF-12) to assess caregiving burden, depression, and QoL among FCs, respectively. Results The median (IQR) ZBI-22 score was 17(11–24) and 34% of FCs had significant burden (ZBI-22 score > 20). Assistance with late loss activities of daily living and availability for longer caregiving duration were associated significantly with higher caregiving burdens (P = 0.004 and 0.047, respectively). FCs with significant burden had significantly higher PHQ-9 scores (P = 0.0003). There was a significant negative correlation between ZBI-22 scores and the bodily pain, general health, mental health, physical function, role emotional, and social function subscales/items of SF-12. Conclusions A substantial proportion of Egyptian FCs of incurable cancer patients experience significant burden early in the course of the disease. This burden is associated with depressive symptoms and worse QoL dimensions, physical, psychological, and social. In a lower-income setting, early PC interventions for FCs of incurable cancer patients are needed.

Osman NO, Faheem DEE, El-Sherief WA, Abdel-Aal HH, Alsirafy S. "Olanzapine for anorexia in cancer cachexia patients: A placebo-controlled randomized trial.". In: ESMO Congress 2022. Paris; 2022. Abstract

Background: Cancer-associated cachexia (CAC) is a complex multifactorial syndrome. Various antipsychotics have been associated with weight gain, especially olanzapine (OLZ) which is suggested to have a role in the management of CAC. It remains unclear whether OLZ has an ameliorating effect on cancer patients’ anorexia, even when those patients exhibit no nausea or vomiting. Given the potential effect of OLZ on CAC and the mixed findings regarding this subject, the current trial aims at evaluating the efficacy of OLZ as a monotherapy in incurable cancer patients with cancer cachexia-associated anorexia.

Trial design: This is a single institution double-blind placebo-controlled randomized clinical trial. One hundred and sixty-four patients are being recruited from December 2021. The trial includes adult patients with incurable solid tumor, CAC, loss of appetite (≥4 score on the 0 to 10 loss of appetite scale of the Edmonton Symptom Assessment System [ESAS]), Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 and a predicted survival >3 months. Causes for exclusion are: highly emetogenic chemotherapy, antipsychotic or appetite stimulant administration, nausea or vomiting score >3 on the 0 to 10 scale of the ESAS, weight gain for a known cause (e.g., oedema) or central nervous system disease. Participants will be 1:1 randomized to the intervention arm (OLZ 5 mg tablet once a night for 28 days) or the control arm (placebo tablet once at night for 28 days). The primary endpoint is the change in the loss of appetite score on the 0 to 10 scale of the ESAS from day 0 to day 7 of treatment. The secondary endpoints include the change in loss of appetite score from day 0 to days 14, 21 and 28 and the change in quality of life, handgrip strength, body mass index, body weight, lean body mass, fatigue and c-reactive protein level from day 0 to day 28.

Clinical trial identification: NCT05243251.

Alsirafy SA, Hassan AD, Sroor MY, Samy I, Mousa SMA. "Contribution of Eastern Mediterranean Region countries to palliative care journals from 1991 to 2020 and its relationship to the development of palliative care." BMC Palliative Care. 2022;21(1):123. AbstractWebsite

Background: Palliative care (PC) is in an early stage of development in the Eastern Mediterranean Region (EMR) of the World Health Organization. A metric based on publishing in specialized PC journals may be useful in assessing PC development. This study was conducted to describe the contribution of EMR countries to PC research and to study the relationship between this contribution and the levels of PC development.

Methods: The Scopus database was used to search 21 PC journals (1991-2020) for articles with at least one EMR-affiliated author independently of his/her position in the article. As an indicator, the 3-year average articles per million population per year (AAMY) was calculated. Changes over time were calculated through a regression analysis. The relationship between the AAMY and the level of PC development and opioid consumption were assessed through Mann-Witney test using the worldmap PC development categories as a proxy, and Spearman analysis, respectively.

Results: The number of articles published during the 30-year period was 31,108 of which 402 (1.3%) were EMR-affiliated. There was a steady rise in the AAMY of the EMR (R2 = 0.894). The number of EMR-affiliated articles increased from 3 in the period 1991-1995 to 191 in 2016-2020. The 2018-2020 AAMY was significantly higher in countries with greater PC development than in those without (median [IQR] = 0.0975 [0.0254-0.1802] and 0.0098 [0-0.0256], p = 0.042). Also, it was significantly higher in countries that progressed to a higher level of PC development between 2006 and 2017 (p = 0.0159). There was a significant positive correlation between the average opioid consumption for the years 2017-2019 and the AAMY for the same period (p = 0.0043).

Conclusions: There is a slow steady progress in the contribution of EMR countries to PC journals, which corresponds to the level of PC development and its progress in the region. A metric based on the contribution to specialized PC journals may be a useful indicator of PC development.

Osman H, Alshammary S, Rassouli M, et al. "Palliative care in the Eastern Mediterranean Region: An overview.". In: Cancer control Eastern Mediterranean Region special report. Suffolk: Global Health Dynamics Limited; 2022.